Retroperitoneoscopic Partial Nephrectomy Research Articles

Comparing technology-based scoring systems for retroperitoneoscopic partial nephrectomy

Comparing technology-based scoring systems for retroperitoneoscopic partial nephrectomy

MP47-13 A Comparative Analysis of Robot-assisted Retroperitoneoscopic Partial Nephrectomy (RARPN) for Anterior vs Posterior Renal Tumors: A Propensity Score Matched Analysis in a Multi-institutional Cohort.

You have accessJournal of UrologyErrata1 Jul 2023MP47-13 A Comparative Analysis of Robot-assisted Retroperitoneoscopic Partial Nephrectomy (RARPN) for Anterior vs Posterior Renal Tumors: A Propensity Score Matched Analysis in a Multi-institutional Cohortis correction ofMP47-13 A COMPARATIVE ANALYSIS OF ROBOT-ASSISTED RETROPERITONEOSCOPIC PARTIAL NEPHRECTOMY (RARPN) FOR ANTERIOR VS POSTERIOR RENAL TUMORS: A PROPENSITY SCORE MATCHED ANALYSIS IN A MULTI-INSTITUTIONAL COHORT View All Author Informationhttps://doi.org/10.1097/JU.0000000000003489AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Volume 209, Issue Supplement 4, Page e649: The fourth author’s name is Mukund Bhandari and the fifth author's name is Indu Saini. The online and PDF versions of the article have been updated. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology23 Mar 2023MP47-13 A COMPARATIVE ANALYSIS OF ROBOT-ASSISTED RETROPERITONEOSCOPIC PARTIAL NEPHRECTOMY (RARPN) FOR ANTERIOR VS POSTERIOR RENAL TUMORS: A PROPENSITY SCORE MATCHED ANALYSIS IN A MULTI-INSTITUTIONAL COHORT Volume 210Issue 1July 2023Page: 222-222 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement Advertisement PDF downloadLoading ...

Single-port retroperitoneoscopic partial nephrectomy: Initial description and standardisation of technique.

Minimally invasive surgery has been established as the gold standard for the treatment of localised renal tumours. A retroperitoneal approach is a feasible option with advantages in posterior tumours and patients with previous abdominal surgeries. In this context, single-port retroperitoneoscopic partial nephrectomy (SPOR-PN) has not been widely explored and developed. We present this technique's description and our first results. We present a case series of nine patients undergoing SPOR-PN in a single institution. We used a multi-channel single-port access dispositive through a 35 mm incision below the 12th rib, a 30° two-dimensional laparoscope, curved graspers and needle drivers on the left hand and standard rigid material in the right hand. In all surgeries, we performed a complete renorrhaphy with the sliding-clip technique. The pain was evaluated through visual analogue scale (VAS) the day after surgery. Patients' age ranged from 44 to 78 years. The median RENAL score was 5p, and the mean surgical time was 134 min. We performed an 'off-clamp' procedure on three patients. Among the patients who had renal artery clamped, the median ischaemia time was 18 min. The median in-hospital stay time was 48 h. Median VAS the day after surgery was 2. None of the anatomical pieces had positive borders. Only one complication was reported (Clavien IIIa). SPOR-PN is a feasible minimally invasive and nephron-sparing technique. The advantages of this procedure may not be only a better cosmetic appearance but also less post-operative pain. Further development and larger studies are needed.

Analysis of Trifecta Results in a Single-Center Experience with Retroperitoneoscopic Partial Nephrectomy: An Observational Study.

To analyze the trifecta results in patients with T1a and T1b renal tumors treated with retroperitoneoscopic partial nephrectomy (RPN). A cross-sectional prospective observational study was conducted on 106 patients with cT1 renal tumor submitted to RPN. Trifecta was reported as no ≥ 2 Clavien-Dindo complications, warm ischemia time (WIT) ≤ 25 minutes, ≤ 15% postoperative ΔGFR, and nonpositive margins. The mean age was 58 years (SD ± 12). The median (Q1; Q3) tumor size was 3.5 (2.2; 4.5) cm. Of the treated patients, 33% had a ventral tumor. R.E.N.A.L nephrometry score was low complexity in 54% of cases and high complexity in 4%. WIT median (Q1; Q3) was 20 (14; 23) minutes. Estimated blood loss median (Q1; Q3) was 50 (0; 100) ml. There were no conversions to open surgery. ΔGFR was >15% in 17.5% of patients. There were no postoperative complications in 84% of cases. Nonpositive margins were observed. Sixty-eight percent were pT1a and 32% were pT1b. Seventy-two percent of patients presented trifecta. A statistically significant difference was found between trifecta and tumor size (3 cm vs. 4.4 cm; p<0.001), complexity (low complexity 90% vs. intermediate complexity 56%; p<0.0001), and pT (T1a 81% vs. T1b 53%; p<0.003). RPN is a safe and effective treatment modality for T1a and T1b renal tumors. Trifecta rate was 72%. Tumor size, tumor complexity, and pT were found to be an associated factor for trifecta.

Management of renal tumors during pregnancy: case reports

BackgroundRenal tumors during pregnancy are rare and the treatment requires evaluation of both the patient and the fetus. No consensus or guidelines has been proposed or verified in this field. We successfully managed three renal tumor cases during pregnancy and reviewed the relative literature.Case presentationIn the first renal cell carcinoma case diagnosed in the 21st week of pregnancy, laparoscopic retroperitoneoscopic partial nephrectomy was performed in the 26th week of pregnancy. In the second renal cell carcinoma case diagnosed in the 3rd week of pregnancy, laparoscopic retroperitoneoscopic radical nephrectomy was carried out after the abortion. In the third angiomyolipoma case who was diagnosed before pregnancy but received no treatment, we performed laparoscopic retroperitoneoscopic partial nephrectomy during the 17th week of pregnancy due to the rapid enlargement of the tumor.ConclusionAlthough no consensus or guidelines for the management of renal tumors in pregnant patients has been proposed or verified, the general rules of kidney tumor management in non-pregnant patients and the guidelines for surgery in pregnancy could be referred to. Renal tumors found in pregnant patients require an individualized treatment regimen involving surgical timing, routes, techniques, and excision ranges, which should be decided by both the patients and the surgical teams.

Retroperitoneoscopic partial nephrectomy for renal cell carcinoma: A single-center Indian experience

Objective:Retroperitoneoscopy, by avoiding peritoneal breach and injury to intra-abdominal organs, provides a more direct and rapid access to the kidney and the renal hilum. Laparoscopic partial nephrectomy by retroperitoneal route (LPNR) is less commonly performed than transperitoneal route for early stage renal cancer. The objective of this study is to carry out the outcomes of partial nephrectomy using retroperitoneal approach.Materials and Methods:Patients, who underwent LPNR from period 2008 to 2014, were retrospectively analyzed. Outcomes of interest included demographic data, preoperative data, perioperative variables, surgical complications, recurrence of disease, and mortality, if any, during their follow-up.Results:Among 24 patients, 16 were male, and 8 were female. Mean age and mean body mass index, respectively, were 49.16 years (range: 25–75) and 25.35 kg/m2 (17.84–34.25). Among renal masses, the right-sided to left-sided distribution was 13:11. The proportions of low-risk and intermediate-risk nephrometry score (NS) cases were 13 (54.17%) and 11 (45.83%), respectively, as assessed by renal NS. Mean operative duration, mean warm ischemia time, mean estimated blood loss, and mean hospital stay, respectively, were 132.5 min (90–170), 21.83 min (15–44), 106 ml (25–300) ml, and 5.25 days. During the postoperative period, complications encountered were lung atelectasis in one, bleeding in two, and urinary leakage in one. Histopathology revealed malignancy in 23 patients and leiomyoma in the remaining one. All patients but two experienced a disease free survival during a median follow- up period of 33 months.Conclusion:Overall outcomes for LPNR is comparable to the outcomes for open and transperitoneal laparoscopic partial nephrectomy mentioned in the literature and is equally safe for the right-sided and left-sided lesions.

Robot-assisted Retroperitoneoscopic Partial Nephrectomy

Objective: To compare the results from 3-arm and 4-arm robot assisted retroperitoneoscopic partial nephrectomy (RARPN) in our initial case series in terms of oncologic and functional outcomes. Patients and Methods: 35 RARPN performed for malignant small renal masses in our hospital were categorized by the method used, 3-arm or 4-arm. Patient demographics (age, body mass index, tumor size, R.E.N.A.L. nephrometry score, tumor location), perioperative outcomes (operative time, warm ischemic time, estimated blood loss, length of stay, surgical margin status, complications, pathology) and functional outcomes (pre and post operative renal function change) were compared. Results: Initial 14 cases were performed in 3-arm method while latter 21 cases performed in 4-arm method. The tumor size was larger in the 4-arm group (3.5 cm vs 2.3 cm, P = 0.0261) but the warm ischemic time was significant shorter in 4-arm group (17 mins vs 23 mins, P = 0.0093). There were no other significant differences in remaining patient demographics, perioperative outcomes and functional outcomes. Conclusion: 4-arm RARPN is a safe, feasible technique in treating malignant small renal masses even the tumor is located at anterior portion as it provides good traction and exposure on surgical field, thus reducing the warm ischemic time.

Comparative study of P.A.D.U.A. and R.E.N.A.L. scoring system in patients undergoing retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

Comparative study of P.A.D.U.A. and R.E.N.A.L. scoring system in patients undergoing retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

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

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

Preoperative scoring systems used in retroperitoneoscopic partial nephrectomy for T1-T2 renal tumors

Introduction. P.A.D.U.A. (The preoperative aspects and dimensions used for anatomic), R.E.N.A.L. (radius exophytic/endophytic nearness anterior/posterior location) and zonal NePhRO scoring were developed in an effort to predict the intraoperative (warm time ischemia, blood loss) and postoperative complications in patients undergoing partial nephrectomy, with an important role on surgical decision-making (2-4). Materials and methods. Between January 2014 and July 2017, 37 patients(p) underwent retroperitoneoscopic nephro-sparing surgery at our center for clinically localized renal tumor. All patients had a normal contralateral kidney. The selection of patients for nephro-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. A chart review was carried out, including age, sex, anatomic preoperative scoring system (P.A.D.U.A., R.E.N.A.L. nephrometry and zonal NePhRO), operative time (skin opening to skin closing), estimated blood loss (EBL), warm ischemia time (WIT), hospital stay. Results. The mean age of patients with partial nephrectomy was 54.3±9.1 years. Mean preoperative serum creatinine level for the patient group was 0.97±0.14 mg/dl. All patients had normal contralateral kidney. Average tumor diameter in this group was 3.6± 0.86 cm. When using P.A.D.U.A. score to predict warm time ischemia p value was of 0.001, even if the mean warm ischemia time is higher in medium risk patients than in high risk patients 24.3 min vs. 23.2 min. R.E.N.A.L. nephrometry score was able to predict the warm ischemia time according to the risk groups (17.6 vs. 23.9 vs. 31 min) with a p value under 0.001. Zonal NePhRO score was statistically correlated with total operative time, blood loss, warm ischemia and renal function decrease, all with a p value &lt; 0.05. Conclusion. P.A.D.U.A. score, R.E.N.A.L. nephrometry score and Zonal NePhRO score have proved to be reliable preoperative tools in order to evaluate surgical complexity and to predict outcomes such as warm time ischemia, blood loss, postoperative estimated GFR and complications rate.

Retroperitoneoscopic Partial Nephrectomy for Moderately Complex Ventral Hilar Tumors: Surgical Technique and Trifecta Outcomes from a Single Institution in China.

T1 ventral renal hilar tumors (VRHTs) represent a very special type of tumor, for which laparoscopic partial nephrectomy (LPN) by the retroperitoneal approach is challenging. In this study, we report our surgical technique and Trifecta results. Renal rotation technique has been established for retroperitoneal laparoscopic partial nephrectomy (RLPN) for VRHTs in our institution. Trifecta was used as a composite outcome measure for assessing quality of PLPN using this technique. A retrospective analysis of RLPN cases in 12 patients with VRHTs was performed. Mean tumor size was 3.4 cm and median R.E.N.A.L. score was 8 (range 7-9). Mean warm ischemia time was 23.1 minutes, suture time 28.1 minutes, estimated blood loss 139.2 mL, operation time 122.8 minutes, and median hospital stay was 4 days. Three patients (25.0%) had Clavien-Dindo grade I-II complications. Seven patients (58.3%) achieved Trifecta. Postoperative pathological examination showed renal cell carcinoma in all cases with negative surgical margin. A median follow-up of 7 months revealed no local recurrence or distant metastases. Our Trifecta outcomes demonstrate that RLPN with renal rotation technique is feasible, safe, and effective for moderately complex VRHTs. The short-term functional and oncologic outcomes are promising; however, long-term follow-up is needed.

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

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

Retroperitoneoscopic Heminephrectomy in Duplex Kidney in Infants and Children: Results of a Multicentric Survey.

Retroperitoneoscopic partial nephrectomy (RPN) in children is considered a complex technique with limited diffusion among pediatric surgeons and urologists. We aimed to report the outcome of this technique in infants and children with duplex kidney in a 5-year retrospective multicentric international survey. Data on 50 children who underwent RPN (41 upper-pole nephrectomies and 9 lower-pole nephrectomies) were retrospectively collected in this six-institution survey. Median age at surgery was 3.3 years. There were 35 girls and 15 boys. The left side was affected in 28 patients, versus the right side in 22 patients. We assessed intraoperative and postoperative morbidity. Follow-up (median, 2.5 years; range, 12 months-5 years) was based on clinical controls and echo color Doppler renal ultrasound scans. Median duration of surgery was 255 minutes. Surgery was always performed with the patient in a lateral position. Special hemostatic devices were used for dissection and parenchymal section in all centers. Three patients from two centers (6%) required conversion to open surgery. We recorded seven complications (six peritoneal perforations, one opening of the remaining calyxes) in the 50 cases. Re-operation rate was 0%. Average length of hospital stay was 4.1 days. Our survey shows that RPN remains a challenging procedure with a long learning curve, performed only in pediatric centers with huge experience in this field. In our survey operative time was longer than 4 hours. The complication rate remains high (7/50, or 14%), with complications classified as Grade II according to the Clavien-Dindo classification. They did not require further surgery, but they were associated with a prolonged hospital stay.

Application of renal-rotation techniques in retroperitoneoscopic partial nephrectomy.

Retroperitoneoscopic partial nephrectomy (RPN) is one of the standard methods for treating T1-stage renal carcinoma, which has a narrow operational space and a difficult surgical procedure. The aim of this study was to examine the safety and feasibility of renal-rotation techniques in RPN. Between April 2012 and June 2014, the renal-rotation technique in RPN was performed in 22 male and 16 female patients, aged between 31 and 75 years (mean, 52 years), with stage T1N0M0 renal-cell carcinoma. In 29 cases the tumor was located at the ventral side of the kidney, including 22 cases at the renal hilum, and in nine cases the tumor was located at the inferior pole of the kidney. The tumor size was between 1.5 and 4.6 cm (mean, 2.8 cm). The results showed that, in all 38 cases, the procedure was successfully accomplished without conversion to open surgery. There were no intraoperative complications and only three cases of postoperative complications. The surgery duration was between 45 and 116 min (mean, 59 min); blood loss was between 10 and 120 ml (mean, 40 ml) and no patients required a blood transfusion. The average kidney ischemia time was 21 min (range, 15–38 min). No patients had local recurrence or metastasis after follow-up of between one and 26 months. In conclusion, the application of the renal-rotation technique in RPN for tumors located at the ventral side, renal hilum or at the inferior pole of the kidney is safe and feasible and worth wider clinical application.

Application of "arch window" technique in retroperitoneoscopic partial nephrectomy

Objective To investigate the feasibility of the technique in retroperitoneoscopic partial nephrectomy.Methods The technique was performed on 128 renal carcinoma patients receiving retroperitoneoscopic partial nephrectomy between June 2012 and June 2014.There were 76 males and 52 females,with age ranging between 31-76 (average 54).The tumors were all at T1N0M0 stage of American Joint Committee on Cancer (AJCC) with diameters of 0.8-6.2 cm (average 2.6 cm) and located in the upper pole,middle,and lower pole of the kidney in 65,31 and 32 cases respectively.Medical data were collected and compared with the same practice performed without using arch window technique from April 2010 to May 2012.Results All 128 operations were successful without conversion to open surgery.There were no serious intraoperative complications such as damaged large blood vessels or adjacent organs.Thirteen patients had postoperative complications,including 8 cases of hematuresis,2 cases of subcutaneous emphysema and 3 cases of delayed healing.Three hematuria patients recovered after conservative treatment.The operation time was 55-186 min (average 89 min),and blood loss was 30-220 ml (average 60 ml).No patient needed intraoperative blood transfusion.The average renal artery occlusion time was 22 min (14-35 min).Pathological examination reported 106 renal clear cell carcinomas and 1 papillary carcinoma with negative margin; and 21 renal angiomyolipomas.Patients were followed up for 1-25 months post-operation (average 18 months).There was no tumor recurrence or distant metastasis and renal functions were normal.Arch window group had significantly shorter suture time,operation time and renal warm ischemia time,and less intraoperative bleeding than non-arch window group.Conclusion The use of technique in retroperitoneoscopic partial nephrectomy is safe and feasible.It benefits from sufficient surgery field exposure and convenient operation and is worthy of wider clinical application. Key words: Retroperitoneoscopy ; Partial nephrectomy

PE13: Initial experience of robotic assisted retroperitoneoscopic partial nephrectomy

PE13: Initial experience of robotic assisted retroperitoneoscopic partial nephrectomy

Surgery: retroperitoneoscopic partial nephrectomy: practice is key.

Surgery: retroperitoneoscopic partial nephrectomy: practice is key.

Technique and Outcomes of Robot-assisted Retroperitoneoscopic Partial Nephrectomy: A Multicenter Study

BackgroundRobot-assisted retroperitoneoscopic partial nephrectomy (RARPN) may be used for posterior renal masses or with prior abdominal surgery; however, there is relatively less familiarity with RARPN. ObjectiveTo demonstrate RARPN technique and outcomes. Design, setting, and participantsA retrospective multicenter study of 227 consecutive RARPNs was performed at the Swedish Medical Center, the University of Michigan, and the University of California, Los Angeles, from 2006 to 2013. Surgical procedureRARPN. Outcome measurements and statistical analysisWe assessed positive margins and cancer recurrence. Stepwise regression was used to examine factors associated with complications, estimated blood loss (EBL), warm ischemia time (WIT), operative time (OT), and length of stay (LOS). Results and limitationsThe median age was 60 yr (interquartile range [IQR]: 52–66), and the median body mass index (BMI) was 28.2kg/m2 (IQR: 25.6–32.6). Median maximum tumor diameter was 2.3cm (IQR: 1.7–3.1). Median OT and WIT were 165min (IQR: 134–200) and 19min (IQR: 16–24), respectively; median EBL was 75ml (IQR: 50–150), and median LOS was 2 d (IQR: 1–3). Twenty-eight subjects (12.3%) experienced complications, three (1.3%) had urine leaks, and three (1.3%) had pseudoaneurysms that required reintervention. There was one conversion to radical nephrectomy and three transfusions. Overall, 143 clear cell carcinomas (62.6%) composed most of the histology with eight positive margins (3.5%) and two recurrences (0.9%) with a median follow-up of 2.7 yr. In adjusted analyses, intersurgeon variation was associated with complications (odds ratio [OR]: 3.66; 95% confidence interval, 1.31–10.27; p=0.014) and WIT (parameter estimate [PE; plus or minus standard error]: 4.84±2.14; p=0.025). Higher surgeon volume was associated with shorter WIT (PE: −0.06±0.02; p=0.002). Higher BMI was associated with longer OT (PE: 2.09±0.56; p<0.001). Longer OT was associated with longer LOS (PE: 0.01±0.01; p=0.002). Finally, there was a trend for intersurgeon variation in OT (PE: 18.5±10.3; p=0.075). ConclusionsRARPN has acceptable morbidity and oncologic outcomes, despite intersurgeon variation in WIT and complications. Greater experience is associated with shorter WIT. Patient summaryRobot-assisted retroperitoneoscopic partial nephrectomy has acceptable morbidity and oncologic outcomes, and there is intersurgeon variation in warm ischemia time and complications.

V70 A standardized suture technique using a barbed suture improves efficacy and safety in retroperitoneoscopic partial nephrectomy: A single surgeon experience

V70 A standardized suture technique using a barbed suture improves efficacy and safety in retroperitoneoscopic partial nephrectomy: A single surgeon experience

90 Renal surgery in the elderly – validation of perioperative outcomes and postoperative complications in 160 consecutive patients undergoing retroperitoneoscopic partial nephrectomy

90 Renal surgery in the elderly – validation of perioperative outcomes and postoperative complications in 160 consecutive patients undergoing retroperitoneoscopic partial nephrectomy