Laparoscopic Partial Nephrectomy Group Research Articles

Robot-Assisted Laparoscopic Partial Nephrectomy Vs Conventional Laparoscopic Partial Nephrectomy: Functional and Surgical Outcomes of a Prospective Single Surgeon Randomized Study.

Background: Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are commonly used techniques for treating small renal masses. Regarding renal function (RF) preservation, no superiority of one technique over the other has yet been definitely demonstrated. Objective: To compare functional and surgical outcomes of LPN and RAPN. Patients and Methods: Between 2015 and 2019, we prospectively randomized 115 patients with cT1-T2 renal masses to LPN in total ischemia or RAPN in selective ischemia. Primary endpoint was RF preservation, assessed by renal scintigraphy (RS). RS assessments were performed preoperatively and at 6 months follow-up. Secondary endpoints included clinical, histopathologic, and surgical outcomes. Results: One hundred eight patients were included in the final analysis. Patient and tumor characteristics were comparable. No significant difference in RS values after 6 months was observed between both groups. Median (interquartile range) RF change after 6 months was -18.0% (-26.5 to -11.0) in LPN group and -20.0 (-33.2 to -12.0) in RAPN group (p = 0.3). Mean (standard deviation [SD]) warm ischemia time was 21.1 (6.1) minutes in LPN group and 19.6 (7.7) minutes in RAPN group (p = 0.2). No positive surgical margins (PSMs) occurred in the LPN group, whereas RAPN group had PSM in 4.9% (n = 3); p = 0.099. Renal volume loss after 6 months was 27.5% (22.7-45.7) in the LPN group vs 37.5 (13.7-54.2) in the RAPN group (p = 0.5). Mean operative times were lower in the LPN group (192.3 minutes [SD 44.5] vs 230.2 minutes [SD 59.6], p = 0.001). More complications occurred in the LPN group (31% vs 21%, p = 0.075). Transfusion rates were 15% for LPN and 11% for RAPN. Conclusions: In terms of preserving RF, LPN in total ischemia and RAPN in selective ischemia are comparable. In most patients, RF decrease of the affected kidney after PN seems to not exceed 25%, regardless of the surgical approach.

Oncological and functional outcomes of open versus laparoscopic partial nephrectomy in T1b tumors: A single-center analysis.

ABSTRACTPurpose:This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis.Materials and Methods:The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis.Results:No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010–8.254), but the surgical technique was not.Conclusion:No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.

Lower Incidence of Postoperative Acute Kidney Injury in Robot-Assisted Partial Nephrectomy Than in Open Partial Nephrectomy: A Propensity Score-Matched Study.

Background: Acute kidney injury (AKI) after partial nephrectomy is attributed to parenchymal reduction and ischemia, but the extent of its effect remains unclear. This study aimed to compare the incidence of postoperative AKI among surgical modalities, robot-assisted partial nephrectomy (RAPN), laparoscopic partial nephrectomy (LPN), and open partial nephrectomy (OPN), and to evaluate the validity of RAPN by comparing it with LPN and OPN in terms of postoperative AKI, perioperative complications, and long-term renal function. Patients and Methods: Patients who underwent RAPN, LPN, and OPN for renal tumors at our institutions between 2004 and 2018 were retrospectively analyzed. RAPN and LPN were performed under warm ischemia and OPN under cold ischemia. En bloc hilar clamping was employed for LPN and OPN and arterial clamping for RAPN. AKI was defined as % decrease in estimated glomerular filtration rate (eGFR) >25% from preoperative eGFR to postoperative nadir eGFR. Multivariate regression analysis was used to test associations of AKI with perioperative factors. Then, we compared the incidence of AKI with two propensity score-matched cohorts: RAPN vs OPN and RAPN vs LPN. Results: This study included 1762 cases (RAPN: 959, LPN: 215, and OPN: 588). After matching, 147 cases each from RAPN and LPN groups and 368 cases each from RAPN and OPN groups were selected. RAPN had shorter warm ischemia time than LPN, lower incidence of AKI, and lower % decrease in eGFR after 6 months. RAPN had a shorter ischemia time and a lower incidence of AKI than OPN, although the % decrease in eGFR after 6 months did not differ significantly. Conclusions: AKI incidence was lower in RAPN than in LPN or OPN, which may be due to the shorter ischemia time or clamping of only arteries in RAPN. Although long-term renal outcomes did not differ between RAPN and OPN, RAPN can help prevent AKI. This supports the validity of RAPN for patients with chronic kidney disease.

Zero ischemia laparoscopic microwave ablation assisted enucleation vs. laparoscopic partial nephrectomy in clinical T1a renal tumor: a randomized clinical trial.

BackgroundThe study aims to evaluate efficiency, safety and the functional outcomes of zero ischemia laparoscopic microwave ablation assisted tumor enucleation (LMWATE) in comparison with laparoscopic partial nephrectomy (LPN) for cT1a renal tumors.MethodsA prospective randomized controlled trial on cT1a renal tumor patients treated by laparoscopic nephron sparing surgeries between October 2014 to September 2017 was conducted. Tumor enucleation was performed in the LMWATE group after microwave ablation (MWA) without hilar clamping. The endpoint was the affected kidney’s change of GFR measured by renal scintigraphy at the 3rd month and 12th month postoperatively. All the patients were followed up for at least 12 months. The Student t-test, Wilcoxon rank sum tests and Pearson Chi-square or Fisher exact were applied to analyse data.ResultsThe number of patients enrolled in the LMWATE group and LPN group were 90 and 93 respectively. Patients in the LPN group showed much more decline of effect kidney glomerular filtration rate at 3 months (10.3 vs. 17.4, P<0.001) and 12 months postoperatively (8.8 vs. 10.2, P=0.023) when compared to the LMWATE group. Additionally, in the LMWATE group, considerably shorter median operation duration (91 vs. 112 minutes, P<0.001), lower median estimated blood loss (82.5 vs. 117.5 mL, P<0.001) and shorter hospital stay (5.5 vs. 6 days, P=0.013) were observed but with similar postoperative complications in both groups. There was no positive margin or local recurrence in both groups.ConclusionsZero ischemia LMWATE may provide better preservation of renal function, decrease operative time and blood loss compared to LPN with similar complication rates.

Robot-assisted versus laparoscopic partial nephrectomy for anatomically complex T1b renal tumors with a RENAL nephrometry score≥7: A propensity score-based analysis.

ObjectivesTo present the perioperative, functional, and oncological outcomes of robot‐assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7.Patients and methodsOne hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria. Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan‐Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM.ResultsOne hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups. And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series.ConclusionsFor patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of complications and weakening the oncological control, while the two surgical methods were similar in renal functional preservation.

Use of a Novel Articulating Laparoscopic Needle Driver for Partial nephrectomy: An Initial Experience

ObjectivesTo demonstrate the clinical feasibility of an articulated laparoscopic needle driver to assist in the performance of laparoscopic partial nephrectomy (LPN). Previous studies have demonstrated under-utilization of minimally invasive techniques for patients undergoing partial nephrectomy (PN). MethodsConsecutive patients with renal masses amenable to PN underwent LPN with an articulating laparoscopic needle driver. A consecutive cohort of patients who previously underwent robot assisted laparoscopic PN (RALPN) was selected as a comparison cohort. Preoperative, perioperative, and postoperative variables were retrospectively collected. ResultsA total of 20 patients underwent PN with 10 patients assigned to each of the LPN and RALPN cohorts. Median R.E.N.A.L. nephrometry scores assigned to the LPN and RALPN cohorts were 7 and 6 respectively (P= .31). Median warm ischemia time for patients in the LPN and RALPN groups was 25.5 and 18.5 minutes respectively (P= .36). Median estimated blood loss for LPN and RALPN was 200 and 50 mL (P= .03). Median operative time for LPN and RALPN was 203 and 194 minutes respectively (P= .76). Median Length of stay after LPN and RALPN was similar (3.0 vs 2.5 nights, P= .26). Following LPN, 3 patients required blood transfusion as compared to 2 patients in the RALPN cohort (P= .61). ConclusionOur initial results demonstrated the clinical safety and feasibility of a new surgical device for performing LPN. Patients who underwent LPN with a novel articulating needle driver demonstrated equivalent results to RALPN across several key outcomes.

Comparison of Partial and Radical Laparascopic Nephrectomy: Perioperative and Oncologic Outcomes for Clinical T2 Renal Cell Carcinoma.

Nephron-sparing surgery has emerged as the treatment of choice for small renal masses. However, its role in larger tumors remains controversial. In this study, we compare the outcomes of laparoscopic partial nephrectomy (LPN) vs those of laparoscopic radical nephrectomy (LRN) for T2 renal tumors. Thirteen patients who had LPN and 16 patients who had LRN for T2 renal tumors were retrospectively analyzed for preoperative factors (age, gender, comorbidities, hemoglobin, and creatinine levels and estimated glomerular filtration rate [eGFR]), operative and perioperative characteristics (tumor characteristics, operative time [OT], warm ischemia time [WIT], estimated blood loss [EBL], length of stay [LOS], and postoperative complications), histopathologic results, and follow-up data (eGFR and recurrences). Tumor size was comparable between groups; however, tumors in the LRN group were more endophytic, central, and closer to the collecting system. There were no cases of positive surgical margins. Median OT was 160 minutes vs 230 minutes (p = 0.0029) and EBL was 25 mL vs 100 mL ([p = 0.0027], LRN vs LPN). Median WIT in the LPN group was 27 minutes, with three zero ischemias. Minor postoperative complications (≤Clavien-Dindo III) were noted in 6.25% and 23% (LRN vs LPN). Median LOS was 4.56 and 5.77 days (LRN vs LPN), respectively. Mean postsurgery eGFR was significantly lower for the LRN group (54.5 cc/[min ·1.73 m2] vs 76.3 cc/[min ·1.73 m2], p = 0.019). Within mean follow-up of 44.5 months, one tumor recurrence in the contra lateral kidney was observed in the LPN group and two cases of metastasis in the LRN group. We show that LPN is technically feasible for T2 tumors, with acceptable intra- and perioperative outcomes. Furthermore, our results show a significant advantage in preservation of renal function for LPN without compromising oncologic results. Taken together, we believe that LPN should be considered for larger tumors based on technical feasibility rather than only tumor size.

Comparison of Short-Term Functional, Oncological, and Perioperative Outcomes Between Laparoscopic and Robotic Partial Nephrectomy Beyond the Learning Curve

To compare the short-term outcomes of robot-assisted partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) when performed by highly experienced surgeons. A prospective multicenter study was conducted, including the 50 last patients having undergone LPN and RPN for T1-T2 renal tumors in two institutions between 2013 and 2016, performed by two different surgeons with an experience of over 200 procedures each in LPN and RPN, respectively, at the beginning of the study. Perioperative parameters and functional and oncological outcomes were collected and compared between the LPN and RPN groups. The laparoscopic approach was associated with a longer warm ischemia time (15.7 versus 23 minutes; P < .001) and hospital stay (3.6 versus 4.6 days; P = .01). Conversely, estimated blood loss was significantly higher in the RPN group (381 mL versus 215 mL; P < .001), but transfusion rates were similar between the two groups (8% versus 6%; P = .33). In the RPN group, three patients (6%) required conversion to open partial nephrectomy and three patients (6%) required a conversion to radical nephrectomy (RN), while no conversion was needed in the LPN group. There were no differences in terms of perioperative complications, and change in renal function was comparable in the two groups postoperatively. Positive surgical margin rates were similar in the RPN and LPN groups (2% versus 6%; P = .36). After a median follow-up of 19 and 14 months in the RPN and LPN groups, respectively (P = .38), recurrence-free survivals did not differ significantly (P = .94). In this series, perioperative and short-term oncological and functional outcomes appeared broadly comparable between RPN and LPN when performed by highly experienced surgeons.

MP42-18 PURE LAPAROSCOPIC VERSUS ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CT1B RENAL TUMORS: A SINGLE TERTIARY CENTER EXPERIENCE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2018MP42-18 PURE LAPAROSCOPIC VERSUS ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CT1B RENAL TUMORS: A SINGLE TERTIARY CENTER EXPERIENCE Riccardo Bertolo, Cristian Fiori, Daniele Amparore, Ivano Morra, Michele Di Dio, Roberto Mario Scarpa, and Francesco Porpiglia Riccardo BertoloRiccardo Bertolo More articles by this author , Cristian FioriCristian Fiori More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Ivano MorraIvano Morra More articles by this author , Michele Di DioMichele Di Dio More articles by this author , Roberto Mario ScarpaRoberto Mario Scarpa More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Superiority of robotic over pure laparoscopic approach for Partial Nephrectomy (PN) is in favor of robotics in the latest publications. Matters of debate are challenging lesions that need further studies. The aim of the study was to evaluate and to compare perioperative results of laparoscopic PN (LPN) versus robot-assisted PN (RAPN) for clinical T1b renal tumors in a single-center database. METHODS Data of the 165 patients who underwent LPN (106) or RAPN (59) for cT1b renal tumors were extracted from our prospectively-maintained database for minimally-invasive renal surgery from 05/2004 to 03/2017. MIC achievement (Margins, Ischemia, Complications) was defined as simultaneous absence of perioperative complications, negative surgical margins and warm ischemia time (WIT) below 20 minutes. LPN interventions were performed at the end of surgeon’s learning curve for LPN; RAPNs were performed since the beginning of the learning curve of the surgeon for RAPN. RESULTS The two groups had comparable BMI, preoperative Hb, CrS and eGFR, clinical tumor diameter (52.8 + 24.5mm for NPL and 51.7 + 32.1mm for RAPN group) and PADUA score (median 9, IQR 8-11). No significant differences were found in terms of warm ischemia time (24.3 ± 12.8 vs 22.6 ± 12.0, LPN vs RAPN, respectively), estimated blood losses, intraoperative complications (4.0% vs 3.5%, LPN vs RAPN), postoperative complications (9.1% vs 8.9%, LPN vs RAPN), lenght of hospital stay (median 6, IQR 5-7 in both the approaches) and positive surgical margins rate (4.0% vs 1.7%, LPN vs RAPN). MIC was achieved in 44 cases (41.5%) in LPN group vs 39 cases (66.1%) in RAPN group (p=0.02), and WIT >20' caused failure to achieve MIC in 90.3% of NPL (56/62) and 85%(17/20) of RAPN. CONCLUSIONS Clinically T1b renal tumors suitable for nephron-sparing surgery can be safely treated by both LPN and RAPN. Transition to RAPN seems to be faster for a surgeon with laparoscopic expertise. Outcomes with robotic approach are comparable to those of pure laparoscopy since the beginning of the learning curve. RAPN allows for significantly higher rate of MIC achievement. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e544 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Riccardo Bertolo More articles by this author Cristian Fiori More articles by this author Daniele Amparore More articles by this author Ivano Morra More articles by this author Michele Di Dio More articles by this author Roberto Mario Scarpa More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD16-09 PARTIAL NEPHRECTOMY CONVERTING TO RADICAL NEPHRECTOMY: IMPACT OF PATIENT AND SURGICAL FACTORS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2018PD16-09 PARTIAL NEPHRECTOMY CONVERTING TO RADICAL NEPHRECTOMY: IMPACT OF PATIENT AND SURGICAL FACTORS Akbar Ashrafi, Peter Mekhail, Ricardo Brandina, Grant Redrow, Mihir Desai, Inderbir Gill, and Monish Aron Akbar AshrafiAkbar Ashrafi More articles by this author , Peter MekhailPeter Mekhail More articles by this author , Ricardo BrandinaRicardo Brandina More articles by this author , Grant RedrowGrant Redrow More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.821AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative conversion of partial nephrectomy to radical nephrectomy may be related to tumor complexity, patient or surgical factors. The aim of this study was to describe the causes for conversion and assess for patient and surgical predictors of conversion in patients undergoing partial nephrectomy at a high-volume academic center. METHODS We identified all patients who were scheduled to have robotic, laparoscopic or open partial nephrectomy at our institution between January 2011 and December 2014. The intraoperative reason for conversion to radical nephrectomy was collated from retrospective review of operative notes. Several variables were analyzed including, age, gender, Charlson co-morbidity score, ASA score, tumor size, procedure type, renal function and complication data. Multivariable logistic regression was used to identify independent predictors for conversion. RESULTS A total of 878 patients were scheduled for partial nephrectomy (PN). The rate of conversion to radical nephrectomy (RN) was 3.6% (n=32). The most common reasons for conversion were invasion of hilar structures in 12 patients (38%), insufficient residual kidney in 11 (35%), excessive intraoperative bleeding in 4 (13%), suspected positive margin in 2 patients (13%) and anesthesiology-related in 1 patient. Patients that were converted had similar preoperative eGFR (73 vs 79 mL/minute/1.73 m2, p=0.2), rates of diabetes (34% vs 23%, p=0.1), mean Charlson co-morbidity score (1.1 vs 1.5, p=0.2) and mean ASA score (2.3 vs 2.5, p=0.3). Patients that had conversion to RN were more likely to be older (mean age 67 vs 61, p=0.02), have hypertension (81% vs 62%, p=0.03) and have larger tumors (mean size 5.2 vs 3.2cm, p<0.01). In the robot-assisted PN group, 10 of 628 cases were converted (1.6%) compared to 4 of 45 cases in open PN (8.2%) and 18 of 173 in the laparoscopic PN group (9.4%, p<0.01). On multivariable logistic regression, tumor size (OR 1.2), hypertension (OR 2.8) and robotic surgery (OR 0.14) were independent predictors of conversion. There were no differences in the complication (3% vs 12%, p=0.2) or malignancy rate (81% vs 78%, p=0.7) though postoperative eGFR was significantly lower in patients that had conversion compared to the PN group (40 vs 65 mL/minute/1.73 m2, p<0.01). CONCLUSIONS Intraoperative conversion of partial nephrectomy to radical nephrectomy was most commonly due to invasion of hilar structures or insufficient residual kidney in this series. Conversion was associated with hypertension and larger tumor size, and increased the risk of chronic kidney disease postoperatively. Robot-assisted partial nephrectomy reduced the risk of conversion compared to the open or laparoscopic approach. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e319-e320 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Akbar Ashrafi More articles by this author Peter Mekhail More articles by this author Ricardo Brandina More articles by this author Grant Redrow More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Feasibility and safety of laparoscopic partial nephrectomy in the treatment of complicated renal tumor

Objective To investigate the feasibility and safety of laparoscopic partial nephrectomy (LPN) in the treatment of complicated renal tumor. Methods A total of 84 cases of complex renal tumor patients in our hospital from January 2013 to July 2014 were admitted as the object of study, renal tumor grading system (R.E.N.A.L.) scores≥7, T1aN0M0 and T1bN0M0 scores were more than or equal to tumor stage (tumor diameter less than 7 cm and no transfer). All patients were randomly divided into LPN group and open partial nephrectomy (OPN) group, the two group of 42 cases, clinical baseline data in two groups were statistically analyzed, and the operation was performed by the same group of experienced doctors in our hospital. The operation time, compared two groups of bleeding, renal artery occlusion time, drainage time, incidence of basic indicators days, treatment costs and complications of hospitalization, postoperative follow-up of 2 years were observed in the two groups had no recurrence and metastasis. Results All patients were successfully completed and without conversion to open surgery in LPN group. There was no significant difference in operation time, renal artery occlusion time, drainage time between the two groups (P>0.05), but there was significant difference in the amount of bleeding, days of hospitalization, medical expenses between the two groups(P 0.05). There was no recurrence and metastasis of tumor, curative effect satisfaction followed up for 2 years. Conclusions LPN treatment of complex renal tumors has similar clinical results with OPN, and reflects the advantages of small amount of bleeding, shorter hospital stay and save medical costs, is a safe and feasible clinical treatment. Key words: Kidney Neoplasms; Laparoscopes; Nephrectomy

Retroperitoneal and laparoscopic heminephrectomy in duplex kidney in infants and children.

Two main techniques are adopted to perform partial nephrectomy in children: laparoscopy and retroperitoneoscopy. The aim of this paper is to review the larger multicentric experience recently published by our group to review indications, techniques and results of both approaches. Data of 102 patients underwent partial nephrectomy in a 5-year period using minimally invasive surgery (MIS) procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2 years. Statistical analysis was performed using χ2 test and Student's t-test. The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) (χ2 =0.05). In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stump (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN: 166.2 min vs. RPN: 255 min; P<0.001) and hospitalization (LPN: 3.5 days vs. RPN: 4.1 days; P<0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. MIS now represents the gold standard technique to perform partial nephrectomy in children with duplex kidney. Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.

Super-Selective Artery Embolization before Laparoscopic Partial Nephrectomy in Treating Renal Angiomyolipoma

Introduction: To investigate the feasibility and efficiency of super-selective artery embolization (SAE) before laparoscopic partial nephrectomy (LPN) in treating renal angiomyolipoma (RAML). Materials and Methods: A retrospective analysis was conducted on 36 consecutive patients who underwent SAE before LPN (group A, n = 16) or LPN directly (group B, n = 20) from June 2010 to March 2016. Intraoperative blood loss, blood transfusion, operation time, warm ischemia time (WIT), and prognosis were compared between groups. Results: SAE before LPN decreased operating time, intraoperative blood loss and WIT (p < 0.05), and improved postoperative renal function (p < 0.001). Complications in group B included intraoperative blood loss of 4 patients and postoperative hematuria of 2 patients who recovered a few days later. No complications were observed in group A. In the follow-up of 3 months, a patient in group B formatted retroperitoneal hematoma without any symptoms and received expectant treatment. Conclusions: The application of SAE before LPN can decrease the difficulty of the surgery, the complications, and the risk of rebleeding and RAMLs recurrence.

Safety and efficacy of partial nephrectomy for solitary kidney tumor

Objective: To explore the safety and clinical efficacy of partial nephrectomy for solitary kidney tumor. Methods: Twenty patients with a functional or anatomic solitary kidney who underwent nephron-sparing surgery for one or more renal masses were retrospectively analyzed. There were 15 male and 5 female patients with mean age of 63 years.Patients were divided into open partial nephrectomy(OPN) group and laparoscopic partial nephrectomy(LPN) group, the two groups were followed up.Demographic and clinical characteristics were analyzed using student t-test for continuous variables, and the χ2 test for categorical variables. Results: There were 21 tumors whose maximum diameter were 1.5 to 6.0 cm, the mean size was (3.7±1.3)cm, mean operative time was (205.3±81.8)minutes, and median estimated blood loss was 385.6 ml.Five cases accepted blood transfusion intro-operation, 1 case appeared leakage of urine post-operation, none had obvious fever.Eighteen cases were clear cell carcinoma, 2 cases were chromophobe renal carcinoma, 1 case was papillary renal cell carcinoma.Seventeen cases were T1aNxM0, 3 cases were T1bNxM0, 1 case was T3NxM0.One case lost to follow up, the others had completed a mean follow-up of 21.5 months (ranging from 1 to 53 months). One case recurred, no one had metastasis, all patients were alive.The hemoglobin ((114.9±19.6)g/L) and estimated glomerular filtration rate(eGFR) ((46.5±18.2) ml/min) of postoperative day were lesser than pre-operation ((130.7±18.8)g/L, (58.0±16.4) ml/min), while the serum creatinine was higher ((123.8±39.8) μmol/L vs.(90.9±33.2) μmol/L). Three months after operation, hemoglobin, serum creatinine and eGFR had no difference with pre-operative.Compared with OPN group, LPN group gain less blood loss (306 ml vs.510 ml)(t=-2.38, P=0.03), had shorter length of stays (15 d vs.21 d)(t=-3.34, P=0.04), had longer time of renal artery clamping (25.8 min vs.16.5 min)(t=2.60, P=0.02). Conclusions: Partial nephrectomy is secure and effective selection for solitary kidney tumor.The LPN has less trauma, gain less blood loss, recover faster and has shorter length of stays than the OPN, which needs shorter ischaemic time.

Comparison of the Clinical Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy and Radical Nephrectomy for Treating Small Renal Cell Carcinoma: Case Report and Literature Review.

BackgroundRenal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality.ObjectivesThis study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC.MethodsIn this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases).ResultsThere were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05).ConclusionsThere were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.

Laparoscopic Partial Nephrectomy for Peripelvic Cystic Renal Cell Carcinoma: A Single-Center Experience

Objective: The study aimed to report our experiences of laparoscopic and open partial nephrectomies on patients with peripelvic cystic renal cell carcinoma (cRCC). Methods: From July 2003 and October 2014, 18 patients with suspected peripelvic cRCCs underwent partial nephrectomies via an open or laparoscopic approach at Nanjing Drum Tower Hospital. Patients' perioperative and oncological outcomes were analyzed and compared between the open partial nephrectomy (OPN) and the laparoscopic partial nephrectomy (LPN) groups. Results: Seven patients underwent OPNs, and 11 patients underwent LPNs for their peripelvic lesions. All procedures were performed successfully; no conversion to open surgery was encountered in the LPN group. There was no significant difference between the groups in mean operation time, blood loss, warm ischemia time or complication rates. The mean hospital stay in the LPN group was significantly shorter than in the OPN group (p = 0.004). The mean follow-up of the OPN and LPN group was 95.0 and 65.1 months, respectively. No local recurrence or metastasis has been noted during the follow-up period. Conclusions: Peripelvic cRCC represents an uncommon variant of RCCs; few cases have been reported addressing peripelvic cRCC treatment. Although technically challenging, LPN is an effective minimally invasive modality for treating peripelvic cRCC in experienced hands.

Comparing Zero Ischemia Laparoscopic Radio Frequency Ablation Assisted Tumor Enucleation and Laparoscopic Partial Nephrectomy for Clinical T1a Renal Tumor: A Randomized Clinical Trial

We evaluated the functional outcome, safety and efficacy of zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation compared with conventional laparoscopic partial nephrectomy. A prospective randomized controlled trial was conducted from April 2013 to March 2015 in patients with cT1a renal tumor scheduled for laparoscopic nephron sparing surgery. All patients were followed for at least 12 months. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation group underwent tumor enucleation after radio frequency ablation without hilar clamping. The primary outcome was the change in glomerular filtration rate of the affected kidney by renal scintigraphy at 12months. Secondary outcomes included changes in estimated glomerular filtration rate, estimated blood loss, operative time, hospital stay, postoperative complications and oncologic outcomes. The Pearson chi-square or Fisher exact, Student t-test and Wilcoxon rank sum tests were used. The trial ultimately enrolled 89 patients, of whom 44 were randomized to the laparoscopic radio frequency ablation assisted tumor enucleation group and 45 to the laparoscopic partial nephrectomy group. In the laparoscopic partial nephrectomy group 1 case was converted to radical nephrectomy. Compared with the laparoscopic partial nephrectomy group, patients in the laparoscopic radio frequency ablation assisted tumor enucleation group had a smaller decrease in glomerular filtration rate of the affected kidney at 3 months (10.2% vs 20.5%, p=0.001) and 12 months (7.6% vs 16.2%, p=0.002). Patients in the laparoscopic radio frequency ablation assisted tumor enucleation group had a shorter operative time (p=0.002), lower estimated blood loss (p <0.001) and a shorter hospital stay (p=0.029) but similar postoperative complications (p=1.000). There were no positive margins or local recurrence in this study. Zero ischemia laparoscopic radio frequency ablation assisted tumor enucleation enables tumor excision with better renal function preservation compared to conventional laparoscopic partial nephrectomy. Less blood loss and a shorter operative time were achieved with similar postoperative complication rates.

Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors: Long-Term Outcome of 179 Patients

Objectives: To compare the long-term functional and oncological results between laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) in selected clinical T1a (cT1a) renal tumor patients. Methods: We retrospectively analyzed the medical records of patients with cT1a renal tumors who had LRFA or LPN at our institution between February 2006 and February 2015. Student's t test was used to compare the perioperative data between the two groups. Survival analyses were calculated using the Kaplan-Meier method. Results: A total of 179 patients were included in the study. Patients in the LRFA cohort were significantly older and had higher American Society of Anesthesiologists sore than in the LPN cohort. The LRFA group had a significantly lower mean blood loss than the LPN group (p = 0.03). The percent decrease of GFR in the LRFA group was significantly lower than in the LPN group (p = 0.021). The 5-year overall, cancer-specific and disease-free survival were 93.3 vs. 94.6%, 98.0 vs. 98.5% and 97.1 vs. 97.3%, for LRFA and LPN, respectively (all p value >0.05). Conclusions: The excellent perioperative results, long-term functional and oncological outcomes of LRFA confirm that this technique is safe, nephron sparing and oncologically effective for the treatment of cT1a renal tumors.

A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey

To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys. Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2years. Statistical analysis was performed using χ (2) test and Student's t test. The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) [χ (2)=0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2min vs RPN: 255min; p<0.001) and hospitalization (LPN: 3.5days vs RPN: 4.1days; p<0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.

Selection of personalized laparoscopic partial nephrectomy based on tumor characteristics: A preliminary study in a single center

ObjectivesTo evaluate the feasibility and therapeutic outcome of a personalized laparoscopic partial nephrectomy (LPN) selection scheme designed according to tumor characteristics. MethodsWe included 187 patients in this study with clinical T1 renal tumors who were diagnosed between March 2012 and February 2014. 93 patients underwent the personalized LPN on the basis of tumor characteristics (Group A, n = 93), including no renal arterial clamping LPN, selective renal arterial clamping LPN and main renal arterial clamping LPN, and the other 94 patients underwent LPN with main renal arterial clamping (Group B, n = 94). Patient characteristics, tumor characteristics, perioperative data and renal function parameters were collected prospectively. Results85 patients in Group A and 90 patients in Group B completed the designed surgery without conversion. Compared with Group B, the operation time was longer in Group A (110.2 vs. 122.3 min, p = 0.001), intraoperative blood loss was increased (127.8 vs. 151.1 ml, p = 0.017), and there was less reduction in GFR 12 months postoperative (7.6 vs. 5.1 ml/min, p < 0.001). The study was limited by the relatively small sample size and long-term postoperative renal function is still awaited. ConclusionsThe result of our study showed that, although the intraoperative blood loss was greater, there was a less decrease in GFR 12 months postoperative in personalized LPN group.