Feasibility Of Robotic Partial Nephrectomy Research Articles

V7-03 ROBOTIC PARTIAL NEPHRECTOMY WITH SELECTIVE CLAMPING FOR RENAL MASS IN

You have accessJournal of UrologyPediatrics1 Apr 2017V7-03 ROBOTIC PARTIAL NEPHRECTOMY WITH SELECTIVE CLAMPING FOR RENAL MASS IN <15KG PEDIATRIC PATIENT: TECHNIQUES ADAPTED FROM ADULT UROLOGY Patricia S. Cho, Michael V. Hollis, Briony K. Varda, Erin R. McNamara, Richard N. Yu, Andrew A. Wagner, and Richard S. Lee Patricia S. ChoPatricia S. Cho More articles by this author , Michael V. HollisMichael V. Hollis More articles by this author , Briony K. VardaBriony K. Varda More articles by this author , Erin R. McNamaraErin R. McNamara More articles by this author , Richard N. YuRichard N. Yu More articles by this author , Andrew A. WagnerAndrew A. Wagner More articles by this author , and Richard S. LeeRichard S. Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1921AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy (RPN) provides for nephron sparing and renal preservation with a minimally invasive approach. Though commonly utilized in adults for resection of renal masses, it is less commonly applied for tumors in children. To optimize outcomes in these patients, techniques from the adult setting were translated to the pediatric realm, with the goals of fostering bi-directional transfer of expertise and knowledge and of achieving safe and effective application of this surgical approach. METHODS A collaborative team was formed and consisted of a pediatric urologist trained in minimally invasive and oncologic surgery as primary surgeon with an adult minimally invasive oncologic urologist as proctor. Key aspects for translation to the pediatric setting included: port placement, lower insufflation pressure, choice and size of instruments and supplies, and minimization of potential hemorrhage and ischemia with selective clamping/early unclamping technique. This approach was applied to a 14 kilogram, 3 year old female with a right lower pole lesion with cystic and solid components, concerning for malignancy. RESULTS The mass was resected with negative margins and demonstrated benign pathology. Clamp time was 14 minutes, and EBL was minimal. There were no intra- or post-operative complications. The patient's creatinine was unchanged, and a follow-up ultrasound demonstrated no residual mass in a normal appearing right kidney. CONCLUSIONS Collaboration of experienced pediatric and robotic teams allows for successful adaptation of adult techniques to pediatric patients. Specific considerations must be made in order to achieve safety and feasibility of RPN with selective clamping for renal preservation in cases of pediatric renal masses. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e823-e824 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Patricia S. Cho More articles by this author Michael V. Hollis More articles by this author Briony K. Varda More articles by this author Erin R. McNamara More articles by this author Richard N. Yu More articles by this author Andrew A. Wagner More articles by this author Richard S. Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V36 Feasibility of robotic partial nephrectomy for cystic tumour

V36 Feasibility of robotic partial nephrectomy for cystic tumour

Current status of robotic partial nephrectomy (RPN)

• Robotic partial nephrectomy (RPN) is a minimally invasive option for patients undergoing nephron-sparing surgery (NSS). As the technique of RPN develops and matures, intraoperative and perioperative outcomes continue to be reported. In the current review, we discuss safety, efficacy, and recent technical advances in RPN. • A Medline search using the keywords 'partial nephrectomy', 'robotic partial nephrectomy', 'robot partial nephrectomy', 'robot-assisted laparoscopic partial nephrectomy', and 'laparoscopic partial nephrectomy' was conducted to identify original articles, review articles, and editorials on RPN. • There have been multiple recent retrospective studies comparing RPN with laparoscopic PN (LPN). These comparisons suggest a shorter learning curve for RPN and confirm the safety and feasibility of RPN, even for select complex renal masses. • Novel techniques have been developed in efforts to decrease warm ischaemia time. These include use of sliding-clip renorrhaphy, selective renal parenchymal clamping, and 'early unclamping' or 'no-clamp' techniques. • RPN appears to be a viable minimally invasive option for NSS. RPN may reduce some of the technical challenges associated with LPN, and thus, extend the potential benefits of minimally invasive NSS to a larger population. • Further studies of the long-term renal functional outcomes and oncological efficacy of RPN are needed before fully advocating this technique.

Feasibility of Robotic Partial Nephrectomy in a UK Cancer Centre

Objective: To present our initial peri-operative and pathological outcome data of 23 patients to establish the feasibility of robotic partial nephrectomy (RPN) in a UK cancer centre. Patient and methods: Clinical data from 23 patients who underwent RPN in a single institution between April 2008 and January 2010 were analysed. The RENAL Nephrometry Scoring System was applied to our series. Results: Mean patient age was 54.6 years with a mean tumour size of 2.53 cm. The median operative time was 198 min and warm ischaemia time (WIT) 30 min. There were two conversions and four patients required transfusion, with no other major complications. Histology confirmed renal cell carcinoma in 17 cases. All surgical margins were negative and to date there have been no local or distant recurrences. A mean RENAL score of 5.56 suggested that all the lesions had a low—moderate complexity and were therefore suitable for partial nephrectomy. Conclusion: RPN achieved acceptable WITs, blood loss and complication rates and oncological outcomes. We conclude that this technique is a feasible alternative to open surgery and conventional laparoscopic partial nephrectomy. The urological community need to establish the place for each technique although surgeon preference is likely to be a significant factor.

Outcomes of Robotic Partial Nephrectomy for Renal Masses With Nephrometry Score of ≥7

To evaluate the safety and feasibility of robotic partial nephrectomy for patients with complex renal masses. We reviewed the data for 164 consecutive patients who had undergone transperitoneal robotic partial nephrectomy at a tertiary care center from February 2007 to June 2010. Of the 112 patients who had available imaging studies to review, 67 were identified and classified as having a moderately or highly complex renal mass according to the R.E.N.A.L. nephrometry score (≥7) (tumor size-[R]adius, location and depth-[E]xophytic or endophytic; nearness to the renal sinus fat or collecting system [N]; anterior or posterior position [A], and polar vs non-polar location [L]). The preoperative, perioperative, pathologic, and functional outcomes data were analyzed. The median body mass index was 29.6 kg/m(2) (range 19.9-44.8). Of the 67 patients, 32 were men and 35 were women, with 32 right-sided masses and 35 left-sided masses. The median tumor size was 3.7 cm (range 1.2-11), and the median operative time was 180 minutes (range 150-180). The median estimated blood loss was 200 mL (range 100-375), and the warm ischemia time was 19.0 minutes (range 15-26). The median hospital stay was 3.0 days (range 3-4). The estimated glomerular filtration rate was calculated at a median decrease of 11.1 mL/min/1.73 m(2) (range 9-1.3). According to the Clavien-Dindo classification of surgical complications, 2 grade 1, 12 grade 2, and 1 grade 3 complication occurred. All margins were pathologically negative, except for 1, and, after a mean follow-up of 10 months, no recurrences had developed. Robotic partial nephrectomy is a safe and feasible option for moderately or highly complex renal masses determined by the R.E.N.A.L. nephrometry score. The warm ischemia time, blood loss, and complications were increased with highly complex masses.

Current status of robotic partial nephrectomy

In recent years, robotic partial nephrectomy has emerged as a technique for treatment of small renal masses alongside laparoscopic and open partial nephrectomy. Since this technique is still in a phase of adoption, many technical improvements, alterations and early experiences are published. We aim to review the recent literature, focus on recent advances in techniques and give an overview of published series. Recent series confirm the feasibility of robotic partial nephrectomy and demonstrate perioperative data and short-term oncological outcomes that are at least comparable to laparoscopic series. The development of better renorrhaphy techniques and optimal use of the robotic features to gain console surgeon independence seem to be the main focus. Also alternative hilar control, early unclamping and off-clamp techniques are being developed to lower the ischaemic effect on the kidney. The learning curve seems to be less steep than laparoscopic techniques. Robotic partial nephrectomy proves to be a well tolerated and efficacious minimally invasive option in the treatment of renal lesions. Main areas of interest are decreasing warm ischaemia time and modified renal closure techniques.

POD-6.10: Robotic Partial Nephrectomy: A Multi-institutional Analysis

Laparoscopic partial nephrectomy for kidney tumors has demonstrated durable oncologic and functional outcomes. The feasibility of robotic partial nephrectomy (RPN) has been demonstrated in several small, single-institution studies. We performed a large, multi-institutional analysis to determine early oncologic results and perioperative outcomes after RPN.

Robotic partial nephrectomy: a multi-institutional analysis.

Laparoscopic partial nephrectomy for kidney tumors has demonstrated durable oncologic and functional outcomes. The feasibility of robotic partial nephrectomy (RPN) has been demonstrated in several small, single-institution studies. We performed a large, multi-institutional analysis to determine early oncologic results and perioperative outcomes after RPN. Between October, 2002 and September, 2007, 148 patients underwent RPN at six different centers by nine different primary surgeons for localized renal tumors. Medical and operative records were reviewed for clinical characteristics, pathologic findings, and follow-up information. A total of 148 patients underwent RPN. Mean tumor size was 2.8cm. Renal hilar clamping was utilized in 120 patients, with a mean warm ischemia time of 27.8min. Positive surgical margins were identified in six patients (4%), of which two had cautery artifact obscuring the margin after off-clamp cautery excision and one underwent completion radical nephrectomy with no evidence of cancer. There is no evidence of tumor recurrence at mean follow-up of 7.2months (range 2-54months) overall, and mean follow-up of 18months (range 12-23months) for patients with positive surgical margin. Complications occurred in nine patients (6.1%), including hematoma requiring drainage (n=1), prolonged ileus (n=3), pulmonary embolus (n=2), prolonged urine leak (n=2), and rhabdomyolysis (n=1). Two patients underwent open conversion for failure to progress, one patient with morbid obesity and one patient with adhesions from prior ureterolithotomy. Mean hospital stay was 1.9days. In this multi-institutional series of surgeons beginning their initial experience in RPN, the procedure is a feasible option for minimally invasive, nephron-sparing surgery, with immediate oncologic results and perioperative outcomes comparable with more mature laparoscopic series.