Mini-Flank Supra-12th Rib Incision for Open Partial Nephrectomy for Renal Tumor With RENAL Nephrometry Score ≥10

Abstract

The skill of supra-12th rib mini-flank approach for open partial nephrectomy (MI-OPN) provides an advanced operative method for renal tumor. Compared with laparoscopic and robotic surgery, it may be a feasible selection for the complex renal tumors. We describe our techniques and results of MI-OPN in complex renal tumors with high RENAL nephrometry score (RENAL nephrometry score ≥10).Fifty-five patients diagnosed with renal tumors between January 2009 and July 2013 were included in this study. Eligibility criteria comprised of patients with complex renal tumor (RENAL score ≥10) being candidates for partial nephrectomy (PN). All patients received MI-OPN and all surgeries were performed by a single urologist. The preoperative workup comprised of medical history, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and 2 to 3 months after operation. Operative time, ischemia time, blood loss, operative and postoperative complications, renal function, and pathology parameters were recorded.MI-OPN was successfully performed in all cases. Mean tumor size was 4.7 cm (range: 2.5–8.1). Mean warm ischemia time was 28.1 minutes (range: 21–39), mean operative time was 105minutes (range: 70–150) and mean estimated blood loss was 68 mL (range: 10–400). Mean postoperative hospital stay was 6.5 days (range: 5–12). Postoperative complications were found in 3 patients (5.5%). The mean pre- and postoperative serum creatinine levels were 76.2 μmol/L (range: 47–132) and 87.1 μmol/L (range: 61–189) with significant difference (P = 0.004). The mean pre- and postoperative estimated glomerular filtration rate (eGFR) were 91.5 (range: 34–133) and 82.5 (range: 22–126.5), respectively with significant difference (P = 0.024). In an average follow-up of 19.9 months (range: 8–50), no local recurrence or systemic progression occurred.In conclusion, MI-OPN can combine the benefits of both minimal invasive and traditional open partial nephrectomy (OPN) techniques with a smaller incision. It is an innovation of traditional OPN and suitable for the complex renal tumors with high RENAL nephrometry score safely and effectively.

Running suture hemostatic technique versus standard reconstruction of the surgical bed in Zero - Ischemia Time mini-flank Open Partial Nephrectomies. Retrospective, Match-Paired Case-Control Study

“…From 543 patients who underwent tumour nephrectomy in our clinic between January 1997 and March 2017, we retrospectively analysed 186 consecutive patients who underwent PN using supra 11 th or supra 12 th rib mini flank approach (2,3). First group numbered 96 patients with running suture hemostatic technique (RSHT), while the control group enrolled 90 patients in whom we performed standard reconstruction technique (SRT).…”

“…The presence of hereditary renal cancers was no contraindication for surgery. The variables we examined when reviewing our database were demographics (age, gender, body mass index), lesion characteristics (location, centrality and size), pathological stage and histological subtype, perioperative variables operative time (OT), estimated blood loss (EBL), postoperative glomerular filtration rate (pGFR), length of hospital stay and intraoperative and postoperative complications (POC) (3). POC were classified according to the modified Clavian system (8).…”

“…oped -the supra 11 th rib mini flank approach and supra 12 th rib approach (2,3). These techniques provide optimum anatomical exposure and better aesthetic outcomes with a low risk of long-term complications (2).…”

“…These techniques provide optimum anatomical exposure and better aesthetic outcomes with a low risk of long-term complications (2). Typically, for a lower pole tumor, a supra 12 th rib incision is more appropriate, while for mid and upper pole tumors a supra 11 th incision ispreferred (3). Clamping of the hilar vessels during partial nephrectomy may cause ischemic damage to the kidney and subsequent chronic renal impairment, which implies the necessity for improving zero-ischemia time techniques, especially for long lasting procedures, where ischemia time can be more than 25-30 minutes (4,5).…”

Mini-Flank Supra-12th Rib Incision for Open Partial Nephrectomy for Renal Tumor With RENAL Nephrometry Score ≥10

“…In the article “Mini-Flank Supra-12th Rib Incision for Open Partial Nephrectomy for Renal Tumor With RENAL Nephrometry Score ≥10: An Innovation of Traditional Open Surgery”, 1 which appeared in Volume 94, Issue 13 of Medicine , the middle right panel of Figure 2 was incorrect. The correct figure is given below.…”