Laparoscopic Partial Nephrectomy Research Articles

Robot-assisted partial nephrectomy: Is it the future of kidney surgery? A comparison of nephron-sparing techniques in partial nephrectomy

Technological advancements are significantly transforming various medical fields, including urology. The increasing adoption of minimally invasive surgical techniques and robotic assistance is particularly impactful. Three partial nephrectomy techniques are investigated: open partial nephrectomy, laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Among these, robot-assisted partial nephrectomy is considered to be superior due to shorter warm ischemia time, reduced blood loss, better early renal functional preservation, and shorter hospital stays. The zero-ischemia partial nephrectomy concept aims to improve postoperative kidney function outcomes. The integration of robotic technology and advancements in artificial intelligence and surgical training systems are expected to further enhance surgical techniques. Artificial intelligence, particularly when combined with computer vision algorithms, shows potential for creating precise and automated three-dimensional models for surgical planning in complex robot-assisted partial nephrectomy procedures, potentially leading to better patient outcomes. This review identifies the current capabilities and prospective advancements in the application of robotic technology in partial nephrectomy.

Efficacy of robot-assisted partial nephrectomy compared to conventional laparoscopic partial nephrectomy for completely endophytic renal tumor: a multicenter, prospective study

BackgroundThis study aimed to compare the efficacy of robot-assisted partial nephrectomy for completely endophytic renal tumors with the reported outcomes of conventional laparoscopic partial nephrectomy and investigate the transition of renal function after robot-assisted partial nephrectomy.MethodsWe conducted a prospective, multicenter, single-arm, open-label trial across 17 academic centers in Japan. Patients with endophytic renal tumors classified as cT1, cN0, cM0 were included and underwent robot-assisted partial nephrectomy. We defined two primary outcomes to assess functional and oncological aspects of the procedure, which were represented by the warm ischemic time and positive surgical margin, respectively. Comparisons were made using control values previously reported in laparoscopic partial nephrectomy studies. In the historical control group, the warm ischemia time was 25.2, and the positive surgical margin was 13%.ResultsOur per-protocol analysis included 98 participants. The mean warm ischemic time was 20.3 min (99% confidence interval 18.3–22.3; p < 0.0001 vs. 25.2). None of the 98 participants had a positive surgical margin (99% confidence interval 0–5.3%; p < 0.0001 vs. 13.0%). The renal function ratio of eGFR before and after protocol treatment multiplied by splits was 0.70 (95% confidence interval: 0.66–0.75). Factors such as preoperative eGFR, resected weight, and warm ischemic time influenced the functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy.ConclusionsRobot-assisted partial nephrectomy for completely endophytic renal tumors offers a shorter warm ischemia time and comparable positive surgical margin rate compared with conventional laparoscopic partial nephrectomy.

The application of mixed reality navigation system in laparoscopic partial nephrectomy for highly complex renal tumors (RENAL score ≥ 10): a retrospective cohort study.

The application of mixed reality navigation system in laparoscopic partial nephrectomy for highly complex renal tumors (RENAL score ≥ 10): a retrospective cohort study.

Comparison of Outcomes Between Partial and Radical Laparoscopic Nephrectomy for Localized Renal Tumors Larger Than Four Centimeters: A Systematic Review and Meta-Analysis.

Earlier studies have juxtaposed different laparoscopic methods for treating renal tumors; however, extensive evidence with a particular focus on large kidney tumors remains lacking. The objective of this meta-analysis was to assess the perioperative outcomes, kidney performance, and cancer-related results of laparoscopic partial nephrectomy (LPN) versus laparoscopic radical nephrectomy (LRN) for treating extensive, localized, non-metastatic kidney tumors (cT1b-cT2N0M0). We systematically searched multiple databases from database inception until December 2023 for relevant studies. Selected data were analyzed with the Cochrane Collaboration's Review Manager 5.4 software using a random-effects model. Outcomes were expressed as odds ratios and weighted mean differences with 95% confidence intervals, considering a P value of < 0.05 as significant. Data from nine studies encompassing 1,303 patients (529 LPN, 774 LRN) revealed that LPN was associated with lengthier surgeries and increased blood loss compared to LRN. While LPN exhibited higher postoperative complication rates, the disparity did not reach statistical significance. LPN led to improved postoperative renal function, manifesting as a reduced estimated glomerular filtration rate (eGFR) decline and fewer incidents of new chronic kidney disease cases. Both groups demonstrated comparable tumor recurrence and overall mortality rates, but LPN exhibited significantly lower cancer-specific mortality rates. LPN, despite longer operative times and greater intraoperative blood loss, was found to be superior to LRN in preserving postoperative renal function. Oncologically, LPN and LRN have comparable overall mortality rates, but LPN showed a significant advantage in terms of lower cancer-specific mortality rates.

Fascial Plane Blocks With Glucocorticoids or Liposomal Bupivacaine Versus Local Infiltration for Laparoscopic Non-donor Nephrectomy: A Propensity Score-Weighted Study.

Study objective The purpose of this study is to investigate the analgesic efficacy of ultrasound-guided fascial plane blocks (FPBs) versus local infiltration in patients undergoing laparoscopic non-donor nephrectomy. This study specifically compares the efficacy of FPBs with liposomal bupivacaine (LB) versus FPBs with dexamethasone sodium phosphate (DXP) and methylprednisolone acetate (MPA) versus surgical site local anesthetic infiltration without FPBs. Design This is a retrospective cohort study conducted over a five-year period (January 2018-December 2022). Setting The study was conducted in a tertiary care, academic, multi-hospital healthcare system. Participants Patients who underwent elective radical or partial laparoscopic non-donor nephrectomy were included in the study. Intervention Patients either received preoperative FPBs without intraoperative surgical site local anesthetic infiltration or received surgical site local anesthetic infiltration without FPBs (n = 141) at participating hospitals. Measurements The primary endpoint of this study was postoperative opioid use, measured as oral milligram morphine equivalents (MME). Secondary endpoints included postoperative pain scores, length of hospital stays, and significant adverse events within 30 days. The impact of medications utilized in FPBs was determined by univariate and multivariable analyses with covariates balancing propensity score weighting. Main results Patients undergoing non-donor laparoscopic radical or partial nephrectomy who received FPBs with bupivacaine or ropivacaine plus glucocorticoids DXP and MPA were more likely to be opioid-free 24-48 hours postoperatively compared to those who received FPBs with LB or surgical site local anesthetic infiltration without FPBs (40.5% vs. 30% vs. 13.9%, respectively; p = 0.017). Patients who received FPBs with glucocorticoids also reported the lowest pain scores at rest and with activity 0-12 hours postoperatively as compared to patients who received LB or local infiltration (p = 0.006 and p = 0.014, respectively). Additionally, patients who received FPBs with glucocorticoids received over 30% fewer opioids during the first 48 hours postoperatively compared to patients who received surgical site local anesthetic infiltration alone (30 MME vs. 44 MME, respectively). However, there was no significant difference in total opioid use during the first 48 hours postoperatively between patients who received FPBs with bupivacaine plus glucocorticoids and those who received FPBs with bupivacaine plus LB (mean ratio: 0.91, (95% CI: 0.05 ~ 15.97); p = 0.948). There was also no difference in the length of hospital stays or rate of adverse events between the groups. Conclusion Perioperative FPBs for non-donor laparoscopic nephrectomy using glucocorticoids as an adjuvant to long-acting local anesthetics may decrease postoperative opioid use and reduce pain scores as compared to FPBs with LB or surgical site local anesthetic infiltration. Bupivacaine or ropivacaine combined with DXP and MPA is a safe and effective alternative to LB for FPBs in laparoscopic nephrectomy.

Comparison of surgical outcomes of robot-assisted laparoscopic partial nephrectomy performed by a single experienced surgeon according to two reconstruction methods, including single-layer and double-layer renorrhaphy.

This study aimed to assess the surgical outcomes of single-layer versus double-layer renorrhaphy in robot-assisted laparoscopic partial nephrectomy (RAPN) performed by an experienced surgeon.We enrolled 655 patients who underwent RAPN between January 2019 and June 2023. After excluding those with multiple tumors or incomplete medical records, 554 patients were included in the final analysis. We compared surgical outcomes between single-layer renorrhaphy (outer cortical closure) and double-layer renorrhaphy (inner layer suture and outer cortical closure), adjusting for preoperative factors such as sex, age, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate (eGFR), preoperative complications (diabetes or hypertension), surgical approach (transperitoneal or retroperitoneal), tumor size, and tumor complexity, using propensity score matching. Of the 554 patients analyzed, 59 were classified into the single-layer group and 495 into the double-layer group. Before matching, the double-layer group had more complex and larger tumors. After matching, 58 patients were included in each group. The single-layer group showed significantly shorter operative times (91min vs. 100min, p = 0.0361), lower estimated blood loss (EBL) (7.9ml vs. 27ml, p = 0.021), and better preservation of eGFR (-1.2% vs. -5.1%, p = 0.0313). Other outcomes, such as perioperative complications and postoperative hospital stay, were not significantly different between the groups. Single-layer renorrhaphy demonstrated better surgical outcomes, including shorter operative time, lower EBL, and better preservation of kidney function, compared to double-layer renorrhaphy. These findings suggest that single-layer reconstruction may optimize RAPN outcomes in selected patients.

Tumor morphology evaluation using 3D-morphometric features of renal masses.

To assess the correlation between the general (gender, age, and maximum tumor size) and 3D morphotopometric features of the renal tumor node, following the MSCT data post-processing, and the tumor histological structure; to propose an equation allowing for kidney malignancy assessment based on general and morphometric features. In total, 304 patients with unilateral solitary renal neoplasms underwent laparoscopic (retroperitoneoscopic) or robotic partial or radical nephrectomy. Before the procedure, kidney contrast-enhanced MSCT followed by the tumor 3D-modeling was performed. 3D model of the kidney tumor, and its morphotopometric features, and histological structure were analyzed. The morphotopometric ones include the side of the lesion, location by segments, the surface where the tumor, the depth of the tumor invasion into the kidney, and the shape of tumor. Out of 304 patients, 254 (83.6%) had malignant kidney tumors and 50 (16.4%) benign kidney tumors. In total, 231 patients, out of 254 (90.9%) were assessed for the degree of malignant tumor differentiation. Malignant tumors were more frequent in men than in women (p < 0.001). Mushroom-shaped tumors were the most common shapes among benign renal masses (35.2%). The most common malignant kidney tumors had spherical with a partially uneven surface (27.6%), multinodular (tuberous (27.2%)), and spherical with a conical base (24.8%) shapes. Logistic regression model enabled the development of prognostic equation for tumor malignancy prediction ("low" or "high"). The univariate analysis revealed the correlation only between high differentiation (G1) and a spherical tumor with a conical base (p = 0.029). The resulting logistic model, based on the analysis of such predictors as gender and form of kidney lesions, demonstrated a large share (87.6%) of correct predictions of the kidney tumor malignancy.

Laparoscopic versus Robot-Assisted Partial Nephrectomy for Renal Tumors with Cystic Features: Comparison of Perioperative Outcomes and Trifecta Achievement

Laparoscopic versus Robot-Assisted Partial Nephrectomy for Renal Tumors with Cystic Features: Comparison of Perioperative Outcomes and Trifecta Achievement

Comparison of the Efficacy of Percutaneous Microwave Ablation Therapy versus Laparoscopic Partial Nephrectomy for Early-Stage Renal Tumors.

This study aimed to compare the efficacy of percutaneous microwave ablation therapy (MWAT) and laparoscopic partial nephrectomy (LPN) in early-stage renal cell carcinoma (RCC) classified as T1a; a retrospective analysis was conducted on patients treated between January 2017 and November 2023. Oncological outcomes, radiological recurrence, length of stay (LOS), and costs were evaluated. The study included 110 patients, with no significant differences between the two groups regarding residual tumors, local tumor progression, and disease-free survival rates (p > 0.05). The LPN group showed significantly lower pre/postoperative serum urea and creatinine and higher estimated glomerular filtration rate values, whereas the MWA group experienced significantly lower mean costs, complication rates, LOS in the hospital, and procedure durations (p ≤ 0.05). However, post-procedure residual tumors and local tumor progression rates did not differ significantly between the LPN and MWAT groups (p > 0.05). MWAT is as effective as LPN for T1a RCC lesions. In addition, MWAT has lower costs than LPN and is a cost-effective treatment method. Therefore, MWAT minimizes hospital stay and complications and since the oncological results are similar to LPN, it might be considered as the first choice of treatment in young patients.

Assessing the Prognostic Utility of the New Mayo Adhesive Probability Score in East Asian Populations and its Correlation with Metabolic-Associated Fatty Liver Disease.

We assessed the prognostic utility of the new perinephric fat adherence risk score - Mayo Adhesive Probability (MAP), in patients of East Asian ethnicity undergoing either laparoscopic partial nephrectomy (LPN) or laparoscopic radical nephrectomy (LRN). A retrospective analysis of clinical data was carried out on 169 patients who either underwent LPN or LRN surgery. These patients were categorized into two groups, group A (0-2 points) and group B (3-4 points) using the new MAP score. The overall clinical data between these two groups was compared and potential risk factors were investigated using logistic regression analyses. The new MAP score yielded an area under the curve of 0.761 (95 % CI: 0.691-0.831), indicating its effectiveness. Group B had a significantly higher incidence of adherent perirenal fat (APF) during surgery (p<0.001) and had a greater average age (p<0.001). There was an increased prevalence of hypertension (p=0.009), type 2 diabetes mellitus (p<0.001), and MAFLD (p<0.001) in group B. Additionally, there were significant differences in posterior perinephric fat thickness (p<0.05), lateral perinephric fat thickness (p<0.001), and perinephric stranding (p<0.001) between the two groups. The new MAP score holds significance in predicting APF in people of East Asian ethnicity undergoing LPN or LRN, and there is a strong correlation between elevated MAP scores and risk factors such as MAFLD and advanced age.

Efficacy of Multimodal Analgesia with Transversus Abdominis Plane Block in Comparison with Intrathecal Morphine and Intravenous Patient-Controlled Analgesia after Robot-Assisted Laparoscopic Partial Nephrectomy.

Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) for renal tumor treatment provides ergonomic advantages to surgeons and improves surgical outcomes. However, moderate-to-severe pain is unavoidable even after minimally invasive surgery. Despite the growing interest in multimodal analgesia, few studies have directly compared its efficacy with intrathecal morphine, a traditional opioid-based analgesic. Methods: We retrospectively investigated the efficacy of multimodal analgesia compared with that of intrathecal analgesia and intravenous patient-controlled analgesia (IV-PCA) in patients who underwent transperitoneal RAPN at our institute between 2020 and 2022. Among the 334 patients who met the inclusion criteria, intrathecal analgesia using morphine 200 µg was performed in 131 patients, and multimodal analgesia, including transversus abdominis plane block and intraoperative infusion of paracetamol 1 g and nefopam 20 mg, was administered to 105 patients. The remaining 98 patients received postoperative IV-PCA alone. Results: As the primary outcome, the area under the curve of pain scores over 24 h was significantly lower in the intrathecal analgesia and multimodal analgesia groups than in the IV-PCA group (89 [62-108] vs. 86 [65-115] vs. 108 [87-126] h, p < 0.001). Cumulative opioid requirements were also significantly lower in the intrathecal analgesia and multimodal analgesia groups at 24 h after surgery (p < 0.001). However, postoperative nausea and vomiting were significantly increased in the intrathecal analgesia group (27.5% vs. 13.3% vs. 13.3%, p = 0.005). Conclusions: Multimodal analgesia with a transversus abdominis plane block is an efficient analgesic method with fewer adverse effects compared to other analgesic methods. Our findings suggest the efficacy and safety of a multimodal approach for opioid-sparing analgesia after RAPN in the current opioid epidemic.

Best predictive single nephrometry score component to correlate with achievement of trifecta outcome in laparoscopic and robotic surgery

BackgroundTo evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN).MethodsPatients that had undergone a Laparoscopic (LPN) or Robotic Partial Nephrectomy (RPN) between 2018 and 2023 were reviewed. Our data collection included Race, Ethnicity, Age, BMI, R.E.N.A.L nephrometry score, and complications. Cases that achieved trifecta outcomes were designated as “Group A” and cases that did not achieve trifecta were “Group B”. All the data were collected using REDCap database.ResultsA total of 111 cases were included, Group A consisted of 82% of all cases, whereas Group B 18%. Radius score demonstrated significant distinction concerning trifecta attainment and was the most predictive component of the 5 scoring metrics of the nephrometry system. In a subgroup analysis, R-score of 3 or a renal mass measuring ≥ 7 cm, was a significant independent negative predictor for trifecta outcomes, as well as tumor size at presentation.ConclusionRenal nephrometry score is predictive of trifecta outcomes for patients undergoing laparoscopic or robotic partial nephrectomy. Radius of mass was the most effective predictive component of the nephrometry score for trifecta prediction.

ASO Author Reflections: A Novel Microwave Scissors-Based Sutureless Laparoscopic Partial Nephrectomy Technique with a Less Technically Demanding Procedure.

ASO Author Reflections: A Novel Microwave Scissors-Based Sutureless Laparoscopic Partial Nephrectomy Technique with a Less Technically Demanding Procedure.

Microwave Scissors-Based Sutureless Laparoscopic Partial Nephrectomy Versus Conventional Open Partial Nephrectomy in a Porcine Model: Usefulness and Complications

BackgroundThis study aimed to compare the benefits and safety of microwave scissors-based sutureless laparoscopic partial nephrectomy (MSLPN) with those of conventional open partial nephrectomy (cOPN).MethodsEach kidney in nine pigs underwent MSLPN using microwave scissors (MWS) via transperitoneal laparoscopy or cOPN via retroperitoneal open laparotomy. The kidney’s lower and upper poles were resected under temporary hilar-clamping. The renal calyces exposed during renal resections were sealed and transected using MWS in MSLPN and were sutured in cOPN. For MWS, the generator’s power output was 60 W. Data on procedure time (PT), ischemic time (IT), blood loss (BL), normal nephron loss (NNL), and extravasation during retrograde pyelogram were compared between the two techniques.ResultsThe authors successfully performed 22 MSLPNs and 10 cOPNs. Compared with cOPN, MSLPN was associated with significantly lower PT (median, 9.2 vs 13.0 min; p = 0.026), IT (median, 5.9 vs 9.0 min; p < 0.001), BL (median, 14.4 vs 38.3 mL; p = 0.043), and NNL (median, 7.6 vs 9.4 mm; p = 0.004). However, the extravasation rate was higher in the MSLPN group than in the cOPN group (54.5 % [n = 12] vs 30.0 % [n = 3]), albeit without a significant difference (p = 0.265). Pelvic stenosis occurred in one MSLPN procedure that involved deep lower pole resection near the kidney hilum.ConclusionsThe study data show that MSLPN can improve intraoperative outcomes while reducing technical demands for selected patients with non-hilar-localized renal tumors. However, renal calyces, if violated, should be additionally sutured to prevent urine leakage.

Robotic partial nephrectomy is associated with a significantly decreased rate of postoperative pseudoaneurysm compared to open and laparoscopic partial nephrectomy

While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.

Laparoscopic nephron-sparing surgery for complex renal cystic lesions: a single-center experience.

This study aimed to explore the feasibility and safety of laparoscopic nephron-sparing surgery (LNSS) for complex renal cystic lesions. A retrospective study was conducted on 83 cases of complex renal cystic lesions treated with LNSS in our hospital. There were 32 men and 51 women, ranging in age from 24 to 73years (average, 47.22±9.03years). The diameter of the cysts was 1.5-5.9cm (average, 3.44±0.86cm). According to the Bosniak classification, there were 15 cases of type II, 23 cases of type IIF, 29 cases of type III, and 16 cases of type IV complex renal cystic lesions. According to clinical classification based on the difficulty of laparoscopic partial nephrectomy and the depth of the lesion, the 83 complex renal cystic lesions were divided into 48 cases of the extra-renal type, 15 cases of the centrally located type, seven cases of the renal sinus type, and 13 cases of the renal hilum type. Laparoscopic partial nephrectomy was successful in all 83 patients. The surgical time was 35-102min (average, 52.13±14.38min), the intraoperative bleeding volume was 10-200ml (average, 27.25±12.26ml), and the renal artery occlusion time was 12-28min (average, 12.46±4.45min). There was no significant change in creatinine before and after surgery. The postoperative pathological results showed 71 cases of renal clear cell carcinoma, five cases of low malignant potential multilocular cystic renal tumors, and seven cases of pure renal cysts with all margins negative. There is potential for the malignant transformation of complex renal cysts into renal cell carcinoma. For complex renal cysts classified as Bosniak IIF or higher, surgical intervention is recommended, and LNSS is safe and effective. The complexity of the surgical procedure varies depending on the location classification of the complex renal cysts.

Preoperative Super-Selective Embolization versus "On-Clamp" Laparoscopic Partial Nephrectomy for T1 Renal Tumors- A Prospective Randomized Study.

To analyze and compare the intraoperative and post-operative outcomes of "on-clamp" laparoscopic partial nephrectomy (LPN) with "preoperative super-selective angioembolization" before LPN. This randomized clinical study was conducted at Gauhati Medical College Hospital, Guwahati, India, between November 2021 and November 2023. Adult patients of either gender diagnosed with T1 renal tumors were included in the study. All patients underwent diethylenetriamine pentaacetate scan preoperatively and at 1-month follow-up. The patients were randomized using a parallel group design with an allocation ratio of 1:1 to receive either preoperative angioembolization followed by LPN or conventional "on-clamp" LPN. Demographic and baseline parameters were recorded along with pre- and post-operative data. There was no significant difference between the two groups in terms of age (P = 0.11), gender distribution (P = 0.32), body mass index (P = 0.43), preoperative hemoglobin (P = 0.34), and preoperative estimated glomerular filtration rate (eGFR; P = 0.64). One patient in the embolization group required radical nephrectomy because of accidental backflow of glue into the renal artery during embolization whereas four patients required clamping due to inadequate embolization. Preoperative super-selective embolization yielded significantly less blood loss, compared to "on-clamp" LPN (145 [50.76 mL] vs. 261 [66.12 mL], P < 0.01). There was no significant difference between post-operative eGFR (at 1 month) between the two groups (P = 0.71). Preoperative embolization offers improved outcomes in the dissection plane, total operative time, and blood loss, compared to conventional "on-clamp" LPN but has no significant effect on change in eGFR.

Intraoperative Ultrasound: Bridging the Gap between Laparoscopy and Surgical Precision during 3D Laparoscopic Partial Nephrectomies.

The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.

Current status and challenges of 3D navigation in partial nephrectomy

Partial nephrectomy, a standard treatment for small renal cancers, has evolved through minimally invasive procedures such as laparoscopic and robot-assisted partial nephrectomy. The use of three-dimensional (3D) kidney models derived from preoperative computed tomography (CT) images has been investigated to improve surgical outcomes. This review explores various navigation techniques, such as 3D printing, virtual reality (VR), and augmented reality (AR), to address organ movement and deformation challenges during surgery. Despite the promising positive impact of these methods, as revealed by a systematic review in 2022, achieving the desired navigation accuracy remains elusive. The use of Virtual Reality and Augmented Reality, capable of overlaying the 3D model onto the surgical image in real-time, has shown potential. Still, we need advanced techniques, for instance, non-rigid 3D models employing nonlinear parametric deformation, to adapt to organ deformation. Additionally, the application of deep learning from artificial intelligence for high accuracy 3D navigation is an emerging area of interest. Although considerable progress has been achieved, a comprehensive, widely adoptable solution has yet to be discovered. The paper underscores the necessity for ongoing research and development in 3D navigation methods, anticipating their substantial contribution to future surgical procedures.

Is 3D Volumetric Evaluation Consistent with Postoperative Renal Parenchymal Preservation in Open and Robot-Assisted Laparoscopic Partial Nephrectomy?

Introduction: To evaluate by using 3D renal volumetric assessment and compare renal parenchymal preservation between patient who underwent open partial nephrectomy (OPN) and robot assisted laparoscopic partial nephrectomy (RALPN). Methods: We retrospectively reviewed the records of the patients to evaluate the effect of OPN (23 patients) or RALPN (19 patients) partial nephrectomy on renal parenchymal preservation. The CT or MRI were examined using 3D-Slicer image processing software. The tumor volume and preoperative and postoperative non-tumor bearing parenchymal volumes were evaluated with the segmentation. The preoperative and postoperative parenchymal volumes, serum creatinine levels, and estimated glomerular filtration rates (eGFRs) were compared between the surgical techniques. Results: The data of 42 patients were included in the final analysis. The patient and tumor characteristics were similar between the two groups. Postoperative renal parenchymal volumetric changes were seen similar between groups. Although the serum creatinine levels and eGFRs did not change postoperatively in the RALPN group (P = .145 and P = .085, respectively), creatinine increased while eGFR decreased in the OPN group (P = .003 and P = .002, respectively). Conclusions: Our analysis showed that RALPN could be considered similar to OPN in terms of parenchymal volume preservation, but the rate of parenchymal volume preservation was not associated with the change in functional parameters. These results should be supported by further research.