940 ROBOTIC-ASSISTED “ZERO-ISCHEMIA” LAPAROSCOPIC PARTIAL NEPHRECTOMY: INITIAL EXPERIENCE

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011940 ROBOTIC-ASSISTED “ZERO-ISCHEMIA” LAPAROSCOPIC PARTIAL NEPHRECTOMY: INITIAL EXPERIENCE Mukul Patil, Manuel Eisenberg, Casey Ng, Andre Berger, Andre Abreu, Osamu Ukimura, Monish Aron, Mihir Desai, and Inderbir Gill Mukul PatilMukul Patil Los Angeles, CA More articles by this author , Manuel EisenbergManuel Eisenberg Los Angeles, CA More articles by this author , Casey NgCasey Ng Los Angeles, CA More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Andre AbreuAndre Abreu 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.2011.02.858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Warm ischemia negatively impacts renal function outcomes after partial nephrectomy. We have described a novel technique of “zero-ischemia” partial nephrectomy, performed in minimally-invasive fashion. Herein, we describe our experience with robotic assisted “zero-ischemia” partial nephrectomy (RaPN) with a focus on perioperative parameters and early outcomes. METHODS Data were prospectively collected in an Institutional Review Board approved database. Twelve cases of robotic assisted “zero-ischemia” partial nephrectomy were identified. Within the patient cohort, five had central tumors (41.7%), 7 had hilar tumors (58.3%), 1 had solitary kidney, and 1 with chronic kidney disease index &[ge]3. One patient underwent concomitant nephrolithotomy at the time of RaPN. Anesthesia-related monitoring included pulmonary artery catheter, trans-esophageal echocardiography, cerebral oximetry, mixed venous oxygen measurements, and vigorous hydration/diuresis. Pharmacologically-induced blood pressure reduction was used to facilitate excision of the deepest aspect of the tumor. Renal parenchymal reconstruction was completed under normotension, ensuring complete hemostasis. RESULTS Median tumor size was 3 cm (1–6.4 cm), operative time was 4 hrs (1–6hrs), blood loss 200mL (25–800mL), and hospital stay was 3 days (1–6.4 days). Warm ischemia time was zero minutes for all cases. There was no conversion to radical nephrectomy or open partial nephrectomy. Two patients were converted to traditional laparoscopy (16.7%). Renal cell carcinoma was confirmed in 9 of 12 cases (T1a = 7, T1b = 2). All surgical margins were negative. Nadir mean arterial pressure ranged between 51–68mmHg (median 60) for less than 10 minutes. No patient had hypotension related sequelae. One patient had post-operative thrombophlebitis, and one patient had a urine leak (managed conservatively). The median preoperative and 1 month postoperative serum creatinine (0.85mg/dL and 1.04mg/dL) were not statistically different. (p=0.07). CONCLUSIONS “Zero ischemia” partial nephrectomy allows excision of renal masses without significantly impacting renal function. Our experience demonstrates that robotic partial nephrectomy may be safely and efficaciously performed without warm ischemia. We believe this represents the initial phase of wider implementation of minimally invasive zero-ischemia partial nephrectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e377 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mukul Patil Los Angeles, CA More articles by this author Manuel Eisenberg Los Angeles, CA More articles by this author Casey Ng Los Angeles, CA More articles by this author Andre Berger Los Angeles, CA More articles by this author Andre Abreu 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 ...