Robotic Versus Laparoscopic Partial Nephrectomy for Complex Tumors: Comparison of Perioperative Outcomes

Long, Jean-Alexandre; Yakoubi, Rachid; Lee, Byron; Guillotreau, J.; Autorino, Riccardo; Laydner, Humberto; Eyraud, Rémi; Stein, Robert J.; Kaouk, Jihad; Haber, Georges-Pascal

doi:10.1016/j.eururo.2012.03.012

Cited by 129 publications

(95 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, RALPN has been associated with more favourable warm ischemia time (WIT) or lower risk of conversion to radical nephrectomy as compared to the pure laparoscopic procedure. [8][9][10][11] This outcome has led to an increased use of robotic technology for partial nephrectomy indications at the expense of open procedures over the last few years. 12 An expanding range of indications for RALPN towards more complex renal masses has also been highlighted in experienced teams with good surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

View full text Add to dashboard Cite

Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

show abstract

Section: Introductionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

View full text Add to dashboard Cite

show abstract

“…While we do believe our renorrhaphy technique represents an important innovation in bloodless surgery, it should be viewed more as an augmentation of existing techniques rather than a completely novel method. Though there have never been any side-by-side comparisons of renorrhaphy techniques, we believe our transfusion rate of zero and our mean EBL of 165mL (sd = 150) is comparable to that of the two largest RPN series by Long et al [33] (BT = 12.1%; EBL = 280.2, sd = 313.6) and Masson-Lecomte et al [34] (BT = 6%; EBL = 244.8, sd =365.4).…”

Section: Discussionmentioning

confidence: 74%

“…Pneumoperitoneum and robotic technology have previously been shown to limit blood loss, and thus boost BT prevention strategies [1,33]. While we do believe our renorrhaphy technique represents an important innovation in bloodless surgery, it should be viewed more as an augmentation of existing techniques rather than a completely novel method.…”

Section: Discussionmentioning

confidence: 99%

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Eun¹

2015

JURNOA

View full text Add to dashboard Cite

Research ArticleAnother group in which BT utilization is limited is the Jehovah's Witness (JW) population. The JW religion is a Christianbased faith founded in the United States characterized by the avoidance of BT, even if it may lead to morbidity or mortality [10]. Because of this belief, many JW patients may experience difficulty in finding surgeons willing to perform elective major operations.Partial Nephrectomy (PN) has been recognized as the standard of care operation for the small renal mass (< 4cm) [11]. While PN has been heralded as a nephron-sparing surgical approach, the incidence of post-operative complications -including hemorrhage and pseudoaneurysm -may prevent widespread adoption [12]. One potential advantage of Robotic Partial Nephrectomy (RPN) is that it may mitigate the hemorrhagic complications and thus make this operation more accessible [13]. This could have particular applications in the JW population.We present the first published series of RPN in a group of JW patients. MethodsAfter proper internal review board approval, we prospectively maintained a database of JW patients undergoing RPN between 2010-2014. The procedures were performed by a single surgeon at two institutions. Preoperative optimization with a hematologist was sought on every procedure, as a part of the Bloodless Medicine program at our institution.All procedures were performed in a transperitoneal fashion. Intraoperative ultrasound was used to localize the tumor, and artery-only clamping was performed unless venous backbleeding was encountered. Tumor excision was performed using a standard technique, with cold scissors and gentle retraction.Renorrhaphy was performed using our innovation of the sliding-clip technique [14], which is unique to our institution. The suture consists of two V-LOC (Medtronic, Minneapolis, MN) sutures attached at the tails Figure 1. The first layer of closure is performed using the 3-0 V-LOC with a CV-23 needle, which is similar to a RV-1. Critical to this step is the approximation of the corticomedullary junction, as this tends to be the stronger layer. Also important in this step is the closure of any collecting Abstract Background: Recent interest in "bloodless" surgery places the urologic surgeon in a difficult position, especially as surgeries such as partial nephrectomy with an increased risk of bleeding, grow in popularity and the availability of blood for transfusion decreases. Jehovah's Witnesses are a religious group that refuses blood transfusion on religious grounds, which necessitates surgery in a setting where blood transfusion is not an option.

show abstract

“…[13] In RAPN series by Scoll et al [14] performed on 100 patients, the average size of the excised tumors (2.8 cm), ischemia time (25.5 min), surgical margin positivity rate (5.7%), transition rate to open surgery (2%), major (6%) and minor (5%) complica tion rates were reported as indicated. A retrospective study by Long et al [15] which compared cases with 199 RAPN and 182 LPN did not detect a significant difference across the perioperative parameters but reported a lower rate of transition (1% vs. 11.5% for LPN) to open surgery, and a smaller decrease (12.6% vs. 16%) in the glomerular filtration rate in the RAPN group Abourmarzouk et al [16] conducted a comparative study with 717 patients (313 RAPN vs. 404 LPN) and discovered a shorter warm ischemia time in the RAPN group but did not detect a significant difference with respect to other parameters. While the complication rates were comparable across LPN and RAPN, the reported complication rate for masses larger than 4 cm was 26.7% in the RAPN group.…”

Section: Discussionmentioning

confidence: 99%

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

Özkan

Coşkuner

Yalçın

2016

Turkish Journal of Urology

View full text Add to dashboard Cite

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.

show abstract

Robotic Versus Laparoscopic Partial Nephrectomy for Complex Tumors: Comparison of Perioperative Outcomes

Cited by 129 publications

References 30 publications

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

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

Contact Info

Product

Resources

About