1846 OVER 100 CASES OF ZERO-ISCHEMIA ROBOTIC/LAPAROSCOPIC PARTIAL NEPHRECTOMY: IS GLOBAL RENAL ISCHEMIA NECESSARY?

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You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 20121846 OVER 100 CASES OF ZERO-ISCHEMIA ROBOTIC/LAPAROSCOPIC PARTIAL NEPHRECTOMY: IS GLOBAL RENAL ISCHEMIA NECESSARY? Andre Luis de Castro Abreu, Dennis Lee, Andre K. Berger, Alvin Goh, Mukul Patil, Casey Ng, Osamu Ukimura, Monish Aron, Mihir Desai, and Inderbir Gill Andre Luis de Castro AbreuAndre Luis de Castro Abreu Los Angeles, CA More articles by this author , Dennis LeeDennis Lee Los Angeles, CA More articles by this author , Andre K. BergerAndre K. Berger Los Angeles, CA More articles by this author , Alvin GohAlvin Goh Los Angeles, CA More articles by this author , Mukul PatilMukul Patil Los Angeles, CA More articles by this author , Casey NgCasey Ng Los Angeles, CA More articles by this author , Osamu UkimuraOsamu Ukimura Los Angeles, CA More articles by this author , Monish AronMonish Aron Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , and Inderbir GillInderbir Gill Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1956AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim is to report peri-operative and short-term outcomes of a novel technique of zero-ischemia robotic and laparoscopic partial nephrectomy (PN). METHODS From March/10 to July/11, 100 zero-ischemia robotic (n=40)/laparoscopic (n=60) PN were performed at our institution. The technique consists of performing micro-dissection of tertiary or higher-order renal arterial branches to super-selectively devascularize the tumor. Blood flow continues uninterrupted to the remainder of the kidney. As such, PN is performed without hilar cross-clamping. The procedure was offered to all comers regardless the tumor complexity or renovascular anatomy. RESULTS Median patient age was 59 years, tumor size was 3cm (0.9-13.6), baseline serum creatinine (SCr) was 1 mg/dl (0.5-2.6), and estimated glomerular filtration rate (eGFR) was 73 ml/min per 1.73m2 (24-149). 21% of patients had imperative indication for PN, 10 had past history of PN, 5 had bilateral masses, 9 had solitary kidney and 8 patients had multiple ipsilateral tumors. Overall, 70% of tumors were complex: central (43%), completely intra-renal (23%), cT1b >4cm (21%), and hilar (19%). Median (range) RENAL, PADUA and C-Index scores were 8 (4-11), 9 (6-13), 2.2 (0.5 – 13.2), respectively. In 1 patient, zero-ischemia LPN was converted to clamped LPN. There were no conversions to radical nephrectomy or open surgery. Warm ischemia time was zero, median operative time was 275 min (126-534), estimated blood loss was 200cc, percent of kidney excised was 20 (5-70) and hospital stay was 4 days (2-20). There were 13 complications in 12 patients, with major complications, Clavien grade ≥3, in 4 patients. None patient died. Histology confirmed malignancy in 80% of tumors. All surgical margins were negative for cancer. There were no significant difference for median percent change in SCr, 0 mg/dl (-31 to 215), and eGFR, -1 (-74 to 53), at discharge. In 65 patients with more than 2 months (median 219 days) follow up data available, median percent change in SCr and eGFR were 18 (-31 to 154), p<.001 and -18 (-66 t0 53), p<.001, respectively. In those patients, there was no significant percent change in eGRF (-3.2; p=0.98), comparing the actual eGRF with the predict eGFR (Predict eGFR = pre-eGFR x total kidney remaining). 1 patient developed pulmonary metastases at 1 year follow up. CONCLUSIONS Zero-ischemia robotic/laparoscopic PN without hilar clamping is feasible and safe. It could be performed even in the setting of complex tumors and various vascular anatomy scenarios. Eliminating global renal ischemia now appears achievable. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e746 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andre Luis de Castro Abreu Los Angeles, CA More articles by this author Dennis Lee Los Angeles, CA More articles by this author Andre K. Berger Los Angeles, CA More articles by this author Alvin Goh Los Angeles, CA More articles by this author Mukul Patil Los Angeles, CA More articles by this author Casey Ng Los Angeles, CA More articles by this author Osamu Ukimura Los Angeles, CA More articles by this author Monish Aron Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir Gill Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...