Conventional Partial Nephrectomy Research Articles

Comparison of off-clamp microwave scissors-based sutureless partial nephrectomy versus on-clamp conventional partial nephrectomy in a canine model.

To compare the usefulness and safety of off-clamp microwave scissors-based sutureless partial nephrectomy (MSPN) with on-clamp conventional partial nephrectomy (cPN) in dogs. We performed off-clamp MSPN using microwave scissors (MWS) in six dogs, and on-clamp cPN in three dogs, in two-stage experiments. The bilateral kidney upper poles were resected via a midline incision under general anesthesia. After 14 days of follow-up, the lower pole resections were performed. The renal calyces exposed during renal resections were sealed and transected using MWS in off-clamp MSPN and were sutured in on-clamp cPN. In the off-clamp MSPN group, the generator's power output of MWS was set as either 50 W or 60 W for each kidney side. We compared the procedure time (PT), ischemic time (IT), blood loss (BL), and normal nephron loss (NNL) between the two techniques using the Mann-Whitney U-test. We successfully performed 24 off-clamp MSPNs and 12 on-clamp cPNs. The off-clamp MSPN was significantly superior to on-clamp cPN in avoiding renal ischemia (median IT, 0 min vs. 8.6 min, p < 0.001) and reducing PT (median PT, 5.8 min vs. 11.5 min, p < 0.001) and NNL (median NNL, 5.3 mm vs. 6.0 mm, p = 0.006) with comparable BL (median BL, 20.9 ml vs. 23.2 ml, p = 0.804). No bleeding and major urine leakage were noted during the reoperations. Off-clamp MSPN outperforms on-clamp cPN in lowering the risks of postoperative renal function impairment in dogs.

Effect of augmented reality navigation technology on perioperative safety in partial nephrectomies: A meta-analysis and systematic review.

To evaluate the impact of augmented reality surgical navigation (ARSN) technology on short-term outcomes of partial nephrectomy (PN). A systematic literature search was conducted in PubMed, Embase, Cochrane, and Web of Science for eligible studies published through March 28, 2022. Two researchers independently performed the article screening, data extraction and quality review. Data analysis was performed using Cochrane Review Manager software. A total of 583 patients from eight studies were included in the analysis, with 313 in the ARSN-assisted PN group (AR group) and 270 in the conventional PN group (NAR group). ARSN-assisted PN showed better outcomes than conventional surgery in terms of operative time, estimated blood loss, global ischemia rate, warm ischemia time, and enucleation rate. However, there were no significant differences in the rate of Conversion to radical nephrectomy (RN), postoperative estimated glomerular filtration rate (eGFR), positive margin rate, and postoperative complication rate. The utilization of ARSN can improve the perioperative safety of PN. Compared with conventional PN, ARSN-assisted PN can reduce intraoperative blood loss, shorten operative time, and improve renal ischemia. Although direct evidence is lacking, our results still suggest a potential advantage of ARSN in improving renal recovery after PN. However, as the ARSN system is still in an exploratory stage, its relevance in PN have been poorly reported. Additional high-quality randomized controlled trial (RCT) studies will be required to confirm the effect of ARSN on PN. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=301798, identifier PROSPERO ID: CRD42022301798.

Off-clamp laparoscopic partial nephrectomy in a hybrid room after tumor embolization versus conventional partial nephrectomy: A propensity score matched pair analysis

ObjectiveOff-clamp laparoscopic partial nephrectomy in a hybrid operating room after superselective arterial embolization (hLPN) is a promising minimally invasive approach. In this study, we compared the perioperative surgical outcomes of this innovative technique with the conventional standard of care laparoscopic partial nephrectomy (cLPN) technique. Patients and methodsOverall, 86 and 127 patients treated with hLPN and cLPN, respectively, were included. These two techniques were compared in terms of surgical complications, estimated blood loss (EBL), operative time, length of stay (LOS), surgical margins, and Trifecta achievement rate (defined as warm ischemia duration <25 min, negative surgical margins and absence of complications). A propensity score based on age, gender, BMI, preoperative eGFR and tumor size was used for a 1:1 matching of patients of each group. After matching, 2 groups of 67 patients with similar characteristics were obtained. ResultsConversion rate to open surgery, complications and EBL were similar in both groups. Conversely, operative time, LOS and Trifecta rates favored hLPN. The multivariate analysis showed that hLPN had a 70% higher chance of Trifecta achievement than cLPN in all age groups and for all tumor size across the study population. ConclusionCompared to a conventional approach, off-clamp laparoscopic partial nephrectomy in a hybrid room after superselective arterial embolization showed satisfying immediate surgical outcomes and reached a higher rate of Trifecta achievement. Mid and long-term functional and oncological results are needed to establish this minimally invasive surgical alternative.

Polyethylene glycol-coated collagen patch (hemopatch\xae) in open partial nephrectomy

PurposeTo describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC).MethodsOut of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN).ResultsMedian age was 65.2 years (range 12.7–95.2) with median follow-up of 9.43 months (0.03–49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38–143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75–167.74) at follow-up.In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN.Median tumor size was 4.3 cm (range 1–38 cm) in CPN with 4.8 cm (range 3.8–18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701).ConclusionsHemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.

Analysis of Atrophy After Clamped Partial Nephrectomy and Potential Impact of Ischemia

Ischemia is a potential contributor to decline of function after partial nephrectomy (PN), although loss of parenchymal mass related to excision and reconstruction appears to be a more significant factor. However, loss of parenchymal mass could also be due to global effects of ischemia leading to parenchymal atrophy. In this study, we evaluated parenchymal volumes in regions away from the operated site to assess for atrophy. A total of 164 patients undergoing PN for whom detailed analysis of function and parenchymal mass within the operated kidney could be performed were assessed for opposite pole volume (OPV) before and 4-12 months after surgery. Tumor location was required to be ≥2 cm away from the opposite polar line to exclude local effects related to excision or reconstruction. OPV was estimated by software analysis, and the ratio of the estimates (OPV ratio = postoperative OPV to preoperative OPV) was used to assess for atrophy. Patient demographics and tumor characteristics were representative of conventional PN populations, and warm ischemia (n = 101; median, 21 minutes) and cold ischemia (n = 63; median, 26 minutes) were applied by surgeon discretion. OPVs before and after PN were 63.2 and 62.5 cm(3), respectively (P = .76). The median OPV ratio was 0.99 suggesting that significant atrophy did not occur. OPV ratio was 0.99 for warm ischemia cases and 0.99 for cold ischemia cases (P = .95). Limited warm ischemia or hypothermia was not associated with significant parenchymal atrophy after PN, which suggests that parenchymal volume loss in this setting is primarily due to excision or reconstruction.

Assessment of outcomes in partial nephrectomy incorporating detailed functional analysis.

To assess perioperative morbidity and margins after conventional clamped partial nephrectomy (PN) while also using volumetric analysis to differentiate the contributions of parenchymal volume loss and recovery from ischemia. The study analyzed 163 patients who underwent PN with appropriate studies to allow analysis of function and parenchymal mass specifically in the operated kidney. Recovery from ischemia (glomerular filtration rate saved/volume saved) would be 100% if all nephrons recovered from ischemia. Precision (postoperative parenchymal volume/predicted parenchymal volume, presuming loss of a 5-mm rim of parenchyma related to excision and reconstruction) reflects efforts to optimize the amount of vascularized parenchyma saved with the PN. Trifecta was defined as negative margins, no Clavien grade 3-5 or urologic complications, and both recovery ≥80% and precision ≥80%. An open procedure was performed in 82 patients (50%), and 59 (36%) had a solitary kidney. Warm ischemia was used in 96 patients (59%). The RENAL nephrometry score (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor, and the location relative to polar lines) was intermediate in 74 (45%) and high complexity in 38 (23%). Median recovery from ischemia was 95% and was ≥80% in 143 patients (88%). Median precision of excision/reconstruction was 93% and was ≥80% in 138 patients (85%). All tumors had negative surgical margins. Perioperative complications occurred in 13 patients (9%). Trifecta was achieved in 113 patients (69%). Multivariable analysis identified solitary kidney as the only significant predictor of trifecta. Given careful patient selection and commensurate surgical expertise, excellent outcomes can be obtained with conventional clamped PN. Analysis of parenchymal volumes is necessary to facilitate comprehensive evaluation of functional outcomes after PN, allowing differentiation of nephron loss vs failure to recover from ischemia.

The 8th American Urological Association and the Japanese Urological Association International Affiliate Society Meeting

The 8th American Urological Association and the Japanese Urological Association International Affiliate Society Meeting

1460 FUNCTION PRESERVED IN THE OPERATED KIDNEY AFTER CONVENTIONAL PARTIAL NEPHRECTOMY IS DIRECTLY RELATED TO PARENCHYMAL VOLUME PRESERVATION

INTRODUCTION AND OBJECTIVES: Ultimate decline in GFR after partial nephrectomy (PN) is influenced primarily by type and duration of ischemia and parenchymal volume preserved. The role of ischemia relative to volume preservation has been controversial. OBJECTIVES: To directly evaluate the function specifically in the operated kidney pre and post conventional PN and to assess relationships with type and duration of ischemia and percent parenchymal volume preserved. METHODS: 55 patients with localized renal tumors (2007-11) had necessary studies for analysis; there were no exclusions. This comprised 24 solitary kidneys and 31 bilateral kidneys with pre and post-operative RFS, and the analysis was exclusively focused on the operated kidney. 33 (60%) cases were open and the remainder were MIS. 24 cases (44%) utilized hypothermia and 31 were performed using limited warm ischemia. Volumetric CT scans were utilized to directly measure the volume of functional parenchyma pre (subtracting out the tumor) and post PN in the operated kidney. eGFR in the operated was determined by the MDRD2 equation, along with RFS data for patients with bilateral kidneys. Regression analysis was used to assess the relationships between ultimate GFR preserved in the operated kidney and potential predictive factors. All postoperative analyses were performed between 6-12 months. RESULTS: Median age was 61 years, median tumor size was 3.5 cm, and median RENAL score was 8. Median cold ischemia time (CIT) was 29 min (IQR 23-33) and median warm ischemia time (WIT) was 21 min (IQR 14.25-27.75). Pathology results showed pT1a in 33 (61.1%) and clear cell carcinoma in 41 (74.5%). Median preop GFR in the operated kidney was 47.2 (33.85-56) compared with 36.1 (25.0547.85) postoperatively. Median percent GFR preserved in the operated kidney was 88 (79-95.1). Median percent volume preserved was 83% (75.3-90.5). On regression analysis, percent GFR saved associated most strongly with percent parenchymal preservation (p 0.0001), but also with lower RENAL score (p 0.0174), and marginally with cold ischemia (p 0.0608). In contrast, length of ischemia did not correlate with percent GFR preserved (p 0.2487). Interestingly, function in the contralateral kidney did not change substantially ( 5% in all cases). CONCLUSIONS: Ultimate function after PN primarily correlated with parenchymal volume preservation, while ischemia played a secondary role. Thus, maximal parenchymal preservation with a precise PN should be a priority during conventional PN.

Generation of Chimeric “ABS Nanohemostat” Complex and Comparing Its HistomorphologicalIn VivoEffects to the Traditional Ankaferd Hemostat in Controlled Experimental Partial Nephrectomy Model

Purpose. Using the classical Ankaferd Blood Stopper (ABS) solution to create active hemostasis during partial nephrectomy (PN) may not be so effective due to insufficient contact surface between the ABS hemostatic liquid agent and the bleeding area. In order to broaden the contact surface, we generated a chimeric hemostatic agent, ABS nanohemostat, via combining a self-assembling peptide amphiphile molecule with the traditional Ankaferd hemostat. Materials and Methods. In order to generate ABS nanohemostat, a positively charged Peptide Amphiphile (PA) molecule was synthesized by using solid phase peptide synthesis. For animal experiments, 24 Wistar rats were divided into the following 4 groups: Group 1: control; Group 2: conventional PN with only 0.5 ml Ankaferd hemostat; Group 3: conventional PN with ABS + peptide gel; Group 4: conventional PN with only 0.5 ml peptide solution. Results. Mean warm ischemia times (WITs) were 232.8 ± 56.3, 65.6 ± 11.4, 75.5 ± 17.2, and 58.1 ± 17.6 seconds in Group 1 to Group 4, respectively. Fibrosis was not different among the groups, while inflammation was detected to be significantly different in G3 and G4. Conclusions. ABS nanohemostat has comparable hemostatic efficacy to the traditional Ankaferd hemostat in the partial nephrectomy experimental model. Elucidation of the cellular and tissue effects of this chimeric compound may establish a catalytic spark and open new avenues for novel experimental and clinical studies in the battlefield of hemostasis.

Laparoendoscopic single‐site (LESS) partial nephrectomy short‐term outcomes

To present our experience of transumbilical laparoendoscopic single-site (LESS) partial nephrectomy (PN) with pathological and short-term oncological and renal functional outcomes. In all, 15 LESS-PNs were performed for cT1a tumours between July 2008 and August 2011 by one surgeon. All patients underwent transumbilical LESS using a 5-mm flexible-tip laparoscope and a combination of flexible and conventional laparoscopic instruments. The technique for transperitoneal LESS-PN otherwise replicated conventional laparoscopic PN. Demographic, perioperative, and postoperative variables were recorded and analysed. Of the 14 patients (eight men), undergoing 15 distinct LESS-PN, the mean (sd) age was 57.9 (8.7) years and the mean (sd, range) tumour size resected was 2.4 (0.8; 1.2-4.0). There were 12 renal cell carcinomas, two angiomyolipomas, and two metanephric adenomas on final pathology, all with negative margins. The mean (sd) operative duration was 169 (47) min with a mean (sd, range) warm ischaemia time of 14.7 (13.4; 0-37) min; bull-dog clamps were used for hilar-control in nine cases with the remaining six cases done without hilar vascular clamping. The mean (sd) estimated blood loss in this series was 293 (325) mL (median 200 mL) and no cases required intraoperative or postoperative blood transfusions. The mean (sd) hospital stay was 2.7 (0.8) days and mean inpatient analgesic requirement in morphine equivalents was 21.7 (11.6) mg. Follow-up surveillance imaging showed no recurrence at a mean (sd, range) follow-up of 18.3 (12.2; 6-36) months and a negligible change in serum creatinine (<0.1 mg/dL) at a mean (sd, range) follow-up of 17.1 (11.9; 1-36) months. LESS-PN is a feasible and effective operation, providing complete oncological resection along with excellent short-term oncological and renal functional outcomes.

1110 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY EFFECTS OF VOLUME LOSS AND ISCHEMIC INJURY

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121110 FUNCTIONAL RECOVERY AFTER PARTIAL NEPHRECTOMY EFFECTS OF VOLUME LOSS AND ISCHEMIC INJURY Matthew Simmons, Shahab Hillyer, Byron Lee, Amr Fergany, Jihad Kaouk, and Steven Campbell Matthew SimmonsMatthew Simmons Cleveland, OH More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Byron LeeByron Lee Cleveland, OH More articles by this author , Amr FerganyAmr Fergany Cleveland, OH More articles by this author , Jihad KaoukJihad Kaouk Cleveland, OH More articles by this author , and Steven CampbellSteven Campbell Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1218AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study used a new method to estimate volume loss after partial nephrectomy (PN) to assess the relative contributions of ischemic injury and volume loss on functional outcomes. METHODS Analysis was conducted for 301 consecutive patients who underwent conventional PN between 2007 and 2010 with available data to meet inclusion criteria. Percent functional volume preservation (PFVP) was measured at a median of 1.4 years after surgery. MDRD-2 estimated GFR was measured pre- and perioperatively, and at a median of 1.2 years after PN. Statistical analyses were conducted to study associations. RESULTS Hypothermia or warm ischemia ≤25 minutes were applied in 75% of cases. Median PFVP was 91% (range: 38-107%). Percent GFR preservation (PGP) at nadir and late time points was 77% and 90% of preoperative GFR, respectively. In multivariate analysis PFVP and warm ischemia time (WIT) associated with nadir GFR (p<0.001), while only PFVP associated with late GFR (p<0.001). Late PGP and PFVP were directly associated (p<0.001). Recovery of function to ≥90% of PFVP-adjusted levels was observed in 86% of patients. In patients with de novo postoperative stage ≥3 CKD, PFVP and Charlson score were associated with late PGP. WIT was not associated with late functional GFR decreases in patients considered high risk for ischemic injury. CONCLUSIONS In this cohort volume loss, and not ischemia time, was the primary determinant of ultimate renal function after PN. Technical modifications aimed at minimizing volume loss during PN while still achieving negative margins may result in improved functional outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e450 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Simmons Cleveland, OH More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Byron Lee Cleveland, OH More articles by this author Amr Fergany Cleveland, OH More articles by this author Jihad Kaouk Cleveland, OH More articles by this author Steven Campbell Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Temporary targeted renal blood flow interruption using a reverse thermosensitive polymer to facilitate bloodless partial nephrectomy: a swine survival study.

What's known on the subject? and What does the study add? Lumagel™ is a reverse thermosensitive polymer (RTP) that has previously been described in the literature as providing temporary vascular occlusion to allow for bloodless partial nephrectomy (PN) while maintaining blood flow to the untargeted portion of the kidney. At body temperature, Lumagel™ has the consistency of a viscous gel but upon cooling rapidly converts to a liquid state and does not reconstitute thereafter. This property has allowed for it to be used in situations requiring temporary vascular occlusion. Previous experience with similar RTPs in coronary arteries proved successful, with no detectable adverse events. We have previously described our technique for temporary vascular occlusion of the main renal artery, as well as segmental and sub-segmental renal branches, to allow for bloodless PN in either an open or minimally invasive approach. These experiments were performed in the acute setting. This study is a two-armed survival trial to assess whether this RTP is as safe as hilar clamping for bloodless PN. Surviving animals showed normal growth after using the RTP, absence of toxicity, no organ dysfunction, and no pathological changes attributable to the RTP. We conclude that Lumagel™ is as safe as conventional PN with hilar clamping, while adding the advantage of uninterrupted perfusion during renal resection. To examine whether randomly selected regions of the kidney could undergo temporary flow interruption with a reverse thermosensitive polymer (RTP), Lumagel™ (Pluromed, Inc., Woburn, MA, USA), followed by partial nephrectomy (PN), without adding risks beyond those encountered in the same procedure with the use of hilar clamping. A two-armed (RTP vs hilar clamp), 6-week swine survival study was performed. Four swine underwent PN using hilar clamps, while six underwent PN with flow interruption using the RTP. The RTP, administered angiographically, was used for intraluminal occlusion of segmental or subsegmental arteries and was compared with main renal artery clamping with hilar clamps. The resection site was randomized for each swine. Laboratory studies were performed preoperatively, and at weeks 1, 3 and 6. Before killing the swine, repeat angiography was performed with emphasis on the site of previous flow interruption. Gross and microscopic examination of kidney, liver, lung, heart, skeletal muscle was later performed, and the vessel that had supported the previous plug was examined. All animals survived. No abnormal chemistry or haematology results were encountered over the 6 weeks. There were no surgical complications in either group. Using angiography we found 100% patency of vessels that had been occluded with the polymer 6 weeks previously for PN. The only gross or microscopic abnormalities were related to the renal resection and scar formation, and were similar in the two groups. Targeted flow interruption with the RTP added no additional risk to PN while allowing bloodless resection and uninterrupted flow to untargeted renal tissue.

Functional Recovery After Partial Nephrectomy: Effects of Volume Loss and Ischemic Injury

We used what is to our knowledge a new method to estimate volume loss after partial nephrectomy to assess the relative contributions of ischemic injury and volume loss on functional outcomes. We analyzed the records of 301 consecutive patients who underwent conventional partial nephrectomy between 2007 and 2010 with available data to meet inclusion criteria. Percent functional volume preservation was measured at a median of 1.4 years after surgery. Modification of diet in renal disease-2 estimated glomerular filtration rate was measured preoperatively and perioperatively, and a median of 1.2 years postoperatively. Statistical analysis was done to study associations. Hypothermia or warm ischemia 25 minutes or less was applied in 75% of cases. Median percent functional volume preservation was 91% (range 38%-107%). Percent glomerular filtration rate preservation at nadir and late time points was 77% and 90% of preoperative glomerular filtration rate, respectively. On multivariate analysis percent functional volume preservation and warm ischemia time were associated with nadir glomerular filtration rate while only percent functional volume preservation was associated with late glomerular filtration rate (each p <0.001). Late percent glomerular filtration rate preservation and percent functional volume preservation were directly associated (p <0.001). Recovery of function to 90% or greater of percent functional volume preservation predicted levels was observed in 86% of patients. In patients with de novo postoperative stage 3 or greater chronic kidney disease, percent functional volume preservation and Charlson score were associated with late percent glomerular filtration rate preservation. Warm ischemia time was not associated with late functional glomerular filtration rate decreases in patients considered high risk for ischemic injury. In this cohort volume loss and not ischemia time was the primary determinant of ultimate renal function after partial nephrectomy. Technical modifications aimed at minimizing volume loss during partial nephrectomy while still achieving negative margins may result in improved functional outcomes.

1861 KTP LASER LAPAROSCOPIC PARTIAL NEPHRECTOMY VERSUS CONVENTIONAL LAPAROSCOPIC PARTIAL NEPHRECTOMY IN ANIMALS. RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111861 KTP LASER LAPAROSCOPIC PARTIAL NEPHRECTOMY VERSUS CONVENTIONAL LAPAROSCOPIC PARTIAL NEPHRECTOMY IN ANIMALS. RANDOMIZED CONTROLLED TRIAL Jorge Rioja, Miguel Hurtado, Federico Soria, Angel Borque, Luis Plaza, Francisco Miguel Sanchez-Margallo, Jesus Uson, and Luis Angel Rioja Jorge RiojaJorge Rioja Zaragoza, Spain More articles by this author , Miguel HurtadoMiguel Hurtado Caceres, Spain More articles by this author , Federico SoriaFederico Soria Caceres, Spain More articles by this author , Angel BorqueAngel Borque Zaragoza, Spain More articles by this author , Luis PlazaLuis Plaza Zaragoza, Spain More articles by this author , Francisco Miguel Sanchez-MargalloFrancisco Miguel Sanchez-Margallo Caceres, Spain More articles by this author , Jesus UsonJesus Uson Caceres, Spain More articles by this author , and Luis Angel RiojaLuis Angel Rioja Zaragoza, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1908AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic Partial Nephrectomy is a challenging procedure. To make laparoscopic nephron sparing surgery easier multiple ablative techniques have been developed but with not as good results as partial nephrectomy. To analyze feasibility of laser KTP partial nephrectomy and compare results with conventional laparoscopic partial nephrectomy. METHODS 30 Large White female pigs were randomized to laser KTP or conventional laparoscopic partial nephrectomy. All pigs weighted 30–35 kg as its kidney size is similar to human kidney. Laparoscopic radical right nephrectomy was performed in all kidneys to make them mono-kidney and analyzed the impact of surgery in their renal function. And artificial renal tumour (plastic) was placed in the left kidney (10 upper pole, 10 mid pole and 10 lower pole). All pigs were heparinised to decrease pig coagulation mechanism and make it more similar to human. Partial nephrectomy was performed in all kidneys until collecting system, to analyzed urinary fistula after both methods. All pigs were followed up for 6 weeks in the clinic and by means of blood test after surgery, 3 weeks and at the end of the study, colour Doppler ultrasound and retrograde pyelography (pre-surgery, after surgery, 3 weeks after surgery and at the end of the study) to study renal function and healing of the urinary system. After 6 weeks all pigs were sacrificed, an autopsy was performed and pathology exam of both kidney and partial nephrectomy was performed. RESULTS All Laser KTP partial nephrectomies were performed without hiliar clamping. Suturing of the colleting system was done in all cases. Only 3 cases required parenchymal stitches for haemostasis. All conventional partial nephrectomies were performed with hiliar clamping, closing of the collecting system and parenchimal stiches with surgicel roll for haemostasis. In the KTP laser, 3 pigs died due to urinary fistula in the first week after surgery. In the conventional partial, 1 pig died due to myocardial infarction. Overall, there was no ischemia time in the laser group. Renal function 24hours after surgery was better in laser group. (p<0,000) In the laser group, there was wider fibrosis (<5 mm) in the normal parenchyma (p<0,000). There were no differences in positive surgical margin within the two groups. At the end of follow-up, there were no differences in autopsy results, by means of fibrosis, haematoma or urinoma. CONCLUSIONS Laparoscopic Laser KTP partial nephrectomy is feasible and safe in the animal model. It might be an easier alternative to Lap. conventional partial nephrectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e746 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jorge Rioja Zaragoza, Spain More articles by this author Miguel Hurtado Caceres, Spain More articles by this author Federico Soria Caceres, Spain More articles by this author Angel Borque Zaragoza, Spain More articles by this author Luis Plaza Zaragoza, Spain More articles by this author Francisco Miguel Sanchez-Margallo Caceres, Spain More articles by this author Jesus Uson Caceres, Spain More articles by this author Luis Angel Rioja Zaragoza, Spain More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

The second step in vitro trial of Ankaferd® Bloodstopper®: comparison with other hemostatic agents

To investigate the efficacy of Ankaferd Bloodstopper (ABS) and compare ABS with the other hemostatic agents still used in urologic surgery. Materials and methods: Forty Wistar rats were divided into 5 groups: Group T (traditional), partial nephrectomy (PN) with hilar control as per the conventional technique; Group G (Glubran 2), conventional PN followed by the application of Glubran 2; Group F (FloSeal), FloSeal application to the resected area of the kidney; Group C (Celox), Celox was applied; Group A (ABS), Ankaferd was used. Warm ischemia time (WIT) and hemostasis time (HT) were recorded and histopathologic features were compared among the groups. Results: In Group A, a significant decrease in WIT was detected while the difference was significant (P < 0.001). Statistical analysis confirmed that the evaluation of HT (in seconds) returned similar results to those seen in WITs among all groups. In Group A, decreased HT was confirmed in comparison to Group T while HT increased in comparison to the other groups (G, C, and F) (P < 0.001). Increased fibrosis and adhesion were shown in Group F while significant erythrocyte aggregation and microvascular proliferation were observed in Groups G, F, and A (P < 0.001). Conclusion: A novel hemostatic agent, ABS, is as effective as other licensed hemostatic agents with comparable WIT and HT and better results in terms of histopathologic findings.

Long term results of excision of small renal cancer surrounded by a minimal layer of grossly normal parenchyma: review of 94 cases.

To assess safety and effectiveness of excision of small renal cancer. We reviewed the records of 94 patients, who underwent, from 1992 to 2001, excision of renal tumor leaving around it a thin layer of grossly normal parenchyma and adjacent perinephric fat. This technique has been called enucleoresection, as it is not a simple enucleation but neither a conventional partial nephrectomy. Patients were followed up mean routine blood examination, ultrasound and computed tomography scan every 6 months for 2 years and annually thereafter. Median age was 63 years (35-76). Median tumour size was 2.1cm (1.1-4.5). Clamping of renal pedicle was performed in 54 cases. Major complications included 4 cases of haemorrhage; only 1 patient required surgical exploration. Pathological stage was pT1a in 87, pT1b in 4 and pT3a in 3 patients. Surgical margins were always negative. Median follow-up was 59 months (range 10-128). Eight patients died without evidence of tumour recurrence. One pT3a patient developed distant metastases and died 2 years after surgery. Five years survival rate was 95.7% (90/94 patients), cancer specific survival rate 98.9% (93/94) and disease free survival rate 98.9% (93/94). Enucleoresection of small renal tumors surrounded by a minimal layer of grossly normal renal parenchyma reproduces the results of partial and radical nephrectomy with minimal morbidity.

Nephron-sparing surgery for renal cell carcinoma using a microwave tissue coagulator

We access a usefulness of nephron-sparing surgery with a microwave tissue coagulator (MTC) for renal cell carcinoma (RCC). Selected 11 patients with small RCC who underwent partial nephrectomy using MTC during January 1998 to September 1998 were evaluated ; They were 9 men and 2 women aged 33-73 years. Three patients were indicated as single kidney and 8 were elected indication. Tumors were 1.4-4.0 cm in size, 6 located in the lateral position, 3 in the proximal position, 2 in the renal hilum. All patients were performed partial nephrectomy without clamping renal vessels and preserved renal function without serious complications. There were no significant differences in the operation time and the blood loss between this procedure and the conventional partial nephrectomy. Our results demonstrated that non-ischemic nephron-sparing surgery using MTC was a useful procedure and would apply to laparoscopic surgery.

APPLICATION OF MICROWAVE TISSUE COAGULATOR IN PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

Purpose At partial nephrectomy there is a risk of excessive blood loss, which necessitates transfusion and also results in renal function deterioration when a vascular clamp is used. We evaluated the usefulness of a microwave tissue coagulator for partial nephrectomy for renal cell carcinoma. Materials and Methods Partial nephrectomy was performed without renal pedicle clamping using a microwave tissue coagulator in 4 patients with a small kidney tumor. Results In 3 of the 4 patients partial nephrectomy was successful using a microwave tissue coagulator without renal pedicle clamping. Mean operative time and blood loss were 203 minutes and 153 ml., respectively, and there were no significant complications. In the remaining case partial kidney resection was also performed without any complications. However, nephrectomy was required due to possible incomplete tumor resection. Conclusions Partial nephrectomy using a microwave tissue coagulator can be safe and successful without renal pedicle clamping. However, the insertion line of the microwave electrode must be carefully determined for resection to be curative and safe, just as when making the cut line for conventional partial nephrectomy or tumor enucleation.