Predictive value of R.E.N.A.L. nephrometry score in robotic assisted partial nephrectomy

Objective: To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. Material and methods:Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. Results:Patients undergoing RAPN had a mean tumor size of 4.42 cm (2-8) and a mean renal nephrometry score of 5.82 (4-11). The mean estimated blood loss was 250 mL (150-450 ml) and the mean operative time was 195 minutes (150-300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p= 0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2-10). In only 1 patient disease recurrence was detected at the 21 st month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3-36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). Conclusion:With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors.

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

Özkan

Coşkuner

Yalçın

2016

“…[26] In another study where predictive value of R.E.N.A.L nephrometry score was analyzed, a strong correlation was observed between R.E.N.A.L nephrometry score, and duration of warm ischemia. [27] Limited warm ischemia time is very well known to be associated with reversible impairment of renal functions. Priorly warm ischemia time below 30 minutes was thought to be compatible with complete recovery of renal functions.…”

Section: Discussionmentioning

confidence: 99%

The impact of non-hilar clamping open partial technique performed for the treatment of patients with small renal masses with lower R.E.N.A.L. nephrometry scores on renal functions during the early postoperative period

Atılgan

Kılıç

Gençten

et al. 2014

Objective: Herein, the impact of off-clamp open partial nephrectomy on early postoperative period renal functions were evaluated in patients with low RENAL nephrometry scoring small renal masses. Material and methods:Twenty-three patients (12 women, and 11 men) who had undergone non-hilar clamping open partial nephrectomy in our clinic between the years 2010, and 2013 were retrospectively evaluated. Mean age, body mass index (BMI), operative time, blood loss, renal nephrometry score, mean hospital stay, pre-, and postoperative serum creatinine (Cr), and glomerular filtration rate (GFR) of the patients were assessed. Results:Mean age, BMI, tumor size, and preoperative renal nephrometry scores were 56.09±10.49 years (36-70 yrs), 24.81±2.44 kg/m 2 , 3.68±1.125 cm, and 6.41±1.77 pts, respectively. Mean operative time, intraoperative blood loss, and hospital stay were detected as 139.14±33.60 min, 274.9±77.02 mL, and 4.27±1.12 days, respectively. Preoperative mean serum Cr, and GFR levels were 0.804±0.216 mg/dL, and 93.97±25.83 mL/min/1.73 m 2 , respectively. Postoperative 1. day mean serum Cr, and GFR levels were 0.896±0.25 mg/ dL, and 85.94±28.85 mL/min/1,73 m 2 , while corresponding 3. month-values were 0.81±0.205 mg/dL, and 93.59±21.00 mL/dk/1.73 m 2 , respectively. A statistically significant difference was not found between preoperative, and postoperative 3. month-serum Cr, and GFR levels. However, postoperative 3.month-serum Cr, and GFR levels were lower than corresponding values estimated on postoperative 1. day (p<0.016). Conclusion:One of the important considerations in partial nephrectomy is to preserve renal functions. Therefore, non-hilar clamping open partial nephrectomy should be taken into consideration for surgeons unexperienced especially in laparoscopic surgery with its lower morbidity, and complication rates.

“…[2] Minimally invasive surgery is increasingly being applied in the management of adrenal and renal masses, including laparoscopic [3][4][5][6][7] and robot-assisted laparoscopic approaches. [8][9][10][11][12][13][14][15] Here we present a challenging case of synchronously detected right adrenal and left renal masses resected via sequential robotic right adrenalectomy and zero ischemia off-clamp left partial nephrectomy.…”

Section: Introductionmentioning

confidence: 99%

Robotic sequential right adrenalectomy and zero ischemia left partial nephrectomy in a patient with synchronous pheochromocytoma and renal cell carcinoma

Canda

Cakici

Ener

et al. 2015

Currently, most renal masses are detected incidentally while still small in size because of the widespread use of radiological imaging, and most pheochromocytomas are localized in the adrenal glands as unilateral lesions. A 5 x 4-cm right adrenal mass and a 19 x 13-mm exophytic left renal mass were synchronously detected by contrast enhancement on computed tomography and magnetic resonance imaging in a 47-yearold male with hypertension. The patient's preoperative serum and 24-h urine catecholamine levels were elevated. Initially, robotic transperitoneal right adrenalectomy was performed, and histopathology confirmed a 4 cm pheochromocytoma. After 3 months, transperitoneal zero ischemia robotic left partial nephrectomy was performed, and histopathology demonstrated clear cell renal cell carcinoma, Fuhrman grade II, 17 mm in size with clear surgical margins. This case indicates that sequential robotic surgery is feasible and safe as a minimally invasive approach to remove bilateral renal and adrenal masses. Zero ischemia robotic partial nephrectomy is also feasible and safe for selected small renal masses.