CRITICAL EVALUATION OF COMPLICATIONS IN LAPAROSCOPIC PARTIAL NEPHRECTOMY (original) (raw)
Related papers
Correlation of the RENAL nephrometry score with warm ischemia time after robotic partial nephrectomy
World Journal of Urology, 2012
Purpose The RENAL nephrometry score (RNS) was developed to quantify complexity of renal tumors in a reproducible manner. We aim to determine whether individual categories of the RNS have different impact on the warm ischemia time (WIT) for patients undergoing robotic partial nephrectomy (RPN). Methods In a retrospective analysis of a prospectively maintained database, we identified 251 consecutive patients who underwent RPN between January 2007 and June 2010. RNS was determined in 187 with available imaging. Univariable analysis and multivariable linear regression analysis were performed to identify which factors were more significantly associated with WIT. Results Overall RNS was of low (4-6), moderate (7-9), and high complexity (10-12) in 84 (45 %), 80 (43 %), and 23 (12 %) patients, respectively. There was no association between gender (p = 0.6), BMI (p = 0.3), or anterior/ posterior location (A) (p = 0.8), and WIT. On univariable analysis, longer WIT was associated with size (R) [4 cm (p \ 0.0001), entirely endophytic properties (E) (p = 0.005), tumor\4 mm from the collecting system/ sinus (N) (p \ 0.0001), and location between the polar lines (L) (p = 0.004). Total RNS and WIT were highly correlated (Spearman correlation coefficient = 0.54, p \ 0.0001). There was a significant trend of higher WIT with increased tumor complexity (p for trend\0.0001). After multivariable analysis, only R (p = 0.0003), E (p = 0.003), and N (p = 0.00002) components of the RNS were significantly associated with WIT. Conclusions The A and L subcategories of the RNS have no significant impact on the WIT of patients undergoing RPN. WIT is significantly dependent upon the other subcategories, as well as the overall RNS. These findings can be used to preoperatively predict which tumor characteristics will likely affect WIT and may be useful in preoperative counseling as well as planning of approach.
Predicting outcomes in partial nephrectomy: is the renal score useful
ARTICLE INFO ______________________________________________________________ ______________________ Introduction and Objective: The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting perioperative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model. Materials and Methods: Seventy-one patients were selected and included in this prospective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrectomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC). Results: No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with convertion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also associated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin.
Comparison of Laparoscopic Radical and Partial Nephrectomy: Effects on Long-Term Serum Creatinine
Urology, 2007
Laparoscopic partial nephrectomy (LPN) and radical nephrectomy (LRN) have been shown to be safe and effective treatment options for renal tumors. However, limited data are available regarding the long-term effect on postoperative renal function in patients undergoing LPN and LRN who have a normal preoperative serum creatinine (sCr) less than 1.5 mg/dL and a two-kidney system. We compared the long-term sCr in patients who were treated with LPN and LRN.
World Journal of Urology, 2016
P-DRF of the operated kidney was attributed to the RI. Subtraction of the P-DRF decline from the T-DRF decline was attributed to the parenchymal loss caused by the resection of the tumor and suturing of the normal parenchyma. Results The mean WI time was 22 min, and the mean weight of resected specimen was 18 g. The mean postoperative eGFR declined to 87 ml/min/1.73 m 2 from its baseline mean value of 97 ml/min/1.73 m 2 (p value = 0.075). Mean postoperative T-DRF and P-DRF of the operated kidney declined by 7 and 3 %, respectively. Conclusions After LPN of small renal mass, decline in renal function is primarily attributed to parenchymal loss caused by tumor resection and suturing of the normal parenchyma rather than the RI.
2020
Objective: This study aimed to investigate the influence of different ischaemia techniques on short-term and one year renal function following laparoscopic partial nephrectomy (LPN). Materials and Methods: Data of 359 patients who underwent LPN between November 2009 and April 2018 were reviewed, retrospectively. A total of 287 patients were included in the study. Patients were divided into 4 groups according to type of ischaemia as follows: group A (n=33) was warm ischaemia time (WIT) >20 minute, group B (n=202) was WIT ≤20 minute, group C (n=16) was selective arterial clamping and group D (n=36) was off-clamp. Demographic data, preoperative and postoperative outcomes were compared. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Change in eGFR according to group and time was evaluated using two-way analysis of variance. P values <0.05 were adopted as significant. Results: The mean tumour size was 46, 34, 36 and 25 mm (p=0.001), and operation time was 123, 92, 100 and 79 minute (p=0.001) for groups A, B, C and D, respectively. There was no need for open surgery in any of the patients. Blood loss, intraoperative and postoperative complication rates were found to be nonsignificantly different (p>0.05) between groups. Only 4 patients in group B had positive surgical margin. The percentage of relative eGFR (% of ΔeGFR) decline 1 year after LPN was significantly (p=0.001) higher in the ischaemic groups (A and B: 9.3% and 7.5%) compared to the zero-ischaemia groups (C and D: 5% and 3.7%). Conclusion: This study revealed that after LPN, cumulative renal function decreases to a certain extent regardless of the technique. However, it was found that cumulative renal functions are better preserved when ischaemia time is reduced to ≤20 min or eliminated.
1263 Renal Nephrometry Score and Selection of Operative Modality for Partial Nephrectomy
The Journal of Urology, 2011
INTRODUCTION AND OBJECTIVES: The RENAL nephrometry score quantifies anatomical characteristics of renal tumors. Although preliminary studies have shown this system to be reproducible, data is lacking regarding its clinical utility for surgical planning. We sought to identify if an association exists between nephrometry score and selected partial nephrectomy (PN) modality. METHODS: We conducted a retrospective analysis of patients undergoing PN for renal masses from 3/2000 for 6/2010. PN modalities included open (OPN), laparoscopic (LPN), and robotic (RPN). Demographic and clinicopathological characteristics were compared. Nephrometry sum was compared between groups (Simple 4-6, Intermediate 7-9, Complex Ն10; and Ͻ8 vs. Ն8). Factors associated with treatment modality selection were entered into a multivariate model. RESULTS: Of 153 OPN, 100 LPN and 26 RPN patients, there were no significant demographic or clinicopathological differences. Median tumor size (cm) was larger in the open group (OPN 4.2 vs. LPN 2.4 vs. RPN 2.0, pϽ0.001). Median operative time (min) and warm ischemia time (min) were shorter in the open group (OPN 190 and 25 vs. LPN 200 and 29 vs. RPN 196 and 30, pϭ0.027 and pϽ0.001), while EBL(mL) was lowest in the robotic group (OPN 250 vs. LPN 200 vs. RPN 125, pϽ0.001). High-grade Clavien complications occurred more often in OPN 22% vs. LPN 7% vs. RPN 8%, pϭ0.004. Mean RENAL nephrometry score was highest with OPN 8Ϯ2 vs. LPN 6.3Ϯ1.8 vs. RPN 6.7Ϯ1.7, pϽ0.001. Significant differences in surgical modality were noted for nephrometry scores Ͻ8, (OPN 38%, LPN 75%, and RPN 69%) vs. Ն8 (OPN 62%, LPN 25%, RPN 31%, pϽ0.001). Complex lesions including those with Radius Ͼ7 cm, Nearness to the collecting system Ͻ4 mm, (A)Posterior location, Location spanning polar line, and Hilar involvement were more likely to undergo OPN (pϽ0.001 in all). On multivariate analysis, lesions with Simple or Intermediate nephrometry scores were more likely to be treated with LPN and RPN vs. OPN (OR 13.6 and 3.5, pϽ0.005). No factors were identified that predicted a greater odds of LPN over RPN. CONCLUSIONS: Nephrometry score correlated with the perceived complexity of surgical excision and renorrhaphy of kidney tumors and was associated with type of surgical approach. Simple and Intermediate RENAL scores were equally associated with LPN and RPN, while Complex scores increased the odds of OPN. Although prospective studies are ideal, nephrometry score quantifies anatomical features of renal tumors and may be clinically useful as a decision instrument to help select surgical approach.
Current Urology, 2013
Partial nephrectomy • RENAL score Aim: We evaluate whether the preoperative R.E.N.A.L Nephrometry Score (RNS) can predict the postoperative outcomes in patients undergoing either an open or laparoscopic partial nephrectomy. Patients and Methods: We retrospectively calculated the RNS of 128 patients who underwent either an open partial nephrectomy (OPN) (n = 38) or laparoscopic partial nephrectomy (LPN) (n = 90) between 2003 and 2011. Patients were categorized into low, moderate or high complexity groups based on RNSs. Intra-operative warm ischemic time (WIT), peri-operative surgical outcomes using the Clavien-Dindo classification, postoperative histology, positive surgical margin rates were correlated to the RNS. Results: The RNS was associated with the length of the WIT in OPN (low vs. moderate vs. high: 11.4 vs. 13.1 vs. 23.4 minutes, p = 0.025) and blood loss in LPN (low vs. moderate 319 vs. 498 ml, p = 0.009). The positive surgical margins were greater in high versus moderate RNS lesions (40 vs. 7.4%, p = 0.045). No differences were seen in complications, hospital stay or transfusion rates. The RNS was significantly higher in OPN versus LPN (7.45 vs. 6.2, p = 0.0002). Conclusion: An Increasing RNS was associated with increased WIT in OPN and blood loss in LPN, supporting RNS relationship to tumor complexity. A higher RNS in OPN indicate it may corroborate procedure choice. RNS should allow comparisons
Radiofrequency-assisted laparoscopic partial nephrectomy: clinical and histologic …
Journal of …
To evaluate a surface conductive radiofrequency (RF) coagulation instrument (Tissuelink FB3.0) in laparoscopic and open partial nephrectomy (PN) in hereditary kidney cancer. The lesion depth and viability in the pathologic specimens from a surgical series and an acute porcine model were characterized under conditions of vascular perfusion and occlusion.
World Journal of Urology, 2014
Laparoscopic and robotic partial nephrectomy (LPN and RPN) are strongly related to influence of tumor complexity and learning curve. We analyzed a consecutive experience between RPN and LPN to discern if warm ischemia time (WIT) is in fact improved while accounting for these two confounding variables and if so by which particular aspect of WIT. This is a retrospective analysis of consecutive procedures performed by a single surgeon between 2002-2008 (LPN) and 2008-2012 (RPN). Specifically, individual steps, including tumor excision, suturing of intrarenal defect, and parenchyma, were recorded at the time of surgery. Multivariate and univariate analyzes were used to evaluate influence of learning curve, tumor complexity, and time kinetics of individual steps during WIT, to determine their influence in WIT. Additionally, we considered the effect of RPN on the learning curve. A total of 146 LPNs and 137 RPNs were included. Considering renal function, WIT, suturing time, renorrhaphy time were found statistically significant differences in favor of RPN (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). In the univariate analysis, surgical procedure, learning curve, clinical tumor size, and RENAL nephrometry score were statistically significant predictors for WIT (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). RPN decreased the WIT on average by approximately 7 min compared to LPN even when adjusting for learning curve, tumor complexity, and both together (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). We found RPN was associated with a shorter WIT when controlling for influence of the learning curve and tumor complexity. The time required for tumor excision was not shortened but the time required for suturing steps was significantly shortened.