Complications Of Partial Nephrectomy Research Articles

Effectiveness of soft coagulation in robot-assisted partial nephrectomy in preventing pseudoaneurysms and its influence on renal function based on propensity score-matched analysis.

Renal artery pseudoaneurysm (RAP) is one of the most stressful and life-threatening complications of partial nephrectomy, the standard treatment for small renal cell carcinoma. The use of a monopolar soft coagulation system for hemostasis during robot-assisted partial nephrectomy (RAPN) is expected to prevent post-surgical RAP development. In this study, we aimed to investigate how the use of a soft coagulation system in RAPN reduces postoperative pseudoaneurysms and changes renal function over time. The incidence of pseudoaneurysms and postoperative renal function were compared in 208 partial nephrectomies performed between May 2016 and March 2023 at a single institution, with propensity score matching to balance patient backgrounds. Outcomes were analyzed using multivariate logistic or linear regression analyses. In total, 80 matched pairs were analyzed. One (1.2%) and eighteen (22.5%) pseudoaneurysms were found in the soft coagulation users and non-users, respectively (P<0.001). Compared to the non-user group, postoperative estimated glomerular filtration rates (eGFRs) in the user group were 89% vs. 96% (P<0.001), 87% vs. 93% (P=0.009), and 88% vs. 92% (P=0.15) at 1, 3, and 12 months, respectively. Subsequent multivariate analyses showed a lower incidence of pseudoaneurysms in the user group with an odds ratio of 0.05 [95% confidence interval (CI): 0.01 to 0.44; P=0.007], and no significant difference in the rate of change in renal function at 12 months postoperatively (-1.1%, 95% CI: -5.5% to 3.3%; P=0.61). The use of a soft coagulation system reduces pseudoaneurysm occurrence after partial nephrectomy. Although renal function decreased in the short-term for the use group, no long-term differences were observed.

Transcatheter renal arterial embolization for intractable urinary fistula occurring after robot-assisted partial nephrectomy: a case report.

Partial nephrectomy is the standard surgical procedure for small renal tumors. Since the advent of robot-assisted partial nephrectomy (RAPN), the number of cases of renal tumors undergoing the procedure has increased exponentially. Urinary fistula is a complication of partial nephrectomy. Conservative management using ureteral stents is useful in most cases of urinary fistulas. However, some patients develop intractable urinary fistulas. Herein, we report a case in which vascular embolization was useful for treating an infected and intractable urinary fistula that developed after RAPN. A 59-year-old man was accidentally found to have a right renal tumor (approximately 3cm in diameter) during a physical examination. Pathology was clear cell carcinoma. RAPN was performed owing to the small size of the renal tumor; however, postoperatively, an intractable urinary fistula with an isolated calyx developed, which was successfully treated with transcatheter renal arterial embolization (TAE). We encountered a rare case of infected refractory urinary fistula with an isolated calyx in which TAE was successful. TAE seems useful in treating intractable urinary fistulas with an isolated calyx occurring after RAPN.

Urine Leak After Partial Nephrectomy: A Rare Complication After Robot-Assisted Partial Nephrectomy

In this systematic review, we looked at the rate of urine leakage from the kidney after surgical removal of kidney tumors. Urine leak (UL) is a common post-operative complication of partial nephrectomy (PN). The reported incidence varies in the literature, and there are no well-established guidelines for management of UL after PN. The goal of this study is to report the incidence and most common management strategies for UL after PN. For our quantitative synthesis, a systematic review of articles related to UL after PN from April 2010 to April 2020 was performed using PubMed and EMBASE. 475 total records were found, of which 40 reported on post-operative UL. A total of 19,904 cases were included. The overall incidence of UL was 2.8% (554/20,140). UL was most common in open cases (5.01%), followed by laparoscopic (4.40%) and robotic (1.18%) PN. Thirty-one of the included studies reported on management technique for a total of 343 interventions. UL was most frequently managed non-operatively (46.6%). Other management strategies included cystoscopy with ureteral stent placement (39.4%), percutaneous drain placement (8.7%), and percutaneous nephrostomy tube placement (2.3%). Use of nephrectomy, open reconstruction, angioembolization, or ureteroscopic techniques was uncommon (3.1%). Our study revealed that UL is rare after robotic approach to PN. Many reported cases have been managed conservatively. A stepwise management strategy is recommended. Most of these leaks heal with time or with placement of a stent into the ureter after surgery. We found that urine leak is less common with robotic surgery versus open or laparoscopic surgery.

MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL

You have accessJournal of UrologyCME1 Apr 2023MP23-02 USE OF MAYO ADHESIVE PROBABILITY SCORE AS A PREDICTOR OF POSTOPERATIVE FEVER FOLLOWING mPCNL Chia-Min Liu and Chan Jung Liu Chia-Min LiuChia-Min Liu More articles by this author and Chan Jung LiuChan Jung Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is the standard treatment for large renal stone. Despite the advanced techniques, postoperative fever and bleeding remain the two major complications but still without effective predictor. Mayo adhesive probability (MAP) score is an image-based renal morphometry scoring system that is used to predict the potential risks and complications of partial nephrectomy but was never evaluated for the association with post-PCNL complications. We aim to explore the predictive value of MAP score on postoperative fever and estimated total blood loss (ETBL) in patients underwent miniaturized PCNL (mPCNL). METHODS: This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores was determined on the basis of pre-operative computed tomography and was calculated algorithmically by posterior renal fat thickness and the extent of perinephric fat stranding. We used Bourke and Smith formula to calculate intraoperative ETBL. Logistic regression analysis was used to determine independent risk factors associated with fever and ETBL. The predictive values of preoperative urine culture combining MAP score for postoperative fever was determined by receiver operating characteristic (ROC) curve analysis. RESULTS: Among 159 study subjects, over half of the patients presented with MAP score ≥ 3 (n=90, 56.6%). Men, elderly, chronic kidney disease, and diabetes mellitus were associated with a higher MAP score. The patients with higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate logistic regression, preoperative positive urine culture (OR 2.44, p=0.01) and a higher MAP score (OR 2.13, p=0.026) were both significantly associated with postoperative fever. ROC curves analysis combining these two factors on predicting postoperative fever showed AUC 0.73 (0.652–0.810) (Figure 1). The posterior perinephric fat thickness was significantly associated with ETBL (β=7.36, p=0.04). CONCLUSIONS: The MAP score was associated with postoperative fever in patients undergoing mPCNL, while posterior perinephric fat demonstrated borderline association with estimated perioperative blood loss volume. The combination of preoperative urine culture and the MAP score can significantly predict the probability of fever in patients receiving mPCNL. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chia-Min Liu More articles by this author Chan Jung Liu More articles by this author Expand All Advertisement PDF downloadLoading ...

PD40-02 ASSOCIATION BETWEEN ORAL ANTITHROMBOTIC DRUGS USE AND BLEEDING IN PARTIAL NEPHRECTOMY: A RETROSPECTIVE COHORT STUDY

You have accessJournal of UrologyCME1 Apr 2023PD40-02 ASSOCIATION BETWEEN ORAL ANTITHROMBOTIC DRUGS USE AND BLEEDING IN PARTIAL NEPHRECTOMY: A RETROSPECTIVE COHORT STUDY Yuzhe Tang, José Nolazco, Zhiyu (Jason) Qian, Marie-Thérèse Valovska, Kendrick Yim, Benjamin Chung, and Steven Chang Yuzhe TangYuzhe Tang More articles by this author , José NolazcoJosé Nolazco More articles by this author , Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Marie-Thérèse ValovskaMarie-Thérèse Valovska More articles by this author , Kendrick YimKendrick Yim More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , and Steven ChangSteven Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Whether perioperative period oral antiplatelet (AP) and anticoagulant (AC) drugs use can lead to bleeding in PN is controversial. This study analyzes the association between oral AP/AC use and bleeding complications in partial nephrectomy in a large cohort. METHODS: Using the Premier Hospital Database, we performed a retrospective cohort study of patients undergoing partial nephrectomy to manage kidney cancer and renal masses from 2003 to 2020. The study cohort was limited to adult patients undergoing elective surgery. Using administrative codes and billing, we assessed for an association between AP/AC drug use and bleeding complication using mixed-effects multiple logistic regression models controlling for a wide range of clinical-demographic, surgical, and hospital factors. The primary outcome was bleeding within 90 days in or after surgery. Secondary outcomes were mortality rate 90 days after surgery and length of hospital stay. RESULTS: The study cohort comprised 48,112 partial nephrectomy patients, of which 10.9% had bleeding complications. Mixed-effects multivariable logistic regression models revealed that AP was associated with 31% increased odds for bleeding (OR 1.31; 95% CI: 1.15-1.49; p<0.01) and AC was associated with 2.25 times odds for bleeding compared with none users (OR 2.25; 95% CI: 1.85-2.74; p<0.01), AP and AC combination group was associated with the most bleeding risk (OR 3.09; 95% CI: 2.q4-4.74; p<0.01). An effect modification of oral AP drug use and Myocardial infarction (MI) history was detected, which is shown in Figure 1. The relationship between surgeon volume and bleeding risk was presented as a "J" shape (Figure 2). More than 33 cases/year for PN surgeons entered a plateau phase and slightly increased the bleeding risk. CONCLUSIONS: AC/AP use is associated with a significant increase in bleeding complications following partial nephrectomy surgery; Compared with AP, AC induces more probability of bleeding; AP and AC combination lead to even more bleeding risk. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1051 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yuzhe Tang More articles by this author José Nolazco More articles by this author Zhiyu (Jason) Qian More articles by this author Marie-Thérèse Valovska More articles by this author Kendrick Yim More articles by this author Benjamin Chung More articles by this author Steven Chang More articles by this author Expand All Advertisement PDF downloadLoading ...

Post Operative Complications Of Open Partial Nephrectomy With Respect To Tumour Location.

Partial Nephrectomy has been the go-to approach for the treatment of small sized renal tumours for years now. Like any other surgical procedure, it is associated with post-operative complications. The study was aimed at determining the post-operative complications of open partial nephrectomy concerning tumour location. This descriptive cross-sectional study was done on 45 patients as per inclusion criteria. The patients were managed as per department protocols and were observed for the development of immediate post-operative complications during hospital stays. RESULTS: Post-operative complications were observed in 4 (8.9%) patients and included haemorrhage (n=1; 2.2%) and urine leak (n=3; 6.7%). There was a statistically significant association between post-operative complications of partial nephrectomy and central tumour location (p=0.008, OR=14.52 and LR=5.70) and increased age (p=0.04, LR=5.40 and OR=8.90). Increased age and tumour location may play a significant role in determining the likelihood of post-operative complications in patients who have undergone surgery for renal tumours.

Three-dimensional topology-based T-index as an indicator of surgical difficulty of partial nephrectomy in patients with small renal mass.

To accurately describe the three-dimensional topology of renal tumors, our study suggests a new nephrometry scoring system, the T-index, that combines information about intraparenchymal extension and peripherality of the renal tumor. This study included 113 patients who underwent partial nephrectomy for small clear cell renal cell carcinoma between 2007 and 2014. Manual segmentation of the renal parenchyma, sinus, and tumor was performed using preoperative computed tomography images. The T-index was calculated by adding the reciprocals of the distances from all points on the tumor-parenchyma interface to the renal sinus. Correlations with perioperative factors and the impact of the T-index on postoperative complications were evaluated and compared with existing nephrometry scoring systems (PADUA, RENAL, contact surface area [CSA], and C-index). The mean value of the T-index among the 113 patients was 116.1±100.5 (1/mm). The T-index showed the strongest correlation with perioperative factors compared with other nephrometry scoring systems. The T-index was able to predict the risk for postoperative complications, either overall (p=0.015) or major complications (p=0.030). A predictive model based on the T-index of the overall postoperative complications presented the best performance (area under the curve, 0.692; 95% CI, 0.599-0.776) compared with other nephrometry scoring systems. The T-index can be considered as a single value comprising key structural indicators for surgical complexity. Our findings suggest that the T-index can provide a quantitative and objective scoring system associated with surgical difficulty and postoperative complications of partial nephrectomy.

Complications of radical nephrectomy and partial nephrectomy: What are they? How can they be anticipated and managed?

Surgical techniques of radical and partial nephrectomy have changed over the last 20years. Indications for partial nephrectomy have widened and mini-invasive surgery (laparoscopy and robotic assistance) has become widely used. However, both still have a significant morbidity. The objective of this article is to review complications of renal surgery and their predictive factors and to offer algorithms of management. Recent literature regarding complications of radical and partial nephrectomy was queried using Pubmed engine search. The most relevant articles were analyzed and served as a basis for this work. The literature on complications of radical and partial nephrectomy has a low level of evidence. There are only retrospective series. The most frequent complications of radical nephrectomy occur during surgery in 5-10% of the cases: wound of the pedicle or of an adjacent organ. The management can often be conservative. Laparoscopy has a similar morbidity compare to the open approach but has greatly increased postoperative outcomes and comfort. Partial nephrectomy has a 20% complication rate. Many factors have an impact on the risk of complications (tumor size, inflammation of perirenal fat, access, surgeon experience, centre volume, comorbidities and age of the patient) and must be taken into consideration before advising partial nephrectomy. The two most feared complications of partial nephrectomy are bleeding (per- or postoperative, 10% of the cases) and urinary fistula (<5% of the cases). Robotic assistance is associated with a lower morbidity in many publications. Complications after partial and radical nephrectomy are quite frequent but have decreased with the improvement of surgical techniques. French urologists should maintain their interest in novel technologies and simplification of perioperative pathway to further improve patients' outcomes.

Renal tumor biopsy does not increase the risk of surgical complications of minimally invasive partial nephrectomy.

For patients with cT1 renal lesions, Partial Nephrectomy (PN) is the gold standard treatment. However, 20% of small renal masses are benign, situation in which the PN is an overtreatment. The percutaneous Renal Tumor Biopsy (RTB) may lower the risk of overtreatment as there is a 90% concordance rate on histotype between the RTB and the final pathology. It has been suggested that the RTB could increase the difficulty of the PN and increase the risk of surgical complications. To compare surgical outcomes and complications of PN with or without previous RTB. monocentric retrospective review of patients who underwent laparoscopic or robotic-assisted PN between January 2012 and December 2019. perioperative complications were recorded using Clavien-Dindo classification, peroperative data included operative time, clamping time and blood loss, and histological outcomes of RTB and PN. In total, 163 patients were included in our study. There were significantly less benign lesions in PN with prior RTB: 7% (4/56) vs. 20% (22/107) without prior RTB (P=0.03). There were no significant differences regarding Clavien-Dindo>2 perioperative complications with respectively 7% (4/56) vs. 10% (11/107) (P=0.57). Same goes for peroperative data such as duration of surgery (P=0.81), warm ischemia (P=0.07) and blood loss (P=0.13). RTB does not increase the risk of surgical complications of PN and may reduce the risk of small renal masses overtreatment.

Predicting acute kidney injury following open partial nephrectomy treatment using SAT-pruned explainable machine learning model

BackgroundOne of the most prevalent complications of Partial Nephrectomy (PN) is Acute Kidney Injury (AKI), which could have a negative impact on subsequent renal function and occurs in up to 24.3% of patients undergoing PN. The aim of this study was to predict the occurrence of AKI following PN using preoperative parameters by applying machine learning algorithms.MethodsWe included all adult patients (n = 723) who underwent open PN in our department since 1995 and on whom we have data on the pre-operative renal function. We developed a random forest (RF) model with Boolean satisfaction-based pruned decision trees for binary classification (AKI or non-AKI). Hyper-parameter grid search was performed to optimize the model's performance. Fivefold cross-validation was applied to evaluate the model. We implemented a RF model with greedy feature selection to binary classify AKI and non-AKI cases based on pre-operative data.ResultsThe best model obtained a 0.69 precision and 0.69 recall in classifying the AKI and non-AKI groups on average (k = 5). In addition, the model's probability to correctly classify a new prediction is 0.75. The proposed model is available as an online calculator.ConclusionsOur model predicts the occurrence of AKI following open PN with (75%) accuracy. We plan to externally validate this model and modify it to minimally-invasive PN.

Histological and radiological evaluation of thermal denaturation depth using soft coagulation during partial nephrectomy in living pigs.

To evaluate thermal denaturation depth using soft coagulation in kidneys invivo. In experiment1, nine kidneys from five pigs were cauterized using five soft-coagulation settings at 80W with effect7 by VIO300D and one monopolar-coagulation setting. The surface of the kidney was cauterized over a period of 2, 5 and 10s. The temperature change was measured at depths of 5 and 10mm. In experiment2, three kidneys from two pigs were excised in a semicircular shape with a diameter of 5, 10 and 20mm without clamping the renal artery. Cauterization was carried out until hemostasis was confirmed by soft coagulation at 80W with effect7. After completion of the experiments, pathology examinations of the kidneys were carried out. Experiment1 showed that with proper saline dripping, denaturation spread with increased cauterization time, reaching a depth of 4mm at 10s with or without clamps. The depth remained at 2-3mm at 10s in the absence or excess of saline. The temperature increased by 15.6°C at a depth of 5mm and 8.8°C at 10mm. In experiment2, the depth was 4.6mm from the incision surface regardless of the cauterization time or excision size. These findings suggest that soft coagulation can be useful for preserving renal function and reducing complications in partial nephrectomy.

Spontaneous Resolution of Renal Artery Pseudoaneurysm after Robotic-Assisted Partial Nephrectomy

Partial nephrectomy (PN) for small renal tumors has become increasingly common. Complications of PN include renal artery pseudoaneurysm (PA), a potentially life-threatening condition. However, the true incidence and natural history of PA after PN remain unclear. Therefore, we conducted a retrospective study of the radiographic characteristics of robotic-assisted partial nephrectomy (RAPN) observed during the postoperative period. We selected 36 consecutive patients with renal carcinoma who underwent RAPN at our institution between December 2016 and May 2019. Patients with contraindications for the use of contrast medium were excluded. A total of 31 eligible patients underwent computed tomography angiography (CTA) during the early postoperative period after RAPN and the incidence of PA was evaluated. Among the patients with PASs, asymptomatic PAs were followed without intervention and their clinical course was assessed using CTA at 1 to 3 months postoperatively. PA was identified in 5 out of 31 (16.1%) patients after RAPN. Median duration between PN and the first CTA was 6 days (range, 1-8). Median PA size was 13 mm (range, 8-17). All (100%) PAs were asymptomatic and resolved spontaneously, as verified by CTA during the late postoperative period. Median duration between identification of PA on early postoperative CTA and subsequent resolution was 92 days (range, 35-106). Our findings indicated that asymptomatic PA after PN can be followed without intervention.

The value of renal score in both determining surgical strategies and predicting complications for renal cell carcinoma: A systematic review and meta-analysis.

ObjectivesRadical nephrectomy (RN) was the standard treatment for renal cell carcinoma (RCC). However, recent studies have found that partial nephrectomy (PN) could achieve similar effects as radical nephrectomy, and has the advantages of less bleeding and shorter hospital stay. The choice of surgical strategies has become a concern of clinicians, which could be guided by renal score introduced by Kutikov et al Therefore, we conducted this meta‐analysis to clarify the value of renal score of determining surgical strategies and predicting complications.MethodsThe keywords “RENAL score,” “renal nephrometry score,” or “nephrometry score” were used to retrieve electronic databases for relevant literature up to Feb 2020, including PubMed, Web of Science, and the Cochrane library. Surgical strategies and complications are outcome measures. Risk ratio (RR) with 95% confidence intervals (CI) is applied to assess the effect size.ResultsA total of 20 studies met the selection criteria for meta‐analysis. There was significant difference in RN operation rate for each subgroup (low‐moderate: RR = 3.50, 95% Cl = 2.60‐4.71, P < .001; low‐high: RR = 6.29, 95% Cl = 4.40‐9.00, P < .001; moderate‐high: RR = 1.80, 95% Cl = 1.39‐2.32, P < .001).The overall incidence of complications from high renal score group was significantly higher than that in low renal score group (low‐moderate: RR = 1.32, 95% Cl = 1.03‐1.69, P = .026; low‐high: RR = 2.45, 95% Cl = 1.48‐4.07, P = .001; moderate‐high: RR = 1.75, 95% Cl = 1.17‐2.61, P = .007).ConclusionsThis meta‐analysis indicated that renal score is an efficient tool for determining surgical strategies and predicting complications in PN. More prospective research is essential to verify the predictive value of renal score.

Selective Trans-arterial Embolization of Iatrogenic Vascular Lesions Did Not Influence the Global Renal Function After Partial Nephrectomy

To evaluate the renal function outcomes after selective trans-arterial embolization (SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous fistula, following partial nephrectomy (PN). A multi-institutional study was conducted including consecutive patients who underwent PN between January 2009 and March 2019. Two surgical approaches were used: open and robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance, RENAL score, and tumor size. The primary outcome was the evolution of global renal function at 6-months postoperatively. A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included. IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical approach (P=.78). Patients from embolization group were matched to 34 cases without postoperative IVL. Groups were comparable concerning clinical, tumor and surgical characteristics. The clinical success of SAE, defined as the absence of recourse to a second embolization or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR) was similar between control group (93 [85-102] ml/min) and embolization group (95 [83-102] ml/min) (P=.99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference (P=.73). IVL are rare complications of PN. SAE is an effective and minimally invasive management tool, with no deleterious effect on global renal function.

Safety and efficacy of embolotherapy for severe hemorrhage after partial nephrectomy.

Partial nephrectomy may be complicated by postoperative hemorrhage, which may be treated by transcatheter embolization. To assess the safety and efficacy of embolotherapy for hemorrhagic complications of partial nephrectomy and to analyze the potential correlation between multiple bleeding sites on angiography and surgical complexity. A cohort of 25 patients presenting with severe, postoperative bleeding after partial nephrectomy and treated with catheter-directed superselective embolization was included. Patients' demographics, radiological investigations before the embolization, and clinical outcome after embolization were analyzed. Mann-Whitney U test was used to analyze the potential difference in the RENAL score between patients with one or more bleeding sites in the resection area. Selective renal angiography revealed multiple bleeding sites at the resection bed in 8 (32%) patients with amorphous contrast extravasation in 10 (40%) patients. Embolization with use of a microcatheter and microcoils was effective to stop the bleeding in all but one patient, the latter requiring a second embolization two days later. Transient decrease in renal function was noted in 3/25 (12%) patients with full recovery in two of the three. Patients with multiple bleeding sites did not show significantly different RENAL scores compared to patients with a single bleeding site (P = 0.148). Embolotherapy for postoperative partial nephrectomy-related bleeding is safe and effective with a low rate of recurrent bleeding. The number of bleeding sites at the resection area did not correlate to the RENAL score.

Sutureless Technique in Robot-Assisted Partial Nephrectomy

Introduction and Objectives: Bleeding is one of the most unfavorable postoperative complications of partial nephrectomy. It is generally accepted that renorrhaphy is necessary for hemostasis because conventional coagulation is uncertain for hemostasis of renal tumor bed. In soft coagulation mode, the output voltage is regulated <190 V and generates Joule heat without producing sparks that cause tissue carbonization. Carbonized tissue sometimes drops off and it leads to bleeding; however, protein degeneration caused by Joule heat is durable. We introduce our minimally invasive sutureless technique using soft coagulation in robot-assisted partial nephrectomy (RAPN). Materials and Methods: We performed RAPN for 76 consecutive patients with cT1 renal tumor from December 2014 to March 2019. We utilize VIO 300D (ERBE, Germany) for hemostasis of renal tumor bed. The device was set in a “soft coagulation” mode with a power setting of effect 7 and 80 W. In each case, the renal artery was clamped without cooling. During tumor excision, the assistant used a suction/irrigator and a monopolar electrocautery coagulating renal tissue concurrently with the resection of tumor. The renal artery was unclamped after the bleeding was controlled using soft coagulation (early unclamping). After unclamping, additional coagulation was done until complete hemostasis was gained. We did not suture the renal parenchyma when sufficient hemostasis was achieved. The renal artery was reclamped if there was an arterial bleeding and additional coagulation was done. Results: Twenty-four out of 76 cases underwent RAPN by complete sutureless technique that was carried out with neither suture nor renorrhaphy. There was no case with >10 points of R.E.N.A.L nephrometry score, 6 cases were with scores between 7 and 9 points, and 18 cases were with score <6 points. The median age was 65 (39–85) years and the median body mass index was 24.6 kg/m2 (19.3–31.8). The median console time was 106 minutes (71–169) and the median estimated blood loss was 21 mL (0–250 mL). The median tumor size was 2.3 cm (1.1–4.0 cm) and the median warm ischemic time was 9.0 minutes (6.0–29.1 minutes). All cases had negative surgical margins. The median rate of change in estimated glomerular filtration rate was −3.9% (−22.7% to 24.4%) 1 month postoperatively. Clavien–Dindo Grade IIIa urinoma occurred in two patients and postoperative bleeding was not observed in all cases. In the first case of urinoma, no obvious opening of collecting system was observed during the surgery for deep endophytic 31 mm tumor. To assure whether there is leakage, retrograde pyelography was performed after wound closure. Minor leakage from renal calix was found and ureteral stent was positioned. Urinoma of the second patient was found with the stricture of ureteropelvic junction in 6 months after partial nephrectomy. The effect of soft coagulation might have been conducted because there was only a couple of millimeters between the ureteropelvic junction and the tumor bed. Ureteral stent was also positioned for the patient. Conclusion: Soft coagulation is an effective technology for tissue hemostasis. Sutureless hemostasis together with early unclamping is a safe and feasible minimally invasive technique for RAPN. No competing financial interests exist. Runtime of video: 4 mins 5 secs

The value of nephrometry scoring systems in prediction of conversion to radical nephrectomy in patients scheduled for nephron-sparing surgery.

Nephrometry scores such as PADUA (1) and RENAL (2) are helpful tools to evaluate the complexity of renal tumors, not only to estimate the risk of complications of partial nephrectomy (PN) (3,4) but also to predict the risk of conversion to radical nephrectomy (cNE) (5).

SC57 - Hemorrhagic complications of partial nephrectomy: Single center experience

SC57 - Hemorrhagic complications of partial nephrectomy: Single center experience

P104 - Complications of partial nephrectomy in patients with tumors of solitary functioning kidney

P104 - Complications of partial nephrectomy in patients with tumors of solitary functioning kidney

Adherent Perinephric Fat in Asian Patients: Predictors and Impact on Perioperative Outcomes of Partial Nephrectomy

Introduction: This study is aimed at evaluating the incidence and predictors of adherent perinephric fat (APF) in Asians during partial nephrectomy (PN), and determining the impact of APF on perioperative outcomes. Materials and Methods: A total of 231 Asian patients with renal tumors underwent PN, and their Mayo adhesive probability (MAP) score was calculated. APF was intraoperatively determined, and the perioperative data were compared according to the presence of APF. The predictors of APF were examined using logistic regression analyses. Results: APF was observed in 40 (17%) patients. In multivariate analysis, male gender and higher MAP score were the independent predictors of APF. The estimated blood loss was higher in patients with APF, however, the complication rates did not differ between the 2 groups. Conclusions: The MAP score can predict APF in an Asian population. The presence of APF was associated with greater blood loss; however it did not increase the postoperative complications in PN.