Nephrectomy Research Articles

Abstract A026: Assessing the impact of obesity on postoperative outcomes in RCC using machine learning

Abstract Introduction Obesity is associated with an increased risk of developing renal cell carcinoma (RCC) but paradoxically correlates with improved outcomes in metastatic cases. Moreover, the data on the relationship between obesity and postoperative outcomes following nephrectomy are inconsistent. Accurate prediction of postoperative outcomes, including complications, 30-day readmissions, and mortality, is essential for improving patient outcomes in surgical procedures. In this study, we utilized ML models to predict such outcomes in RCC patients undergoing nephroureterectomy, radical nephrectomy, partial nephrectomy, and other excision procedures on the kidney using data from the National Surgical Quality Improvement Program (NSQIP; 2016- 2021). Methods A gradient-boosted tree (GBT) ML model was developed and trained to predict the primary outcomes of interest: major complications, minor complications, 30-day readmission, and mortality. Patients with a BMI ≥30 kg/m2 were considered obese, and patients with a BMI <30 kg/m2 were used as controls. The model's performance was rigorously evaluated using various measures, such as AUROC, generalized R-square, and misclassification rate. The model's predictions were validated using separate training (70%) and validation (30%) cohorts to ensure generalizability and applicability in diverse patient populations. Results In the analysis, 36,284 cases were included. Bivariate analysis revealed that obesity was associated with an increased rate of minor complications (5.48% vs. 4.41%, p<0.0001) compared to non-obese individuals with similar major complications (3.33 vs. 3.21, p=0.49), mortality (0.54 vs. 0.64, p=0.22) and 30-day readmission rates (5.74 vs. 5.83, p=0.70). The GBT model demonstrated substantial predictive power across all four outcomes. In predicting mortality, the model achieved an AUROC of 0.80 in the validation set, with a misclassification rate of 0.68%. The prediction of major complications was also robust, with an AUROC of 0.91 in the validation set and a misclassification rate of 2.2%. Similarly, the model's performance in predicting minor complications and 30-day readmissions was strong, with AUROC values of 0.70 and 0.66, respectively, in the validation sets. Conclusions Obesity was linked to a higher rate of minor complications but did not affect other postoperative outcomes in RCC patients undergoing nephrectomy. By integrating a wide range of patient-specific variables, ML models are powerful tools for clinicians to identify high-risk patients and tailor perioperative care accordingly. The interaction between RCC and the surrounding adipose tissue microenvironment may have clinical relevance, warranting further research to elucidate the role of BMI in postoperative complications. Our findings advocate for the expanded use of ML techniques in surgical decision-making, which could enhance patient safety, optimize resource use, and improve overall surgical outcomes. Citation Format: Atulya A. Khosla, Manas Pustake, Sufal Chhabra, Yanjia Zhang, Mukesh Roy, Muni Rubens, Venkataraghavan Ramamoorthy, Anshul Saxena, Ishmael A. Jaiyesimi. Assessing the impact of obesity on postoperative outcomes in RCC using machine learning [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr A026.

Possible treatments for synchronous bilateral small renal masses

Currently, there is no established consensus on the best treatment approach for patients with bilateral synchronous renal masses (BSRM). The timing and method of managing these cases remain subjects of debate. This review aims to summarize the available literature and explore the ongoing controversies surrounding this topic. Three studies investigated non-surgical treatments within BSRM. Specifically, one study focused on active surveillance (AS) and showed no statistical differences in terms of progression and development of metastatic disease relative to their unilateral counterpart. Two studies investigated ablative techniques showing promising results. Eight papers have been published regarding robot assisted partial nephrectomy (RAPN) for BSRM. All these papers highlighted the safety, feasibility, and efficacy of bilateral RAPN for BSRM. Literature regarding treatments other than surgery such as AS and ablative therapies (ATs) for BSRM is scarce, but promising. Progression, rate of metastases and survival of BSRM are similar to unilateral disease, and AS is a safe option in these cases. Few studies focused on RAPN related outcomes for BSRMs, but all confirmed the safety, feasibility, and efficacy of this procedure. Finally, one step RAPN resulted as feasible as the two staged procedures, especially when selective clamping techniques can be chosen.

Exploring the Role of Intracorporeal Ultrasound in Partial Nephrectomies: A Systematic Review.

Renal cell carcinoma accounts for the sixth most common cancer in the United Kingdom. With the increasing application of cross-sectional imaging, the frequency of incidental renal masses has increased over time. Laparoscopic and robot-assisted partial nephrectomy has become the standard of care in the management of size and stage-appropriate renal masses. The objective of this systematic review was to analyse the surgical outcomes when intracorporeal ultrasound was utilised as an adjunct in partial nephrectomy. A comprehensive search in PubMed and Google Scholar was performed in July 2024 for publications in the English language. The primary endpoint was to evaluate the role of intracorporeal ultrasound as an adjunct in robotic partial nephrectomies and its impact on tumour clearance. After identifying 609 records, 52 records were screened and 44 records were sought for retrieval. Eight publications were included in this systematic review comprising 765 patients. Seven of the eight studies reported outcomes from single centres. The mean percentage of negative surgical margins was 97.6% (range = 92.1-100%). The use of intracorporeal ultrasound as an adjunct in partial nephrectomy for T1 renal cell cancer has proven to improve the rates of negative surgical margins thereby reducing the incidence of local recurrence and distant metastasis.

The clinical efficacy of monolayer suture combined with hem-o-lok clip in partial nephrectomy among patient with renal cell carcinoma: a quasi-experimental study

ObjectiveTo explore the clinical efficacy of monolayer suture combined with a hem-o-lok clip during partial nephrectomy among patients with renal cell carcinoma (RCC).MethodsEighty patients with RCC underwent laparoscopic partial nephrectomy from January to October 2021. They were assigned into a control group and an intervention group, each with 40 cases using random number table. The control group received double-layer sutures on the wound, while the intervention group had single-layer sutures with a hem-o-lok clip for hemostasis. The study compared operative indexes and postoperative recovery of the two groups.ResultsIntraoperative bleeding and warm ischemia time in the intervention group were significantly shorter than that in the control group. There were no significant differences in operation time, drainage volume on the first day after operation, and hospital stay between the two groups. Before operation, there were no significant differences in serum creatinine and blood urea nitrogen between the two groups. However, 24 h post-operation, both groups experienced a significant increase in these levels, with the intervention group showing lower levels than the control group. Changes in glomerular filtration rate were significantly lower in the intervention group than the control group. Complication rates were similar, with 7.5% in the research group and 10.0% in the control group.ConclusionMonolayer suture combined with a hem-o-lok clip can shorten the time of warm ischemia, reduce intraoperative bleeding and the loss of normal renal parenchyma in patients undergoing laparoscopic partial nephrectomy. More studies with larger sample size are needed to confirm the results.

The prognostic value of visible hematuria is only significant in T1a renal cell carcinoma: a single-center retrospective study

ObjectivesTo investigate the prognostic value of visible hematuria in T1a renal cell carcinoma (RCC).Materials and methodsIn the RCC database of the Chinese People’s Liberation Army General Hospital Department of Urology, we assembled the records of patients with unilateral RCC over 18 years of age diagnosed between 2008 and 2019. The clinical stage was cT1, and the tumors ranged in size from 0 to 7 cm. The primary treatments were partial nephrectomy (PN) or radical nephrectomy (RN). Logistic regression analysis, Cox regression, interaction analysis, and Kaplan-Meier survival analysis were used to study the correlation between visible hematuria and progression-free survival (PFS), and cancer-specific survival (CSS).ResultsA total of 7,610 patients with cT1 RCC comprised the study population, including 505 RCC patients with visible hematuria. The average follow-up time was 64.6 months (range: 12–144 months). Visible hematuria was significantly associated with the prognosis (PFS, hazard ratio [HR] = 2.7, P < 0.001; CSS, HR = 4.2, P < 0.001) of T1a RCC, but was more significant for CSS in cases of a tumor size ≤ 2 cm (HR = 26.8, P = 0.026). This effect was not significant in T1b RCC (PFS, HR = 0.7, P = 0.153; CSS, HR = 1.1, P = 0.862). The interaction between visible hematuria and tumor size was significant (P = 0.001).ConclusionsThis study showed that visible hematuria was an independent risk factor for PFS and CSS in T1a RCC. The predictive value of visible hematuria for CSS was more significant in RCCs ≤ 2 cm, but did not reach statistical significance in T1b RCC. T1a RCC patients with visible hematuria should be intensively monitored during follow-up.

The clinical application value of mixed reality in robotic laparoscopic partial nephrectomy

PurposeRobot-assisted laparoscopic partial nephrectomy (RAPN) has become a key technology in the treatment of renal tumors. Effective preoperative planning and precise intraoperative navigation are critical to a successful surgical outcome. This study aimed to evaluate the clinical application value of mixed reality (MR) in robotic nephron-sparing partial nephrectomy for patients with renal tumors of different complexity based on the R.E.N.A.L. score.Patients and methodsA retrospective analysis was conducted on 68 eligible patients with renal cancer who underwent RAPN at The Second Affiliated Hospital of Nanchang University from January 2021 to December 2023, with postoperative pathology confirmation. Patients were divided into two groups: the MR group, with 28 cases, and the traditional imaging (control) group, with 40 cases. All patients underwent mid-abdominal CT plain scans and enhancements. The MR group utilized three-dimensional reconstruction of CT data and employed 3D tablets and HoloLens glasses for preoperative discussions, surgical planning, and intraoperative guidance. Collect clinical data and metrics to assess surgical outcomes, as well as evaluate performance in areas such as preoperative discussions, doctor-patient communication, surgical planning, and intraoperative navigation.ResultsCompared to robot-assisted partial nephrectomy in the control group, the MR group experienced a reduction in operation time by approximately 30 min [(135.89 ± 23.494) min vs. (165.00 ± 34.320) min, P&amp;lt; 0.001)] and a decrease in ischemia time by around 2.5 min [(20.36 ± 3.956) min vs. (23.80± 6.889) min, P = 0.02)]. Within the subgroup with a R.E.N.A.L. score of less than 7 points, the MR group only showed a significant reduction in operation time [(134.55 ± 150.190) min vs. (150.19 ± 28.638) min, P = 0.045], with no notable differences in other parameters. For the subgroup with a R.E.N.A.L. score of 7 points or higher, the MR group exhibited shorter operation time [(140.83 ± 25.183) min vs. (195.77 ± 23.080) min, P&amp;lt; 0.001] and reduced warm ischemia time [(21.17 ± 2.714) min vs. (28.85 ± 7.570) min, P = 0.029]. Additionally, there was less estimated blood loss [(53.33 ± 5.164) min vs. (114.62 ± 80.376) min, P = 0.018]. All patients had negative resection margins, indicating equivalent therapeutic outcomes between the two groups.ConclusionIn comparison to traditional RAPN, MR technology demonstrates the ability to decrease operation time and warm ischemia time all the while maintaining equivalent curative outcomes. Additionally, it enhances preoperative discussions, doctor-patient interactions, preoperative strategizing, and intraoperative navigation, particularly excelling in complex renal tumor cases of RAPN, where its benefits are most pronounced.

Over-the-Wire Retrieval of Infectious Hemodialysis Catheter-Related Right Atrial Thrombus Causing Recurrent Pleural Empyema and Sepsis: A Case-Based Review

Introduction: Infectious catheter-related right atrial thrombus (CRAT) is a potentially fatal but often underestimated contingency associated with central venous catheter (CVC) in patients on hemodialysis. Management guidelines for CRAT are lacking, and its occurrence poses clinical challenges. Here, we describe the case of an infectious CRAT in a young patient on hemodialysis with peculiar clinical complications and perform a literature review. Case presentation and literature review: A 30-year-old man on hemodialysis after bilateral nephrectomy due to polycystic disease presented with hyperpyrexia resistant to broad-spectrum antibiotics. A pleural empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) was diagnosed. Since fever persisted despite targeted antibiotic therapy, a transthoracic echocardiogram to exclude infective endocarditis was performed, showing a right atrial thrombus. CVC was promptly removed and the thrombus was aspirated through a percutaneous retrieval system. The thrombus cultural exam resulted positive for MRSA. After performing an extensive literature review, we could not find another case reporting the concomitance of these two rare complications. Conclusions: CRAT is a life-threatening complication in hemodialysis patients. While various treatment options exist, evidence-based guidelines are lacking, leading to individualized management strategies. Minimizing CVC use remains the best option for preventing such a complication.

C-reactive Protein-albumin-lymphocyte Index as a Novel Biomarker for Progression in Patients Undergoing Surgery for Renal Cancer.

Some patients with renal cell carcinoma (RCC) develop early or late recurrence after surgery. However, there is no clear consensus on which patients with postoperative RCC should be treated. This study aimed to establish a biomarker for selecting patients who are at a higher risk of relapse following renal cancer surgery. A total of 378 patients who underwent nephrectomy or partial nephrectomy for a diagnosis of RCC at our hospital were included, with a focus on pT3 cases at high risk of recurrence. Factors associated with postoperative progression, including pathological and hematological parameters, were examined. Sarcomatoid features, Fuhrman grade 4, and C-reactive protein-albumin-lymphocyte (CALLY) index were statistically significant predictive factors for progression-free survival after surgery (p<0.0011, p=0.0047, and p<0.0001, respectively). In the multivariate Cox proportional regression analysis, the CALLY index was the most statistically significant predictor of the risk of postoperative recurrence (p=0.0002). In addition to the existing risk factors for RCC recurrence, such as sarcomatoid features and Fuhrman grade, we propose that the CALLY index is a predictor of postoperative recurrence and that patients with a low CALLY index are good candidates for postoperative treatment. Our study may help select patients with pT3 disease with a high risk of recurrence who require postoperative treatment.

LINC00365 as a potential biomarker for total nephrectomy in advanced-stage renal cell carcinoma patients

BackgroundRenal cell carcinoma (RCC) is one of the most frequent urological cancers globally that has a good prognosis in the early tumor stages. However, there is a poor prognosis in metastatic RCC patients. Therefore, it is needed to evaluate the molecular biology of RCC progression to introduce the efficient diagnostic and therapeutic markers in these patients. Long non-coding RNAs (lncRNAs) have key roles in regulation of molecular mechanisms during RCC progression. In the present study, we assessed the levels of LINC00365 expressions in RCC patients to suggest that as a tumor marker in these patients. MethodsFifty fresh RCC tumor tissues and their normal margins were collected to assess the levels of LINC00365 expressions and probable correlations with clinicopathological features of RCC patients. ResultsThere was significant LINC00365 up regulation in females compared with males (p=0.050). Among the RCC patients with total nephrectomy, there was a significant LINC00365 up regulation in advanced stage compared with primary stage tumors (p=0.035). RCC patients older than 60 years old who were undergone the total nephrectomy had also significant LINC00365 up regulation compared with RCC patients younger than 60 years old (p=0.039). Conclusionsgiven the significant increase in LINC00365 expression in advanced stage RCC tumors and patients over 60 years old who had total nephrectomy; it could serve as a useful diagnostic marker in screening programs for old high-risk individuals. It was also noticed that female RCC patients had elevated levels of LINC00365 expressions in their tumor samples, suggesting its potential use as a gender-specific diagnostic marker for high-risk females. Nevertheless, evaluating the levels of LINC00365 in serum samples of RCC patients is necessary to suggest that as a reliable diagnostic marker in clinical settings.

ADVANCES IN UPPER URINARY TRACT ANATOMY THROUGH IMAGING TECHNIQUES

This scoping review was conducted based on the Joanna Briggs Institute's theoretical framework and registered with the Open Science Framework (https://osf.io/b27wc). The study analyzed 29 manuscripts published between 2013 and 2023, focusing on imaging exams to synthesize evidence on the anatomy and clinical correlations of the upper urinary tract. The results revealed significant findings, highlighting the intrarenal pelvis as a possible predictive indicator of urinary loss after partial nephrectomy. This emphasizes the importance of anatomical assessment of the renal pelvis. Brödel's avascular plane has been categorized into three types relevant to pre-surgical patient planning. Multiple renal arteries and venous variations have also been reported, including retro-aortic and circum-aortic renal veins. A movable section related to the ureter was described in the perirenal space, delimited by the point of intersection with the gonadal vessels. The ureteropelvic and ureterovesical junctions were found to be anatomical points susceptible to ureteral constriction. On the other hand, the point at which the ureter crosses the iliac vessels is no longer considered a site prone to ureteral obstruction. The authors emphasize the need to adopt a standardized terminology to describe the anatomical variations of the blood vessels related to the kidney. Using diverse and unclear terms can hinder teaching and research in this area and lead to inaccuracies. From the authors' perspective, imaging exams have enhanced anatomical accuracy, benefiting the teaching of human anatomy and significantly contributing to continuous medical breakthroughs.

P205 Comparative outcomes of partial vs. radical nephrectomy for localized renal carcinomas: Insights from real-world data

P205 Comparative outcomes of partial vs. radical nephrectomy for localized renal carcinomas: Insights from real-world data

Application of Multi-Slice Spiral CT Renal Angiography Combined with Intraoperative Ultrasound in Laparoscopic Partial Nephrectomy.

This study aimed to evaluate the clinical significance of multi-slice spiral CT renal angiography combined with intraoperative ultrasound in laparoscopic partial nephrectomy. Eighty patients were seen at the Affiliated Hospital of Hebei University from January 2021 to December 2022. The patients were divided into two groups, the experimental group and the control group, with 40 cases in each group. The experimental group received laparoscopic partial nephrectomy combined with intraoperative ultrasound, while the control group received only conventional laparoscopic partial nephrectomy. The experimental group had significantly shorter operative time and intraoperative thermal ischaemia time (p <0.05) and had significant advantage in the detection of microscopic cancer foci (p = 0.04). The experimental group also had significantly lower of positive rate of postoperative incisal margin (p = 0.01). The experimental group had significantly lower of recurrence rate (p = 0.03). The study concluded that multi-slice spiral CT renal angiography combined with intraoperative ultrasound boasts various benefits in the treatment of patients with renal cell carcinoma, it is safe and effective with no significant impact on renal function. Key Words: CT renal angiography, Intraoperative ultrasound, Laparoscopic partial nephrectomy, Renal cancer.

Valveless and conventional insufflation on pneumoperitoneum-related complications in robotic partial nephrectomy: a systematic review and meta-analysis of prospective studies

IntroductionThe use of pneumoperitoneum is an essential step for performing laparoscopic and robotic surgery. Pneumoperitoneum insufflation can cause complications such as pneumothorax, subcutaneous emphysema, and pneumomediastinum. The purpose of this meta-analysis is to compare the safety of using the conventional insufflation system versus a Valveless insufflation system as devices for manufacturing pneumoperitoneum in robotic-assisted nephrectomy.MethodsA comprehensive literature search was conducted on PUBMED, EMBASE, SCOPUS, and Cochrane, from inception until January 2024. Randomized and nonrandomized prospective studies were included in the meta-analysis, performed by the R+ Rstudio.ResultsThree publications encompassing 478 patients were included. We observed no difference in SCE (OR 0.60, CI 95% 0.27;1.34, p = 0.134, I2 = 0), PNM (OR 0.82, CI 95% 0.24;2.78, p = 0.558, I2 = 0), When comparing groups conventional insufflation system (CIS) versus AirSealTM insufflation system (AIS) with pneumoperitoneum pressure of 15 mmHg or 12 mmHg.ConclusionThe presented data showed no difference between the AIS when compared with CIS in Pneumoperitoneum insufflation-related complications.

Application of Multi-Slice Spiral CT Renal Angiography Combined with Intraoperative Ultrasound in Laparoscopic Partial Nephrectomy.

This study aimed to evaluate the clinical significance of multi-slice spiral CT renal angiography combined with intraoperative ultrasound in laparoscopic partial nephrectomy. Eighty patients were seen at the Affiliated Hospital of Hebei University from January 2021 to December 2022. The patients were divided into two groups, the experimental group and the control group, with 40 cases in each group. The experimental group received laparoscopic partial nephrectomy combined with intraoperative ultrasound, while the control group received only conventional laparoscopic partial nephrectomy. The experimental group had significantly shorter operative time and intraoperative thermal ischaemia time (p <0.05) and had significant advantage in the detection of microscopic cancer foci (p = 0.04). The experimental group also had significantly lower of positive rate of postoperative incisal margin (p = 0.01). The experimental group had significantly lower of recurrence rate (p = 0.03). The study concluded that multi-slice spiral CT renal angiography combined with intraoperative ultrasound boasts various benefits in the treatment of patients with renal cell carcinoma, it is safe and effective with no significant impact on renal function. Key Words: CT renal angiography, Intraoperative ultrasound, Laparoscopic partial nephrectomy, Renal cancer.

Regional analgesia techniques following nephrectomy: a systematic review and network meta-analysis.

This network meta-analysis (NMA) was performed to assess the relative efficacy and safety of various regional analgesic techniques used in patients undergoing partial nephrectomy or nephrectomy. Randomized controlled trials (RCTs) evaluating different regional analgesia techniques in patients underwent partial nephrectomy or nephrectomy were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to January 2024. The NMA was made by using Stata 15.1 softwares. The certainty of evidence was assessed by using CINeMA. We included 27 trials with 1852 patients and 14 techniques. Postoperative resting pain scores within 24 hours were decreased by erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), intrathecal morphine (IM), retrolaminar block (RLB). Postoperative movement pain scores within 24 hours were decreased by ESPB, TPVB, lateral quadratus lumborum block (QLB-L), transversus abdominis plane block. Postoperative opiates consumption within 24 hours were decreased most by QLB-L, followed by transmuscular QLB (QLB-TM), TPVB, and IM. Postoperative nausea and vomiting (PONV) were decreased by RLB, anterior QLB approach at the lateral supra-arcuate ligament (QLB-LSAL). Length of hospital stay were decreased by TPVB, ESPB. This available evidence suggests that ESPB and TPVB are more likely to reduce pain scores within 24 hours and shorten the length of hospital stay. QLB-L and QLB-TM are more likely to reduce the cumulative opiates consumption within 24 hours. RLB and QLB-LSAL are more likely to decrease the incidence of PONV. The wound infiltration (WI), intraperitoneal instillation (IPI), and WI+IPI are less likely to be effective.

Surgery or Comorbidities: What Is the Primum Movens of Kidney Dysfunction After Nephrectomy? A Multicenter Study in Living Donors and Cancer Patients.

Background and Hypothesis: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are significant risks for kidney cancer (KC) patients undergoing partial (PN) or radical nephrectomy (RN) and for living kidney donors (LKD). This study compares AKI and CKD incidence in these groups with a pre-operative glomerular filtration rate (GFR) over 60 mL/min/1.73 m2. Methods: This study included 465 KC patients with cT1-2N0M0 kidney mass and 256 LKD who underwent nephrectomy at four Italian institutions from 2014 to 2021. Data on demographics, comorbidities, and therapies were analyzed. Serum creatinine and estimated GFR (eGFR) were measured before and after surgery. Outcomes were AKI (per KDIGO guidelines) and CKD stage progression. Analyses included descriptive statistics, ANOVA, logistic regression, and Kaplan-Meier survival. Results: Among 721 patients, significant age and gender differences were noted. Hypertension (41%) and diabetes (7.1%) were prevalent in RN and PN groups. Post-surgery AKI was more common in donors (84%), while CKD stage progression varied by surgery type (CKD stage G3 after 60 months: RN 48.91%, PN 18.22%, LKD 26.56%). Age, pre-surgery CKD, and surgery type predicted CKD progression. Limitations include retrospective design and bias. Conclusions: Both LKD and KC patients face similar AKI and CKD risks. Surgery type significantly influences AKI and CKD incidence, highlighting the importance of approach.

Implementation of surgical rehearsal utilizing patient specific hydrogel kidney phantoms prior to complex renal cancer surgery: a pilot study.

With the advancement of surgical technology, the opportunity to integrate novel surgical preparation is imperative to improve patient outcomes and enhance safety. Patient specific perfused kidney phantoms including the tumor, parenchyma, artery, vein, and calyx were fabricated using 3D-printing and hydrogel injection molding from scans of 25 patients scheduled for robotic partial-nephrectomy (RAPN). Models are validated for anatomical accuracy, mechanical, functional properties and surrounded by the other models of relevant anatomy in a body cast for a simulated surgical rehearsal. We investigated the impact of these preoperative rehearsals preceding complex RAPN by analyzing changes in surgeons' decisions following review of both axial-imaging and following rehearsal simulation. Predictive ability of these rehearsal platforms was compared to live surgery outcomes and trifecta of cases as an outcome was calculated. 25 patients with complex renal tumors, average 9.8 nephrometry score and 4.9cm mean tumor diameter were consented. Mean blood loss and WIT were 193.2ml and 19.8min. Two Clavien 2 complications were reported at 30-day postoperative. Trifecta was achieved in 17 (68%) of surgical cases. Surgeons' confidence in their ability to complete a partial nephrectomy and ability to predict WIT significantly increased from initial viewing the axial imaging to after the rehearsal. The correlation coefficient between the procedural clinical data collected during the rehearsals and live surgery were calculated. The application of this versatile method for creating authentic perfused kidney phantoms can result in increased confidence in surgical plan and thus improved surgical performance and outcomes.

Urine leak and vascular complications following robotic partial nephrectomy: a contemporary single-center experience.

Urine leak (UL) and vascular complications (VC), i.e., pseudoaneurysms and arteriovenous fistulas are well-described complications of robotic-assisted partial nephrectomy (RAPN). Historically, UL incidence ranges from 0.3 to 17% and VC from 0.8 to 5.6%. We report the contemporary experience of UL and VC from a single, high-volume center in cases of RAPN. 447 patients were identified from an IRB-approved Renal Tumor Database of 2174 cases who underwent RAPN from 1/2017 to 5/2023. VC occurred in 9 cases (4 pseudoaneurysms, 1 AV fistula, 4 concurrent AV fistula/pseudoaneurysm), UL occurred in 9 (2.0%), and there was one concurrent case of VC and UL. Collecting-system entry occurred in five VC cases and five UL cases. For VCs, the median nephrometry score and maximal tumor diameter was 8 (IQR 3.0) and 3.8 (0.9)cm, respectively, and 8 (3.0) and 3.7 (1.1)cm for UL cases, respectively. Most complications occurred with tumors ≤ 4mm from the collecting system (n = 7 VC, n = 6 UL). VCs presented after 18 (6.0)days, 6 with gross hematuria; 3 required clot irrigation, 1 required continuous bladder irrigation, and 8 required embolization. No patients required postoperative transfusion. Patients with UL presented after a median of 1 (12)day, with 5 cases detected by elevated creatinine in drain fluid and the remainder detected on routine ultrasound. The duration of UL was 13 (41)days with only 2 cases requiring stenting and one case requiring a drainage catheter. No patients required kidney re-operation or removal. Our rate of VC and UL following RAPN are low and consistent with other contemporary series. Complications occurred in patients with high nephrometry scores or tumors located close to the collecting system. Both complications generally present early and can be managed without kidney re-operation or removal.

Omission of intraoperative drain placement during robotic partial nephrectomy and robotic radical prostatectomy is safe: an analysis of 18,000 patients

PurposePlacement of a drain during robotic assisted partial nephrectomy (RAPN) and robotic assisted radical prostatectomy (RARP) is standard practice for many urologists and can aid in assessment and management of complications such as urine leak, lymphocele, or bleeding. However, drain placement can cause discomfort and delay patient discharge, with questionable benefit. We aim to assess the correlation between drain placement with post operative complications.MethodsThe NSQIP targeted database was queried for patients who underwent RAPN or RARP from 2019 to 2021. Our primary outcomes included 30-day complication rates stratified by intraoperative drain placement. Secondary outcomes included procedure-specific complications, length of stay (LOS), and readmissions. Multivariable regression analyses, with Bonferroni correction, were performed for each post-operative complication.ResultsWe identified 4738 and 13,948 patients who underwent RAPN and RARP, respectively. Drains were not placed in 2258 (47.7%) and 6700 (48%) patients, respectively. On adjusted multivariable analysis in the RAPN cohort, omission of drain placement was associated with decreased LOS (β -0.45; 99.58% CI [-0.59, -0.32]) but no difference in overall complication rates. After adjusted analysis in the RARP cohort, omission of drain placement was associated with decreased risk of any complication (OR 0.73 [0.62–0.87]), infectious complication (OR 0.66 [0.49–0.89]), and LOS (β -0.30 [-0.37, -0.24]).ConclusionsUsing a large contemporary database, this study demonstrates that omission of drains during RAPN and RARP was safe without increased risk of postoperative complications. Despite inherent selection bias in this cohort, our data suggests that routine drain placement is not necessary for these procedures.

Survival improvement over time in renal cell carcinoma treated with nephrectomy: A longitudinal propensity score-matched study.

Surgical treatment for renal cell carcinoma (RCC) has drastically evolved for the past 30 years. However, survival outcomes of RCC according to times have not been fully elucidated, especially in the real-world setting. This study aimed to assess the survival improvement over time in RCC treated with nephrectomy by analyzing a longitudinal cohort using propensity score matching (PSM). We retrospectively reviewed 960 patients with RCC who underwent radical or partial nephrectomy between 1981 and 2018. Patients were divided into two groups according to the time of surgery (1981-1999 vs. 2000-2018). Using PSM, overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared between the two groups. Overall, 255 and 705 patients underwent surgery in the earlier (1981-1999) and recent (2000-2018) eras, and PSM derived a matched cohort of 466 patients (233 patients per each group). All patients in the earlier era cohort received open surgeries, whereas about a half (47.4%) of patients in the recent era cohort received minimally-invasive (laparoscopic/robotic) surgeries. After PSM, 137 (29.4%) patients developed recurrence, 105 (22.5%) died of RCC, and 113 (24.2%) died from other causes, with a median follow-up period of 90 months. The recent era cohort had significantly longer OS, CSS, and RFS than the earlier era cohort. Patients with RCC treated in the recent era (2000-2018) showed significantly longer survival than those treated in the earlier era (1981-1999). The improved survival might be attributable to the prevalence of minimally-invasive (laparoscopic/robotic) surgeries.