Robot-assisted Laparoscopic Partial Nephrectomy Group Research Articles

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.

Comparisons of survival and surgical outcomes between minimally invasive partial nephrectomy and radical nephrectomy in elderly patients with stage 1 renal cell carcinoma.

We compared survival and perioperative outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic radical nephrectomy (LRN) for older patients (age 70 years or older) with stage 1 renal cell carcinoma (RCC). This retrospective, single-center study included 260 patients who underwent RAPN and 44 patients who underwent LRN. The overall survival (OS) and perioperative outcomes were compared between these two groups using an inverse probability of treatment weighting (IPTW) analysis. Compared with the LRN group, a trend of more complications was observed in the RAPN group, including a higher body mass index (24 vs. 22 kg/m2 ; P = 0.0002) and higher rates of hypertension (77% vs. 55%; P = 0.0029) and chronic kidney disease (62% vs. 36%; P = 0.0027). After adjustment by the IPTW analysis, the RAPN group had a shorter operative time (143 vs. 282 min; P = 0.033), shorter postoperative length of hospital stay (PLOS) (4.1 vs. 7.9 days; P = 0.004), and less change in the estimated glomerular filtration rate during surgery (-8.4% vs. -32%; P < 0.0001) than the LRN group; however, the perioperative complication rates were similar. Patients who underwent RAPN had better 5-year OS than those who underwent LRN (95% vs. 90%; log-rank, P = 0.017). RAPN resulted in better OS and surgical outcomes, with shorter operative time, shorter PLOS, and better renal function preservation, than LRN for older patients with stage 1 RCC. Therefore, RAPN may be the primary option for patients indicated for surgical intervention. Geriatr Gerontol Int 2024; 24: 269-274.

Robot-assisted laparoscopic versus open partial nephrectomy for renal cell carcinoma in patients with severe chronic kidney disease.

To compare surgical and functional outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with renal cell carcinoma with stage 4 chronic kidney disease. This was a retrospective analysis of 60 patients with stage 4 chronic kidney disease (estimated glomerular filtration rate 15-30 ml/min/1.73 m2 ) who underwent partial nephrectomy for T1 renal cell carcinoma between April 2004 and April 2020. We compared perioperative outcomes according to the surgical approach. Multivariable analysis was performed to identify predictive factors for end-stage renal disease. Robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy were performed in 31 and 29 patients, respectively. The median age was 68 years and 17% of all patients were women. Patient and tumor characteristics did not differ between groups. The operative time (155.2 vs. 221.0 min, p < 0.0001) and the postoperative length of hospital stay (5.2 vs. 10.6 days, p = 0.0083) were significantly shorter, and the estimated blood loss was lower (53.4 vs. 363.2 ml, p = 0.0003) in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group. Preoperative estimated glomerular filtration rate was the only significant predictor of end-stage renal disease after partial nephrectomy on multivariable analysis. Both procedures preserved renal function in this patient cohort, delaying the requirement for postoperative dialysis. Furthermore, robot-assisted laparoscopic partial nephrectomy was associated with shorter operative time and postoperative length of hospital stay, as well as lesser estimated blood loss than open partial nephrectomy.

Comparison of parenchymal volume loss assessed by three-dimensional computed tomography volumetry and renal functional recovery between conventional and robot-assisted laparoscopic partial nephrectomy.

We retrospectively investigated if robot-assisted laparoscopic partial nephrectomy (RAPN) contributes to a decrease in resected parenchymal volume (RPV), an increase in postoperative parenchymal volume (PPV), and an improvement of postoperative renal function when compared with conventional laparoscopic partial nephrectomy (LPN) using a three-dimensional image analysis system. Patients who underwent LPN (n=37) and RAPN (n=66) from November 2013 to November 2018 were included in this study. All patients had a tumor diameter of 4cm or less. Patients with an anatomical or functional single kidney were excluded. RPV and PPV were measured using SYNAPSE VINCENT®. The surgical outcomes were compared between the two groups. Warm ischemic time in the RAPN group was significantly shorter than that in the LPN group (p < 0.001). The ratio of RPV to tumor volume (RPV/TV) in the RAPN group was significantly lower than that in the LPN group (p = 0.016). PPV in the RAPN group was significantly higher than that in the LPN group (p = 0.049). The decreased estimated glomerular filtration rate in the RAPN group was significantly lower than that in the LPN group on days 1, 7, 30, 90, and 180 after surgery. Postoperative renal function in the RAPN group was significantly better than that in the LPN group in both the short and long term. In addition to a short warm ischemia time, the decreased RPV/TV and increased PPV may have contributed to the improvement of postoperative renal function.

Comparison of Robot-Assisted Laparoscopic Partial Nephrectomy with Laparoscopic Cryoablation in the Treatment of Localised Renal Tumours: A Propensity Score-Matched Comparison of Long-Term Outcomes.

Preserving renal function and controlling oncological outcomes are pertinent when managing renal neoplasms. Cryoablation is the recommended treatment only for clinical T1a stage renal tumour. Here, we compared the outcomes of robot-assisted laparoscopic partial nephrectomy (RaPN) and laparoscopic cryoablation (LCA) in the treatment of patients with localised T1-T2 renal tumours. Overall, 86 patients who received RaPN and 78 patients underwent LCA were included in this study. The intraoperative, postoperative, and oncological outcomes in the LCA group were non-inferior to the RaPN group. Moreover, LCA demonstrated shorter operative time (267.45 ± 104.53 min vs. 138.56 ± 45.28 min, p < 0.001), lower blood loss (300.56 ± 360.73 mL vs. 30.73 ± 50.31 mL, p < 0.001), and slight renal function deterioration because of the reduced invasiveness, without compromising on the oncological outcomes.

Robot-assisted laparoscopic partial nephrectomy is a safe and effective option for clinical T2 renal cell carcinoma: a case-series from single-institution.

BackgroundRobot-assisted laparoscopic partial nephrectomy (RAPN) is increasingly used in the treatment of complex renal tumors, but it is still not commonly performed for T2 renal tumors and the reports of RAPN for renal tumors ≥7 cm were limited. Here we report our single-institution outcomes to evaluate the safety and efficacy of RAPN in treating T2 renal tumors.MethodsThis study was designed as a case-series study. We retrospectively reviewed our database and finally identified 16 patients undergoing RAPN for clinical T2 tumors. Seven patients who underwent standard laparoscopic partial nephrectomy (LPN) and 30 patients who were treated by radical nephrectomy(RN) were included as controls. The baseline characteristics, perioperative outcomes, change of renal function, and oncological outcomes were analyzed.ResultsThere was no significant difference between groups in baseline characteristics, intraoperative complications, and long-term oncological outcomes. Both RAPN and LPN had a longer operative time and higher blood loss compared with RN, but they could offer better renal function reservation. Two patients who underwent LPN converted to radical nephrectomy or open partial nephrectomy and no conversions happened in the RAPN group. The ischemia time seemed shorter in RAPN group but did not reach statistical significance (median 20.0 vs. 25.5 min, P=0.118). Except for blood transfusions, no other major complication was detected.ConclusionsRAPN can provide fair preservation of renal function with acceptable major complications and oncological outcomes, therefore it is a safe and effective procedure for renal tumors ≥7 cm. Its advantages over LPN still need to be ascertained by further studies with better design and larger sample sizes.

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

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

International multi-center study on clinical efficiency of robot-assisted laparoscopic partial nephrectomy in the treatment of clinical T2 renal tumors

Objective To analyze the safety and effectiveness of robot-assisted laparoscopic partial nephrectomy(RLPN) for cT2 renal tumors in international multi-centers. Methods This study was conducted to collect information on surgical procedures performed by RLPN and robot assisted laparoscopic radical nephrectomy(RRN) in nineteen international urological centers from January 2012 to December 2017. RLPN were performed in 159 patients (118 males and 41 females), with the average age of (59.3±13.2) years, body mass index(BMI) of (28.7±5.4 )kg/m2, preoperative GFR of (77.3±22.1) ml/min. RRN were performed in 219 patients, with the average age of (62.0±12.9) years, BMI of (28.7±6.1)kg/m2, preoperative GFR of (71.4±20.3) ml/min. There was no statistical difference between the two groups in gender and BMI. The age of the patients in RLPN group was younger than that in RRN group, and the preoperative GFR was better. The patient′s baseline demographics, perioperative data, tumor pathology, oncologic outcomes, and renal function(GFR) were recorded. Results All 378 cases underwent successful surgery. The operation time of RLPN was 150 min(65-353 min), which was shorter than that of RRN [180 min(85-361 min), P<0.001]. The intra-operative blood loss of RLPN was more than that of RRN [150 ml(40-3 000 ml) vs. 100 ml (10-1 100 ml), P<0.001]. The incidence of intra-operative complications were not statistically different between the two groups [5.7%(9/159) vs. 3.2%(7/219), P=0.240]. The incidence of postoperative complications was higher in the RLPN group than that in RRN group [19.5%(31/159) vs. 10.5%(23/219), P=0.014], but there was no significant difference in the incidence of complications of grade 3 or above [4.4%(7/159) vs. 2.3%(5/219), P=0.246] . The recurrence-free survival rate of RLPN group was higher than that of RRN group [91.4%(117/128) vs. 81.9%(167/204), P=0.013], and RLPN group was more conducive to renal function protection (P<0.001). Conclusions RLPN for cT2 tumors can obtain effective tumor control rate and better renal function preservation. It could be an acceptable alternative for surgical management of cT2 tumors. Key words: Kidney neoplasms; Locally advanced; Partial nephrectomy; Renal function; Radical nephrectomy

Application of a laser-guided docking system in robot-assisted urologic surgery.

This work explores the clinical significance of a laser-guided docking system for robot-assisted urologic surgery. Between July 2013 and June 2014, 40 patients underwent robot-assisted laparoscopic prostatectomy (RALP), and 32 patients underwent robot-assisted laparoscopic partial nephrectomy (RAPN) performed by a single surgeon. In the RALP and RAPN groups, the robot was docked in the traditional way in 20 and 16 cases, respectively. A laser guiding system was used in the other cases. The docking time and the time required to adjust the angles were recorded. The docking time was significantly shorter for the laser-guided process performed by inexperienced nurses. The time required to adjust the angles was also lower. There were no significant differences between the processes performed by experienced nurses. A laser-guided docking system may simplify and standardize the docking process and shorten the learning curve. Copyright © 2015 John Wiley & Sons, Ltd.

Conventional laparoscopy and da Vinci robot-assisted technique for partial nephrectomy: comparison of indications and clinical outcomes

Objective To investigate the clinical benefits and role of robot-assisted laparoscopic partial nephrectomy(RAPN) by comparing the clinical data of patients receiving the RAPN or conventional laparoscopic partial nephrectomy(CLPN).MethodsA retrospective analysis was performed for 67 patients who underwent either RAPN(n =24) or CLPN (n =43) between January 2011 and December 2012 at our institution.Preoperative clinical stages of both groups were T1N0M0.Univariate analysis and logistic regression model were used to detect factors affecting indication selection in RAPN.The intraoperative parameters and postoperative outcomes were compared between RAPN and CLPN groups matched for DAP score.ResultsUnivariate and multivariate logistic regression analysis revealed that DAP score(β =1.987,P =0.022,95%CI[1.34,39.79]) was the only predictor of RAPN approach in logistic regression analysis.Only 38 DAP matched cases in RAPN(n =19) and CLPN(n =19) were included for analysis,and the demographics were comparable between the matched two groups except for the preoperative estimated glomerular filtration rate(eGFR).One open conversion was required in the RAPN group due to intra-operation bleeding,and all the cases were smoothly completed in the conventional laparoscopic group.There were no significant differences between the matched two groups regarding the estimated blood loss,time off oral-intake,highest visual analog pain scale,length of stay,complication rate or transfusion rate(all P 0.05).Patients undergoing RAPN had a significantly shorter warm ischemia time([27.0±5.3] min vs [34.2±7.3] min,P 0.05) and a longer operative time([249.5±49.6] min vs [212.9±57.11] min,P 0.05) compared with CLPN group.The surgical margins were negative in both groups.During a mean follow-up of(5.6±2.2) months and(6.6±2.6) months,only one tumor recurrence was notice in the CLPN group.At the last follow-up,the decrease percentage of eGFR was(12±8)% in the RAPN group versus(17±15)% in the CLPN group(P 0.05).ConclusionRAPN requires a shorter warm ischemia time and provides a more rapid learning curve,good surgical safety and good short-term efficacy.For surgeons with experienced CLPN technique,they can use RAPN to treat high-complexity tumors which are beyond the conventional laparoscopic technique.

Robot‐assisted partial nephrectomy vs laparoscopic cryoablation for the small renal mass: redefining the minimally invasive ‘gold standard’

To identify differences between the ablative and extirpative minimally invasive techniques of laparoscopic cryoablation (LC) and robot-assisted laparoscopic partial nephrectomy (RPN), respectively, in treating small renal tumours in terms of safety, peri-operative morbidity and early oncological outcomes. Between June 2008 and April 2012 56 patients underwent LC and from October 2010 to April 2012, 47 patients underwent RPN using the Da Vinci robotic platform (Intuitive Surgical, Sunnyvale, CA, USA). Data on intra-operative, postoperative and oncological outcomes were collected prospectively, and were analysed and compared for both groups. The median patient ages were 69 and 60 for the LC and RPN groups, respectively (P < 0.05). There was no significant difference in disease stage, but there was a significant difference in tumour size, with patients in the RPN group having larger tumours. The mean operating times were 146 and 159 min for the LC and RPN groups, respectively (P = 0.094) and the mean blood loss was 47 and 94 mL for the LC and the RPN groups, respectively (P = 0.251). The median length of hospital stay (1 day) was the same for both groups and the mean warm ischaemia time was 23 min in the RPN group. The marginal change in preoperative and 6-week postoperative renal function was recorded: the mean postoperative increase in serum creatinine was 5.4 mmol/L in the LC group and 9.2 mmol/L in the RPN group. Of the 47 patients in the RPN group, two (4.3%) were converted to laparoscopic radical nephrectomy because of difficulty in controlling bleeding during hilar dissection. Only two patients (3.6%) had recurrence in the LC group, both of whom were treated with re-cryoablation. A total of 5.4% of patients in the LC and 4.3% in the RPN group had Clavien grade I postoperative complications, one patient in the LC group had a Clavien grade II complication, while 1.8 and 4.3% of patients had Clavien IIIb in the LC and RPN groups, respectively. Our data confirm that LC is a successful, minimally invasive and safe treatment option for the management of small renal tumours, but the apparently similar characteristics of RPN suggest that an increasing proportion of patients, whatever their age or medical comorbidities, may be reasonably offered a robot-assisted extirpative procedure with the likely benefit of lower risk of local recurrence and need for retreatment.

A prospective comparison of surgical and pathological outcomes obtained after robot‐assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study

To prospectively compare the surgical and pathological outcomes obtained with robot-assisted laparoscopic partial nephrectomy (RAPN) or laparoscopic PN (LPN) for renal cell carcinoma in a multicentre cohort. Between 2007 and 2011, 265 nephron-sparing surgeries were performed at six French urology departments. The patients underwent either RAPN (n = 220) or LPN (n = 45) procedures. The operative data included operative duration, warm ischaemia time (WIT) and estimated blood loss (EBL). The postoperative outcomes included length of stay (LOS), creatinine variation (Modification of Diet in Renal Disease group), Clavien complications and pathological results. The complexity of the renal tumour was classified using the R.E.N.A.L. nephrometry scoring system. Student's t-test and chi-squared tests were used to compare variables. The median follow-ups for the RAPN and LPN groups were 7 and 18 months, respectively (P < 0.001). Age and American Society of Anesthesiology score were significantly higher in the LPN group (P = 0.02 and P = 0.004, respectively). These variables were lower in the RAPN group: WIT [mean (sd) 20.4 (9.7) vs 24.3 (15.2) min; P = 0.03], operative duration [mean (sd) 168.1 (55.5) vs 199.7 (51.2) min; P < 0.001], operating room occupation time [mean (sd) 248.3 (66.7) vs 278.2 (71.3) min; P = 0.008], EBL [mean (sd) 244.8 (365.4) vs 268.3 (244.9) mL; P = 0.01], use of haemostatic agents [used in 78% of RAPNs and 100% of LPNs; P < 0.001] and LOS [mean (sd) 5.5 (4.3) vs 6.8 (3.2) days; P = 0.05). There were no significant differences between pre- and postoperative creatinine levels, pathology report or complication rates between the groups. The main limitation was due to the study's non-randomised design. RAPN is not inferior to pure LPN for perioperative outcomes (i.e. EBL, operative duration, WIT, LOS). Only a randomised study with a longer follow-up can now provide further insight into oncological outcomes.

Laparoscopic Partial Nephrectomy Versus Robot-Assisted Laparoscopic Partial Nephrectomy

Laparoscopic partial nephrectomy (LPN) is an alternative treatment modality for small-sized renal tumors. Robot-assisted LPN (RLPN) has also been performed with an advantage in repairing the defect after a resection of the tumor. We compared the perioperative data of patients treated with LPN with patients who underwent RLPN. From September 2006 to April 2008, 26 patients were treated with LPN and 31 with RLPN. Three arms were used for RLPN; camera was inserted through the 12 mm umbilical trocar port. Laparoscopic Bulldog clamps were used for clamping the renal hilum. We retrospectively compared each group on tumor size, operative time, estimated blood loss, warm ischemic time, and hospital stay. Operative time of LPN was shorter than that of RLPN (p = 0.034). Tumor size, estimated blood loss, and hospital stay were not significantly different in each group. No case was converted to open surgery. One patient in the RLPN group, however, was converted to robot-assisted radical nephrectomy because of severe bleeding. RLPN is safe and feasible for small-sized renal tumors. Warm ischemic time is within reasonable limits. Associated morbidity is also low.

Robotic versus Standard Laparoscopic Partial/Wedge Nephrectomy: A Comparison of Intraoperative and Perioperative Results from a Single Institution

Laparoscopic partial/wedge nephrectomy, similar to laparoscopic radical prostatectomy, is a technically challenging procedure that is performed by a limited number of expert laparoscopic surgeons. The incorporation of a robotic surgical interface has dramatically increased the use of minimally invasive pelvic surgery such that robotic laparoscopic radical prostatectomy is commonly performed even by laparoscopically naïve surgeons. This analysis compares the outcomes of our initial experience with robot-assisted laparoscopic partial nephrectomy (RLPN) performed by an experienced open surgeon to that of standard laparoscopic partial nephrectomy (LPN) performed by two experienced laparoscopic surgeons. We reviewed the medical records of 11 consecutive patients who underwent 12 standard LPNs (EMM, RVC) (one patient had two unilateral tumors) and 10 consecutive patients (representing the first 11 of such robotic procedures performed at our institution) who underwent 11 RLPNs (one patient had bilateral tumors managed in an asynchronous manner) (DKO). The mean tumor size was 2.3 cm (range 1.7-6.2 cm) for LPN and 3.1 cm (range 2.5-4 cm) for RLPN. The mean total procedure time was 289.5 minutes (range 145-369 min) for LPN and 228.7 minutes (range 98-375 min) for RLPN (P=0.102). The mean estimated blood loss was 198 mL (range 75-500 mL) for LPN v 115 mL (25-300 mL) for RLPN (P=0.169). The mean warm ischemia time was 35.3 minutes (range 15-49 min) in the LPN group and 32.1 minutes (range 30-45 minutes) in the RLPN group (P=0.501). Introducing a robotic interface for laparoscopic partial/wedge resection allowed a fellowship-trained urologic oncologist with limited reconstructive laparoscopic experience to achieve results comparable to those for laparoscopic partial/wedge resection performed by experienced laparoscopic surgeons. In this regard, the learning curve appears truncated, similar to that with robot-assisted laparoscopic prostatectomy.