Multi-Institutional Analysis of Robotic Partial Nephrectomy for Hilar Versus Nonhilar Lesions in 446 Consecutive Cases

Dulabon, Lori M.; Kaouk, Jihad; Haber, Georges-Pascal; Berkman, Douglas S.; Rogers, Craig G.; Petros, Firas; Bhayani, Sam B.; Stifelman, Michael

doi:10.1016/j.eururo.2010.11.017

Cited by 140 publications

(116 citation statements)

References 19 publications

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“…Indications for robotic partial nephrectomy (RPN) have signifi cantly expanded to include even complex renal tumours [ 10 -12 ] . Early comparative studies have shown that RPN offers equivalent [ 10 ] or potentially better [ 11 ] perioperative outcomes than laparoscopic partial nephrectomy.…”

Section: Resultsmentioning

confidence: 99%

The impact of body mass index on surgical outcomes of robotic partial nephrectomy

et al. 2012

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" What ' s known on the subject? " and " What does the study add? " Obesity is associated with higher incidence of renal cell carcinoma. Laparoscopic and robotic partial nephrectomy (RPN) was shown to be technically feasible in the obese population. In the present study we evaluated the impact of obesity on outcome of RPN, in a large cohort of patients.In the present study, obese patients had a higher American Society of Anesthesiologists score and larger tumour size. We evaluated obesity as a categorical and a continuous variable, and we adjusted for confounding factors. We categorized obesity based according to the WHO classifi cation of obesity. We described our technical modifi cations to overcome diffi culties that can be encountered during the surgery. Obese patients had a higher estimated blood loss, but no difference in blood transfusion rate, operation duration or warm ischaemia time. OBJECTIVE• To assess the impact of body mass index (BMI) on the surgical outcomes of robotic partial nephrectomy (RPN). PATIENTS AND METHODS• Medical charts of 250 consecutive patients who underwent RPN at our institution between 2006 and 2010 were reviewed.• Patients were categorized based on their BMI into four groups per international classifi cation of obesity into: normal (BMI < 25 kg/m 2 ), overweight (25 -29.9), obese (30 -39.9) and morbidly obese ( ≥ 40).• Preoperative characteristics as well as perioperative and postoperative outcomes were analysed and compared between the groups. RESULTS• Of the 250 patients, 43 (17.2% of the entire cohort) were non-obese, 104 (41.6%) were overweight, 75 (30%) were obese, and 28 (11.2%) were morbidly obese.• Groups were similar in terms of age, gender, history of previous surgery and nephrometry score ( P = 0.5).• Patients with higher BMI had a higher American Society of Anesthesiologists (ASA) score (median 3 for obese and morbidly obese groups vs 2 for non-obese groups; P = 0.002) and tumour size (median 3.6, 2.9, 2.5 and 2.3 cm in those who were morbidly obese, obese, overweight and with normal BMI, respectively; P = 0.005).• Patients within the morbidly obese group had a higher estimated blood loss (median 250 mL) than other groups (median: 200, 200, 150 mL, respectively) ( P = 0.03).• No signifi cant difference was detected between the groups in terms of operation duration, warm ischaemia time, transfusion rate and postoperative complications. CONCLUSION• Robotic partial nephrectomy represents an effective treatment modality for renal tumours providing equivalent surgical outcomes even for patients with BMI up to 60 kg/m 2 .

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Section: Resultsmentioning

confidence: 99%

The impact of body mass index on surgical outcomes of robotic partial nephrectomy

et al. 2012

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“…Scores of [8][9] have been shown to have 14-fold risk and scores > 10 were associated with a 30-fold increase risk of complications compared to those patients reporting scores of 6 to 7 [6].…”

Section: Analyse the Impact Of Case MIX On The Rpn Lcmentioning

confidence: 99%

Robotic partial nephrectomy – Evaluation of the impact of case mix on the procedural learning curve

Roman

Ahmed

Challacombe

2016

International Journal of Surgery

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“…35,36 Furthermore, surgeons highly experienced with laparoscopic renal surgery have adopted RALPN for use with moderately and highly complex renal masses with excellent outcomes. 37,38 The robotic platform has also been used in retroperitoneal LPN with a demonstrated shorter learning curve and similar functional and oncological outcomes to the traditional retroperitoneoscopic LPN. 39 …”

Section: Robotic-assisted Laparoscopic Pnmentioning

confidence: 99%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

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Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

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Multi-Institutional Analysis of Robotic Partial Nephrectomy for Hilar Versus Nonhilar Lesions in 446 Consecutive Cases

Cited by 140 publications

References 19 publications

The impact of body mass index on surgical outcomes of robotic partial nephrectomy

The impact of body mass index on surgical outcomes of robotic partial nephrectomy

Robotic partial nephrectomy – Evaluation of the impact of case mix on the procedural learning curve

Laparoscopic partial nephrectomy: state of the art review

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