Nephrectomy For Renal Hilar Tumors Research Articles

Off-clamp robot-assisted partial nephrectomy for renal hilar tumors.

Off-clamp robot-assisted partial nephrectomy for renal hilar tumors.

Robot-assisted versus conventional laparoscopic partial nephrectomy for renal hilar tumors: Parenchymal preservation and functional recovery.

To determine whether robot-assisted laparoscopic partial nephrectomy (RALPN) can benefit patients in terms of functional recovery in the treatment of renal hilar tumors compared to conventional laparoscopic partial nephrectomy (CLPN). Between January 2019 and July 2021, patients with hilar tumors who underwent partial nephrectomy (PN) were acquired at our center and were classified into RALPN and CLPN groups. Ipsilateral parenchymal volume (IPV) and glomerular filtration rate (GFR) were determined independently 3-5 days before and 3 months after PN using contrast-enhanced computed tomography and nuclear renal scans. Pearson correlation was used to determine the link between ipsilateral GFR preservation and IPV preserved. Concurrently, multivariable analysis was employed to determine characteristics associated with functional recovery. A total of 96 patients with hilar tumors were studied, of which 41 received RALPN and 55 received CLPN. Excisional parenchymal volume was 27 and 37 cm3 (p = 0.005) in RALPN and CLPN groups, respectively, and IPV preserved was 77% and 68% (p < 0.001). Furthermore, the ipsilateral GFR preserved was 77.7% and 75.3%, respectively (p = 0.003). On Pearson correlation, ipsilateral GFR preservation was linked with IPV preserved (r = 0.36, p < 0.001). According to a multivariate study, baseline GFR, IPV preserved, and surgical procedures (RALPN vs. CLPN) were significant factors influencing functional recovery. Our study suggests that RALPN, rather than CLPN, can achieve better functional recovery in the treatment of hilar tumors due to its ability to win more IPV preserved. RALPN should be recommended as the first-line treatment for hilar tumors, but randomized controlled trials are required to validate our findings.

Comparison of Robot-Assisted and Laparoscopic Partial Nephrectomy for Renal Hilar Tumors: Results from a Tertiary Referral Center

Objective: To compare perioperative, functional, and oncologic outcomes between robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for renal hilar tumors. Methods: We retrospectively reviewed patients who underwent minimally invasive partial nephrectomy for renal hilar tumors at our institution between January 2014 and August 2018. The entire cohort was divided into two groups according to surgical approach: RAPN and LPN group. Perioperative, functional, and oncologic outcomes of the two groups were collected and compared. Results: A total of 116 patients with renal hilar tumors were identified, including 52 patients who underwent RAPN and 64 patients who underwent LPN, respectively. Demographic baseline characteristics were similar in two groups. There were no differences between the RAPN and LPN groups for operative time, transfusion rate, conversion rate, surgical margin, perioperative complication, and hospital stay. Compared with the LPN group, the RAPN group was associated with significant less estimated blood loss (100 vs 150 mL; p < 0.001), shorter warm ischemia time (20.3 vs 24.5 minutes; p = 0.001), and higher direct cost (p < 0.001). Percentage of estimated glomerular filtration rate change at 6 months after surgery was lower in RAPN group than LPN group (10.4% vs 15.2%; p = 0.020). No significant difference was observed between the two groups in terms of oncologic outcomes. Conclusions: For hilar tumors, both RAPN and LPN were safe and feasible surgical treatments. RAPN might be associated with superior perioperative outcomes (less estimated blood loss and shorter warm ischemia time) and better postoperative renal functional preservation. RAPN might be the preferred option when condition permits for renal hilar tumors.

Navigation of Intelligent/Interactive Qualitative and Quantitative Analysis Three-Dimensional Reconstruction Technique in Laparoscopic or Robotic Assisted Partial Nephrectomy for Renal Hilar Tumors.

Purpose: To evaluate the feasibility and effectiveness of the navigation of intelligent/interactive qualitative and quantitative analysis (IQQA) three-dimensional (3D) reconstruction technique in laparoscopic or robotic assisted partial nephrectomy (LPN or RAPN) for renal hilar tumors. Patients and Methods: The study retrospectively reviewed 26 patients with hilar tumors from February 2016 to February 2018. IQQA 3D reconstruction technique was applied for the purpose of navigation and resection of the tumors. Relevant clinical parameters and surgical outcomes were recorded. Results: All 26 LPN or RAPN were effectively completed without conversion to a hand-assisted or an open approach. Under the navigation of IQQA, all tumors were found precisely at the first time during surgeries. The mean operative time was 142 minutes (142 ± 35), with a mean warm ischemia time of 24.3 minutes (24.3 ± 9.5). The estimated blood loss was 156 mL (156 ± 112). No intraoperative complications occurred. Two patients suffered from postoperative complications. All patients had negative margins on the final pathological examination. At a mean follow-up period of 3 months, the mean glomerular filtration rate is 22.5 mL/min (22.5 ± 7.1) without tumor recurrence. Conclusions: With peculiar features, such as accurate location, complete resection, and fewer perioperative complications, the navigation of IQQA 3D reconstruction technique in partial nephrectomy represents a safe and effective procedure for hilar tumors.

AB073. Application of IQQA three-dimensional reconstruction technique in precise laparoscopic or robotic-assisted laparoscopic partial nephrectomy for renal hilar tumors

BackgroundTo evaluate the feasibility and effectiveness of the application of IQQA three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy (LPN or RAPN) for renal hilar tumors.MethodsThe study retrospectively reviewed 11 patients with hilar tumors from February 2016 to February 2017. Of the 11 patients, 4 were women and 7 were men, with an average age of 51.3 years (range, 38 to 70 years). The average tumor size was 3.1 cm (range, 1.7 to 4.3 cm). For tumor stage, nine patients were in T1a stage and two patients were in T1b stage. The average R.E.N.A.L score was 8.7 (range, 7 to 10). The mean preoperative glomerular filtration rate (GFR) was 40.6 mL/min (range, 32 to 45 mL/min). IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors. Multivariate analysis was used to identify predictors of warm ischemia time, estimated blood loss, major perioperative complications, and postoperative renal function.ResultsAll 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach. Under the navigation of IQQA, all tumors were found precisely at the first time during surgeries. The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas. The mean operative time was 142 minutes (range, 90 to 230 minutes), with a mean warm ischemia time of 24.3 minutes (range, 17 to 33 minutes). The estimated blood loss was 146 mL (range, 50 to 400 mL). No intraoperative complications occurred. Two patients suffered from postoperative complications. One patient with gross hematuria was recovered by consistent bladder irrigation. The other patient with postoperative hemorrhage needed transfusion. All patients had negative margins on the final pathologic examination. At a mean follow-up period of 3 months, the mean GFR is 22.5 mL/min (range, 13 to 34 mL/min) without any disease recurrence.ConclusionsWith peculiar features, such as accurate location, complete resection and fewer perioperative complications, the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors.

Clinical study of transperitoneal and retroperitoneal robot-assisted partial nephrectomy for renal hilar tumors

Objective To investigate the clinical value and experience of transperitoneal and retroperitoneal robot-assisted partial nephrectomy for renal hi1ar tumors. Methods We evaluated 48 patients who had partial nephrectomy for renal hilar tumor by robotic surgical syestem from January 2013 to March 2017. In those cases, 35 were male and 13 were female, with an average age of 57.3 (range from 41 to 75 ), 27 cases were ventral tumor and 21 cases were dorsal tumor. 3 cases were totally confined to the renal parenchyma, the other 45 cases were partially confined to the renal parenchyma.18 cases were performed surgery by retroperitoneal route, the rest 30 cases were performed by peritoneal route. Results A total of 48 patients underwent successful robotic partial nephrectomy for renal hilar tumors. The mean warm ischemia time was 22 minutes (range from 16 to 33 minutes) and the mean estimated blood loss was 88 ml (range from 50 to 350 ml). No bleeding-related complications were found. Histopathology confirmed 39 cases of ccRCC, 7 cases of angioleiomyolipoma, 2 cases of renal oncocytoma. There was one case in this review was positive surgical margin (2.1%) and found no sign of recurrence during the short term post-operation follow-up. All cases in this review are following up after surgery to date from 2 months to 4 years, no cases of tumor recurrence or metastasis were found. Conclusions The application of transperitoneal and retroperitoneal RAPN is the effective and safe way for renal hilar tumor resection, and it has a clear advantage of renal surgical incision stitching and tumor complete resection.The choice of surgical approaches depends on the size and location of tumor and the clinical experience of the surgeon. Key words: Kidney cancer; Renal hilar tumor; Robotic surgery; Laparoscopy; Partial nephrectomy

Application of IQQA three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy for renal hilar tumors

Objective To evaluate the feasibility and effectiveness of the application of IQQA (Intelligent/interactive Qualitative and Quantitative Analysis) three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy (LPN or RAPN) for renal hilar tumors. Methods The study retrospectively reviewed 11patients with hilar tumors from February 2016 to February 2017. Of the 11 patients, 4 were women and 7 were men, with an average age of 51 years (range 38 to 70 years). The average tumor size was 3.1 cm (range 1.7 to 4.3 cm). For tumor stage, 9 patients were in T1a stage and 2 patients were in T1b stage. The average R. E.N.A.L score was 8.7 (range 7 to 10). The mean preoperative GFR was 40.6 ml/min (range 32 to 45 ml/min). IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors. Multivariate analysis was used to identify predictors of warm ischemia time, estimated blood loss, major perioperative complications, and postoperative renal function. Results All 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach. Under the navigation of IQQA, all tumors were found precisely at the first time during surgeries. The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas. The mean operative time was 142 minutes (range 90 to 230 minutes), with a mean warm ischemia time of 24 minutes (range 17 to 33 minutes). The estimated blood loss was 146 ml (range 50 to 400 ml). No intraoperative complications occurred. Two patients suffered from postoperative complications. One patient with gross hematuria was recovered by consistent bladder irrigation. The other patient with postoperative hemorrhage needed transfusion. All patients had negative margins on the final pathologic examination. At a mean follow-up period of 3 months, the mean GRR is 22.5 ml/min (range 13 to 34 ml/min) without any disease recurrence. Conclusions With peculiar features, such as accurate location, complete resection and fewer perioperative complications, the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors. Key words: Renal cell carcinoma; Renal hilar tumor; Partial nephrectomy; Three-dimensional reconstruction; Surgery navigation

V-Hilar Suture Renorrhaphy During Robotic Partial Nephrectomy for Renal Hilar Tumors: Preliminary Outcomes of a Novel Surgical Technique

To report the preliminary outcomes of a novel renorrhaphy surgical technique, V-hilar suture (VHS), developed and implemented at our institution to manage hilar masses chosen for robotic partial nephrectomy. Of all patients who underwent robotic partial nephrectomy for a single renal tumor from June 2007 to October 2011, 15 had hilar renal tumors. Of these 15 patients, only 5 had been considered for VHS renorrhaphy and were compared with the rest. The patients' demographic and perioperative data were recorded. They were followed up postoperatively for renal function. The VHS renorrhaphy was obtained by first having inner layer sutures to reshape the renal parenchyma with medialization of the central-lateral border of the resection bed. Next, a continuous horizontal mattress suture was used to reapproximate the renal capsule. The main patient and tumor characteristics were comparable between the 2 groups. No difference was found in terms of operating room time or warm ischemia time. A trend was noted in favor of the VHS group for estimated blood loss (250 vs 575 mL; P = .137), postoperative complications (2 vs 6; P = .056), and hospital stay (2.6 vs 6.6 days; P = .157). No significant difference was found in the postoperative changes in the estimated glomerular filtration rate between the 2 groups. The preliminary outcomes of the present surgical technique have demonstrated its safety and efficacy. It might represent a valuable asset for robotic surgeons treating complex hilar renal tumors. Additional larger studies with longer follow-up are required to confirm these encouraging findings.

The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and Depth

Treatment decisions for renal malignancies depend largely on qualitative data, including a description of tumor anatomy and the experience of the treating surgeon. Currently characterization of renal tumor anatomical elements is descriptive and lacks standardization. Surgical decision making and data set comparisons would be significantly enhanced by a consistent, reproducible system that quantitates the pertinent characteristics of localized renal lesions. We have developed and propose a standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score) to quantify the anatomical characteristics of renal masses on computerized tomography/magnetic resonance imaging. The nephrometry score is based on 5 critical and reproducible anatomical features of solid renal masses. Of the 5 components 4 are scored on a 1, 2 or 3-point scale with the 5th indicating the anterior or posterior location of the mass relative to the coronal plane of the kidney. We applied the R.E.N.A.L. Nephrometry Score to 50 consecutive masses resected at Fox Chase Cancer Center. The R.E.N.A.L. Nephrometry Score consists of (R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of the tumor, (N)earness of tumor deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line. The suffix h (hilar) is assigned to tumors that abut the main renal artery or vein. The nephrometry scoring system accurately classified the complexity of 50 consecutive tumors undergoing excision at our institution. Standardized reporting of renal tumor size, location and depth is essential for decision making and effective comparisons. The R.E.N.A.L. Nephrometry Score is a reproducible standardized classification system that quantitates the salient anatomy of renal masses. This novel approach for the systematic characterization of renal tumors provides a tool for meaningful comparisons of renal masses in clinical practice and in the urological literature.

Robotic Partial Nephrectomy for Renal Hilar Tumors: A Multi-Institutional Analysis

Laparoscopic partial nephrectomy is an advanced surgical procedure requiring technical skill in minimally invasive techniques. Tumors located adjacent to the renal hilum pose an additional challenge. We report a multi-institutional study of robotic partial nephrectomy for renal hilar tumors and describe our results. We evaluated patients from 2 institutions who underwent robotic partial nephrectomy for renal hilar tumors. Renal hilar tumors were defined as tumors abutting the renal artery and/or renal vein on preoperative imaging. After clamping the renal hilar vessels tumors were excised with fine dissection from the renal vessels followed by sutured renal reconstruction. Robotic partial nephrectomy was successfully performed on 11 patients (mean age 56.4 years, range 30 to 76). Mean tumor size was 3.8 cm (range 2.3 to 6.4). Mean warm ischemia time was 28.9 minutes (range 20 to 39) and mean operating time was 202 minutes (range 154 to 253). Mean blood loss was 220 ml (range 50 to 750). Mean hospital stay was 2.6 days (range 1 to 4). Histopathological evaluation confirmed 8 cases of clear cell renal cell carcinoma, 1 of papillary renal cell carcinoma and 2 of chromophobe renal cell carcinoma. Surgical margins were negative for malignancy in all cases. Robotic partial nephrectomy is a safe and feasible approach for select patients with renal hilar tumors. Robotic assistance may facilitate tumor resection and renal reconstruction for challenging renal hilar tumors, offering a minimally invasive and nephron sparing surgical option for select patients who might otherwise require open surgery or total nephrectomy.

Laparoscopic Partial Nephrectomy for Hilar Tumors: Technique and Results

BackgroundLaparoscopic partial nephrectomy for hilar tumors is a cutting edge procedure for which little data is available in the current literature. ObjectiveTo describe our technique and results of laparoscopic partial nephrectomy for renal hilar tumors. Design, Setting, and ParticipantsBetween April 2000 and September 2006, 94 partial laparoscopic nephrectomies were performed at our institution. A total of 18 (19.1%) patients had hilar tumors. A hilar tumor was defined as a lesion suspicious for renal cell carcinoma in contact with a major renal vessel on preoperative cross-sectional imaging. In 3 (16.7%) of the patients, the indication for nephron-sparing surgery was imperative. Mean tumor size was 3cm (range, 2–4.5). Eight (44.4%) surgeries were performed with renal artery perfusion for cold ischemia; the remaining surgeries were performed under warm ischemia. Intervention(s)After occluding the renal artery and controlling the renal vein by using separate rubber band tourniquets, we excised the tumor mass including delicate mobilization away from the blood vessels. Although we used to insert a ureteral stent at the beginning of our experience with laparoscopic partial nephrectomies, we no longer do so. All surgeries were performed by a single urologist (G.J.). MeasurementsOperative time, ischemia time, blood loss, renal function using the Cockroft formula as well as renal scans, operative and post-operative complications, pathology parameters. Results and LimitationsAll surgeries were completed laparoscopically. Mean surgical time was 238min (range, 150–420). Mean ischemia times were 42.5min (range, 27–63) and 34.1min (range, 24–56) for the cold and warm ischemia groups, respectively. Estimated intraoperative blood loss was 165ml (range, 50–500). There were two (11%) entries into major vessels during tumor excision, namely a segmental renal artery in one patient and a segmental renal vein in another. Both of these occurrences were managed laparoscopically. One patient necessitated laparoscopic reexploration for urine extravasation in the immediate postoperative period. All postoperative nuclear scans (available in 12 of 18 patients) showed functional kidney moiety. Mean split renal function was 38.6% (range, 24–50) on the operated side. Histopathological examination confirmed renal cell carcinoma in 14 (77.8%) of the patients. One (7.1%) patient had a positive surgical margin on the surface that was adjacent to the renal artery. In a median follow-up of 26 mo (range, 1–59), no local recurrence or systemic progression occurred. ConclusionLaparoscopic partial nephrectomy for hilar tumors is a feasible and safe procedure in the hands of experienced laparoscopic surgeons. Oncological results seem excellent, but further follow-up is needed for accurate long-term assessment of this surgical approach.

5-Year Outcomes of Laparoscopic Partial Nephrectomy

Laparoscopic partial nephrectomy is increasingly a definitive therapeutic option in patients with a small renal mass. Intermediate term oncological outcomes after laparoscopic partial nephrectomy are excellent up to a mean followup of 3 years. We present outcomes in 56 patients, each of whom has now completed a minimum of 5 years of followup after laparoscopic partial nephrectomy. Of the 557 laparoscopic partial nephrectomies performed at our institution 58 patients with a localized tumor have completed more than 5 years since surgery. Clinical and renal functional data on 56 patients (97%) were obtained from medical records, radiographic reports and patient contact via telephone. Average patient age was 64 years and 9% were symptomatic at presentation. Average tumor size was 2.9 cm. On histopathology renal cell carcinoma was confirmed in 37 cases (66%) and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in 1 patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median followup of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer specific survival was 86% and 100%, respectively, at 5 years. To our knowledge this is the initial report in the literature of oncological and renal functional outcomes 5 years after laparoscopic partial nephrectomy with excellent results comparable to those of open nephron sparing surgery. At our center laparoscopic partial nephrectomy is an established alternative to open partial nephrectomy.

Temporary Renal Ischemia During Nephron Sparing Surgery is Associated With Short-Term but Not Long-Term Impairment in Renal Function

The emergence of laparoscopic nephron sparing surgery has rekindled interest in the impact of warm renal ischemia on renal function. To provide data with which warm renal ischemia can be compared we analyzed short-term and long-term changes in the glomerular filtration rate after temporary cold renal ischemia. In patients undergoing open nephron sparing surgery the estimated glomerular filtration rate was assessed preoperatively, early in the postoperative hospital stay, and 1 and 12 months after surgery using the abbreviated Modification of Diet in Renal Disease Study equation. We separately analyzed 70 patients with a solitary kidney and 592 with 2 functioning kidneys. The end point was the percent change from the baseline glomerular filtration rate. A linear regression model was used to test the association between the glomerular filtration rate change, and ischemia time, patient age, tumor size, estimated blood loss and intraoperative fluid administration. Median cold ischemia time was 31 minutes in patients with a solitary kidney and 35 minutes in those with 2 kidneys. Compared to patients with 2 kidneys those with a solitary kidney had a significantly lower preoperative estimated glomerular filtration rate (p < 0.001), which decreased a median of 30% during the early postoperative period, and 15% and 32% 1 and 12 months after surgery, respectively. In patients with 2 kidneys the corresponding glomerular filtration rate decreases were 16%, 13% and 14%, respectively. On multivariate analyses in each group cold ischemia duration and intraoperative blood loss were significantly associated with early glomerular filtration rate changes. However, 12 months after surgery age was the only independent predictor of a glomerular filtration rate decrease in patients with 2 kidneys. Cold renal ischemia during nephron sparing surgery is a significant determinant of the short-term postoperative glomerular filtration rate. Longer clamping time is particularly detrimental in patients with a solitary kidney but it does not appear to influence long-term renal function. Patients of advanced age may be less likely to recover from acute ischemic renal injury.