Robot-assisted Partial Nephrectomy In Patients Research Articles

Robot-assisted partial nephrectomy in patients with multiple ipsilateral renal tumors: single-centre experience

Robot-assisted partial nephrectomy in patients with multiple ipsilateral renal tumors: single-centre experience

Robot-assisted Partial Nephrectomy With Selective Artery Clamping for Renal Cell Carcinoma in Horseshoe Kidney.

Robot-assisted partial nephrectomy (RAPN) has become the standard treatment for small renal tumors, including highly complex cases. However, applying RAPN to renal tumors in the horseshoe kidney (HSK) is clinically challenging due to malformations and complex blood supply. Herein, we present two cases of RAPN in patients with HSK treated using selective artery clamping methods. A 61-year-old male with a 15 mm renal tumor located on the upper pole of the right HSK was referred to our Department. The patient underwent RAPN via the transperitoneal approach, following a three-dimensional computed tomography (3D-CT) assessment. Additionally, before surgery, we confirmed which renal arteries would be clamped in surgery by examining the kidney regions supplied by each renal artery. The second patient referred to our Department, a 45-year-old male, had a 46 mm renal tumor located on the isthmus of the HSK. His tumor received blood supply from two renal arteries, with the bilateral collecting systems converging and forming a ureter on 3D-CT. The patient underwent RAPN through an intraperitoneal approach in the semi-lateral position, with port placement lower than in standard RAPN. Pathological examinations revealed clear-cell renal cell carcinoma with negative surgical margins in both cases. Both patients had no recurrences or metastases at 53 and 13 months post-surgery, respectively. We present cases successfully treated with RAPN with selective artery clamping methods for HSK using 3D-CT without encountering complications, even in isthmus tumors.

Perioperative outcomes of open and robot-assisted partial nephrectomy in patients with renal tumors of moderate to high complexity

ObjectiveTo compare the perioperative outcomes of patients with complex renal tumors treated with open versus robot-assisted partial nephrectomy. MethodsThis retrospective study included 273 patients diagnosed with localized renal tumors at our institution between January 2007 and October 2020. Patients with moderate to high complexity tumors based on the RENAL nephrometry score were included. Perioperative outcomes were compared between open and robot-assisted partial nephrectomy patients. Remnant renal function was defined as the estimated glomerular filtration rate at 12 months after surgery. ResultsOpen and robot-assisted partial nephrectomy were performed in 43 and 77 patients, respectively. There was no significant difference in overall, cancer-specific, recurrence-free, and metastasis-free survival between the two groups. Remnant renal function was significantly better preserved in the open group, and body mass index was identified as an independent predictive factor (odds ratio 3.05, P = 0.017). Ischemia or type of surgery were not related to remnant renal function. The trifecta achievement rate was 51.2% in the open group and 71.4% in the robot-assisted group (P = 0.031), and the incidence of complications was significantly higher in the open partial nephrectomy group (P = 0.0030). Multivariate analysis revealed that open partial nephrectomy was an independent predictive factor for the incidence of complications (odds ratio 3.92, P = 0.0020). ConclusionRobot-assisted partial nephrectomy can provide good and acceptable oncological and functional outcomes with fewer complications in patients with more complex renal tumors. Further research is needed to establish appropriate treatment strategies and guidelines in current clinical practice.

Redo Robotic Partial Nephrectomy for Recurrent Renal Tumors: A Multi-Institutional Analysis.

Introduction: As the experience with robot-assisted partial nephrectomy (RAPN) grows, the indications have expanded to incorporate previously operated ipsilateral kidneys with recurrent renal masses. We sought to analyze the outcomes of redo RAPN in patients with a recurrent renal mass. Methods: Using a multi-institutional series, the data of 72 patients who underwent RAPN for a recurrent renal mass between 2010 and 2020 were retrospectively analyzed. Patients with familial renal cell carcinoma and multiple renal tumors were excluded. Major complication was defined by Clavien grade ≥3. The median follow-up was 28.5 months. Baseline demographics, clinical and tumor characteristics, and perioperative and postoperative outcomes are reported. Results: Our cohort consisted of a combination of previous thermal ablation (19.6%), laparoscopic (19.6%), open (26.1%), and robotic (34.8%) partial nephrectomy. The median R.E.N.A.L. score was 8. Twenty percent had hilar tumors and 9.7% had a solitary kidney. RAPN was completed in all cases. Two cases (2.8%) were converted to open surgery. None of the cases were converted to radical nephrectomy intraoperatively. One patient underwent radical nephrectomy postoperatively because of bleeding. Transfusion rate was 5.9% and major complication rate was 8.3%. Median length of stay was 3 days. Estimated glomerular filtration rate preservation was 78.7% at discharge and 90.8% at 1-year follow-up. Positive surgical margin rate was 8.3%. Overall, distant recurrence was seen in 11 patients (15.3%), however, only 1 patient had local progression (1.4%). Conclusion: In experienced hands, RAPN is an effective approach to treat select cases of locally recurrent renal masses with promising perioperative and functional outcomes. Patients should be carefully monitored for distant recurrence.

MP50-17 PROSPECTIVE COMPARATIVE STUDY TO EVALUATE THE CLINICAL UTILITY OF IRIS 3-D ANATOMICAL MODELING SOFTWARE FOR PREOPERATIVE SURGICAL PLANNING AND INTRA-OPERATIVE NAVIGATION FOR ROBOT ASSISTED PARTIAL NEPHRECTOMY (RAPN): A PRELIMINARY ANALYSIS

You have accessJournal of UrologyCME1 May 2022MP50-17 PROSPECTIVE COMPARATIVE STUDY TO EVALUATE THE CLINICAL UTILITY OF IRIS 3-D ANATOMICAL MODELING SOFTWARE FOR PREOPERATIVE SURGICAL PLANNING AND INTRA-OPERATIVE NAVIGATION FOR ROBOT ASSISTED PARTIAL NEPHRECTOMY (RAPN): A PRELIMINARY ANALYSIS Ahmed Ghazi, Tanner Corse, Thomas Osinski, Thomas Frye, William Tabayoyong, Linda Dayan, Ravi Munver, Hani Rashid, Jean Joseph, and Michael Stifelman Ahmed GhaziAhmed Ghazi More articles by this author , Tanner CorseTanner Corse More articles by this author , Thomas OsinskiThomas Osinski More articles by this author , Thomas FryeThomas Frye More articles by this author , William TabayoyongWilliam Tabayoyong More articles by this author , Linda DayanLinda Dayan More articles by this author , Ravi MunverRavi Munver More articles by this author , Hani RashidHani Rashid More articles by this author , Jean JosephJean Joseph More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The objective of the study was to evaluate the clinical utility of IRIS (Intuitive Surgical Inc., Sunnyvale, CA, USA) with CT scans in comparison to CT scan alone for preoperative surgical planning and intraoperative navigation during RAPN. METHODS: This is a prospective, multi-center, post-market study (NCT04329767) with 54 currently enrolled RAPN patients. Patients were randomized into two groups with preoperative surgical planning and intraoperative navigation using either CT scans alone (N=21) or IRISTM with CT scans (N=33). Demographic and intraoperative data were collected and analyzed. A 5-point Likert-type scale evaluated the impact of each modality on anatomy interpretation, confidence completing the procedure and procedure efficiency was evaluated for every case. Overlap between the preoperative planned clamping and the actual operative clamping was evaluated. RESULTS: Results are summarized in Table 1. Tests of significance were not performed in this interim analysis of an ongoing trial. Higher incidence of surgeons in IRIS arm (97%) vs CT arm (81%) reported confidence in successfully completing the planned RAPN procedure. During intraoperative navigation, surgeons rated (>4) that all IRIS cases achieved good spatial sensation of the anatomy compared to CT cases (100% vs 76%). This was most enhanced in patients (6 vs 6) with RENAL score 10-12, where a 50-80% increase in anatomical interpretation of various critical structures was reported using IRIS. Surgeons preoperatively reviewing IRIS reported higher confidence in performing zero or selective vs global ischemia which translated to higher actual execution in IRIS (39%) vs CT arm (9.5%).Intraoperatively IRIS demonstrated improved procedure efficiency in 88% of cases vs. 29% in the CT arm, mainly attributed to ease in interpreting anatomy in the IRIS arm (91% vs 33%). CONCLUSIONS: In this pilot study comparing the utility of IRIS to standard 2D imaging during RAPN, IRIS improved self-reported surgeon confidence, efficiency, and complex anatomical interpretation particularly during complex RAPN cases with increased incidence of non-global ischemia approaches. Source of Funding: Intuitive Research Grant © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e872 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ghazi More articles by this author Tanner Corse More articles by this author Thomas Osinski More articles by this author Thomas Frye More articles by this author William Tabayoyong More articles by this author Linda Dayan More articles by this author Ravi Munver More articles by this author Hani Rashid More articles by this author Jean Joseph More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Impact of Postoperative Renal Function Recovery after Laparoscopic and Robot-Assisted Partial Nephrectomy in Patients with Renal Cell Carcinoma.

Background and objectives: This study aimed to evaluate the association between warm ischemic time (WIT) and postoperative renal function using Trifecta achievement in patients with renal cell carcinoma (RCC) who underwent robotic (RAPN) or laparoscopic partial nephrectomy (LPN). Materials and Methods: We conducted a retrospective multicenter cohort study of patients with RCC who underwent RAPN (RAPN group) or LPN (LPN group) at three institutions in Japan between March 2012 and October 2021. The primary endpoints were the rate of trifecta achievement in both surgical techniques and the association between WIT and recovery of postoperative renal function surgical outcomes. Results: The rate of trifecta achievement was significantly lower in patients with LPN than in those with RAPN (p < 0.001). WIT ≥ 25 min were 18 patients (18%) in the RAPN group and 89 (52.7%) in the LPN group. The postoperative estimated glomerular filtration rate (eGFR) was almost the same. However, 13 patients (7.7%) had a decreased in eGFR ≥ 15% at 3 months after LPN compared with the preoperative eGFR. Conclusions: The rate of trifecta achievement in the RAPN group was significantly higher than that in the LPN group. However, eGFR was identified as relatively better preserved after PN in both groups.

Simplified PADUA renal (SPARE) nephrometry score validation and long-term outcomes after robot-assisted partial nephrectomy.

International guidelines suggest the use of anatomic scores to predict surgical outcomes after partial nephrectomy (PN). We aimed at validating the use of Simplified PADUA Renal (SPARE) nephrometry score in robot-assisted PN (RAPN). Three hundred and sixty-eight consecutive RAPN patients were included. Primary endpoints were overall complications, postoperative acute kidney injury (AKI) and TRIFECTA achievement. Secondary endpoint was estimated glomerular filtration rate (eGFR) decrease at last follow-up. Multivariable logistic and linear regression models were used. Of 368 patients, 229 (62%) vs. 116 (31%) vs. 23 (6.2%) harboured low- vs. intermediate- vs. high-risk renal mass, according to SPARE classification. SPARE score predicted higher risk of overall complications (Odds ratio [OR]: 1.23, 95%CI 1.09-1.39; P < 0.001), and postoperative AKI (OR: 1.20, 95%CI 1.08-1.35; P < 0.01). Moreover, SPARE score was associated with lower TRIFECTA achievement (OR: 0.89, 95%CI 0.81-0.98; P = 0.02). Predicted accuracy was 0.643, 0.614 and 0.613, respectively. After a median follow-up of 40 (IQR: 21-66) months, eGFR decrease ranged from -7% in low-risk to -17% in high-risk SPARE. SPARE scoring system predicts surgical success in RAPN patients. Moreover, SPARE score is associated with eGFR decrease at long-term follow-up. Thus, the adoption of SPARE score to objectively assess tumor complexity prior to RAPN may be preferable.

Holographic reconstruction technology used for intraoperative real-time navigation in robot-assisted partial nephrectomy in patients with renal tumors: a single center study.

BackgroundTo explore the efficacy and advantages of real-time navigation using holographic reconstruction (HR) technology combined with da VinciTM robotic system for partial nephrectomy (PN) in patients with renal tumor.MethodsThe clinical data of 41 patients with totally intrarenal tumors receiving robot-assisted partial nephrectomy (RAPN) from April 2018 to October 2020 in our department were collected and retrospectively analyzed. All operations were performed by the same surgeon. HR technology and three-dimensional (3D) reconstruction techniques were applied for real-time navigation to resect tumors using the da VinciTM robotic system. The relevant clinical parameters and surgical outcomes of the patients were recorded and analyzed.ResultsHR technology allowed accurate evaluation of tumors, renal hilus vessels, and surrounding organs during the operation. With real-time navigation HR, all cases were performed by RAPN. The mean operative time was 115.3±20.3 (range, 70–153) minutes, and the warm ischemia time (WIT) was 18.7±3.9 (range, 13–28) minutes. The estimated blood loss (EBL) was 98.8±18.7 (range, 60–141) mL. Negative surgical margins were reported in all cases. Patients with absence of grade ≤1 Clavien-Dindo complications. Compared with the clinical outcomes of standard RAPN, as reported in the literature, HR-assisted technology reduced the mean operative time, the WIT, and the EBL in patients undergoing RAPN. Therefore, combining HR with robotic abdominal surgery can enhance the efficiency of locating blood vessels and allow for more accurate resection of tumors.ConclusionsAs a novel and promising computer digital technology, HR can significantly improve the success of RAPN operations. This retrospective study demonstrated that HR-assisted operations resulted in shorter operation times and less perioperative complications and were thus safer and more effective in patients with renal tumors compared with RAPN not used HR.

Varying Outcomes among Patients with Large Angiomyolipomas according to the Treatment Method

Purpose: This study aimed to evaluate the outcomes of large angiomyolipoma (AML) treatment by selective arterial embolization (SAE) versus nephron-sparing surgery (NSS) using a robotic surgical system. Materials and Methods: Between January 2011 and June 2018, we retrospectively reviewed 25 patients who underwent robot-assisted partial nephrectomy (RAPN) or SAE for large AMLs. Ten patients underwent RAPN, and 15 underwent SAE. Patient demographics, AML characteristics, and operative and postoperative clinical outcomes were recorded and analyzed. Outcomes were compared between patients who underwent RAPN and patients who underwent SAE. Specifically, changes in renal function and size were evaluated after the treatment. Results: The mean age of the patients was 52.9 years, and 22 of 25 patients were female. The mean maximum AML diameter on computed tomography was 8.9 cm, and 8 patients had multiple masses. Twenty-two of 25 patients had moderate to high RENAL complexity. Patients who underwent SAE had more symptoms (p = 0.018) and higher RENAL complexity scores (p = 0.013) on average. On average, tumor size decreased by 99% among RAPN patients and by 58% among SAE patients (p = 0.001). Although the mean pretreatment estimated glomerular filtration rate (eGFR) was higher among RAPN patients (99.8 vs. 80.0 mL/min/1.73 m², p = 0.043), there were no significant changes in eGFR in either group after the treatment. One patient in the RAPN group experienced complications, but the postoperative ileus resolved without intervention. Conclusions: Both RAPN and SAE were effective and feasible treatment options for large AMLs. The AML characteristics and the condition of the patient might be important in determining the appropriate treatment method.

Retroperitoneal or transperitoneal approach in robot-assisted partial nephrectomy, which one is better?

PurposeTo systematically assess the perioperative outcomes of retroperitoneal (RP) and transperitoneal (TP) approaches in robot‐assisted partial nephrectomy (RAPN), we conducted an updated meta‐analysis.MethodsA literature retrieval of multi‐database including PubMed, Web of Science, Embase, Cochrane Library, and CNKI was performed to identify eligible comparative studies from the inception dates to January 2021. Perioperative outcomes included operative time (OT), estimated blood loss (EBL), warm ischemia time (WIT), postoperative length of stay (PLOS), positive surgical margin (PSM), and complications (major complications and overall complications). Outcomes of data were pooled and analyzed with Review Manager 5.4.1.ResultsTwenty‐one studies involving a total of 2482 RP and 3423 TP approach RAPN patients met the inclusion criteria. Operating time (OT) (weighted mean difference [WMD] −16.60; 95% confidence interval [CI] −23.08, −10.12; p < 0.01) and PLOS (WMD −0.46 days; 95% CI −0.69, −0.23; p < 0.01) were shorter in RP‐RAPN. Besides, lower EBL (WMD −21.67; 95% CI −29.74, −13.60; p < 0.05) was also found in RP‐RAPN. Meanwhile, no significant differences were found in other outcomes.ConclusionsRP‐RARN was superior to TP‐RAPN in patients undergoing RAPN in terms of OT, PLOS, and estimated blood loss. Besides these two approaches have no significant differences in PSMs or perioperative complications.

Trifecta outcomes of modified robot-assisted simple enucleation and standard robot-assisted partial nephrectomy for treating clinical T1b renal cell carcinoma.

BackgroundTo compare perioperative outcomes and Trifecta achievement of modified robot-assisted simple enucleation (MRASE) with robot-assisted partial nephrectomy (RAPN) for treating clinical T1b renal tumors.MethodsWe analyzed 203 patients who underwent MRASE or RAPN for clinical T1b renal tumors at our institution from September 2014 to June 2018. The two groups were compared regarding perioperative outcome variables. Trifecta was defined as no perioperative complications, negative surgical margin, and ischemia time ≤25 minutes.ResultsIn all, 139 patients underwent MRASE and 64 underwent RAPN respectively. Patients in the MRASE group had shorter operative time (197.7 vs. 215.6 min, P=0.039) and warm ischemic time (21.2 vs. 24.1 min, P=0.004) in comparison to the RAPN group. The groups were comparable in estimated blood loss (230.5 vs. 269.8 mL, P=0.259). Tumor bed suturing was performed with a significantly lower frequency in the MRASE group than in the RAPN group (11.5% vs. 90.6%, P<0.01). The incidence of perioperative complications was similar. The rate of positive surgical margins was similar in both groups (2.2% vs. 6.3%, P=0.284). Trifecta was achieved in 61.2% and 42.2% of MRASE and RAPN patients (P=0.012). On multivariable analysis, the type of procedure, RENAL score, estimated blood loss, and operative time were positive factors for the achievement of Trifecta.ConclusionsIn this series MRASE was superior to RAPN with regard to the achievement of Trifecta in treating T1b renal tumors. Besides, MRASE had better outcomes for shorter operative time, shorter warm ischemic time, and less need for tumor bed suturing as compared with RAPN.

PD11-04 COMPARING ENDOSCOPIC ROBOT-ASSISTED SIMPLE ENUCLEATION AND STANDARD ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR T1 RENAL CELL CARCINOMA: INITIAL RESULTS OF A NON-INFERIORITY RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-04 COMPARING ENDOSCOPIC ROBOT-ASSISTED SIMPLE ENUCLEATION AND STANDARD ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR T1 RENAL CELL CARCINOMA: INITIAL RESULTS OF A NON-INFERIORITY RANDOMIZED CONTROLLED TRIAL Qun Lu*, Xiaozhi Zhao, Changwei Ji, Guangxiang Liu, Linfeng Xu, and Hongqian Guo Qun Lu*Qun Lu* More articles by this author , Xiaozhi ZhaoXiaozhi Zhao More articles by this author , Changwei JiChangwei Ji More articles by this author , Guangxiang LiuGuangxiang Liu More articles by this author , Linfeng XuLinfeng Xu More articles by this author , and Hongqian GuoHongqian Guo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000845.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephron-sparing surgery is the gold standard treatment for localized renal masses. Although published studies have showed excellent long-term oncologic results of simple enucleation (SE), many urologists still consider SE an unsafe technique with a high risk of incomplete tumor excision. This is a non-inferiority, randomized controlled trial to compare the peri-operative, renal functional and oncologic outcomes of endoscopic robot-assisted simple enucleation (ERASE) and standard robot-assisted partial nephrectomy (RAPN) in the treatment of T1 renal cell carcinoma (RCC). METHODS: Patients with newly diagnosed sporadic, unilateral, T1 presumed RCC were recruited for this clinical trial from October 2018. This trial was registered in ClinicalTrials.gov (NCT03624673). The protocol had been approved by the ethics committee of Nanjing Drum Tower Hospital. The inclusion criteria were clinical T1 RCC, age 18 to 80 years, normal contralateral renal function, RENAL score <=9 and willingness to participate in this study. The exclusion criteria were intolerance of robotic surgery, metastastic renal cell carcinoma, entry into collection system or hematuria and a history of other renal diseases. The primary outcome measure was rate of positive surgical margin (PSM). The Surface–Intermediate–Base margin score was reported for each tumor specimen. On the basis of the assumption of no difference in PSM rate between two techniques, we calculated that 190 participants per group were needed. RESULTS: The trial had presently enrolled 180 patients, of whom 90 were randomized to the ERASE group and 90 to the RAPN group. Demographic characteristics were similar. Mean operative time was 162.0 and 169.9 min, respectively (p=0.297). Warm ischemic time was comparable in the ERASE and RAPN group (18.7 vs 21.3 min; p=0.056). The estimated blood loss was similar (p=0.129). Tumor bed suturing was performed in 8.9% and 83.3% of ERASE and RAPN cases (P=0.000). No hilar clamping was performed in 8 (8.9%) ERASE patients and 5 (5.6%) RAPN patients (p=0.388). The rates of intraoperative and postoperative complications were similar. The incidence of PSMs was comparable between the ERASE and RAPN groups (2.2% and 3.3%, p= 1.000). No recurrence was found in the two groups during follow-up. CONCLUSIONS: The initial results of this trial reveal that ERASE is an oncologically safe and effective alternative to RAPN for T1 renal cell carcinoma. ERASE confers comparable peri-operative and oncologic results with RAPN, with similar incidence of PSM. The final results of this trial are required to validate our findings. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e254-e254 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Qun Lu* More articles by this author Xiaozhi Zhao More articles by this author Changwei Ji More articles by this author Guangxiang Liu More articles by this author Linfeng Xu More articles by this author Hongqian Guo More articles by this author Expand All Advertisement PDF downloadLoading ...

Re: A Multi-Institutional Report of Peri-Operative and Functional Outcomes after Robot-Assisted Partial Nephrectomy in Patients with a Solitary Kidney.

Re: A Multi-Institutional Report of Peri-Operative and Functional Outcomes after Robot-Assisted Partial Nephrectomy in Patients with a Solitary Kidney.

A multi-institutional report of peri-operative and functional outcomes after robot-assisted partial nephrectomy in patients with a solitary kidney.

To evaluate peri- and post-operative outcomes after robotic partial nephrectomy (RPN) in patients with a solitary kidney. A multi-institutional database of 1868 patients was used to identify 35 patients with a solitary kidney who underwent RPN at six different centers from 2007 to 2016. Peri-operative outcomes were summarized with descriptive statistics. We assessed the change in eGFR over time with a linear mixed-effects model. Median operative time, ischemia time, and estimated blood loss were 172min, 16min, and 113mL, respectively. There were no positive surgical margins. The median length of stay was 1 day (range 1-7), and over half (54.3%) of patients were discharged one post-operative day 1. Seven post-operative complications occurred in six patients (17.1%); of which four were Clavien I, two were Clavien II, and one was Clavien III. The linear decline in eGFR up to 24month post-RPN was marginal and not significant (ß = - 0.14; 95% CI = - 0.51, 0.23; p = 0.453), with predicted mean eGFR decreasing from 59.2 to 55.8mL/min/1.73 m2 at 24months. These results suggest that, in patients with a solitary kidney, RPN is a safe and feasible treatment option. In patients with a solitary kidney, RPN did not significantly compromise renal function for up to 2 years after surgery.

MP42-04 MODIFIED ROBOT-ASSISTED SIMPLE ENUCLEATION WITH SINGLE LAYER RENORRHAPHY TECHNIQUE VERSUS STANDARD ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR TREATING LOCALIZED RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2018MP42-04 MODIFIED ROBOT-ASSISTED SIMPLE ENUCLEATION WITH SINGLE LAYER RENORRHAPHY TECHNIQUE VERSUS STANDARD ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR TREATING LOCALIZED RENAL CELL CARCINOMA Xiaozhi Zhao, Qun Lu, Rong Yang, Guangxiang Liu, Feng Qu, Xiaogong Li, Weidong Gan, and Hongqian Guo Xiaozhi ZhaoXiaozhi Zhao More articles by this author , Qun LuQun Lu More articles by this author , Rong YangRong Yang More articles by this author , Guangxiang LiuGuangxiang Liu More articles by this author , Feng QuFeng Qu More articles by this author , Xiaogong LiXiaogong Li More articles by this author , Weidong GanWeidong Gan More articles by this author , and Hongqian GuoHongqian Guo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1311AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephron-sparing surgery is the gold standard treatment for localized renal masses. Simple enucleation has proven to be oncologically safe. In this study, we used our large institutional experience to compare perioperative results and early oncological outcomes with modified robot-assisted simple enucleation (MRASE) and robot-assisted partial nephrectomy (RAPN) for treating localized renal tumors. METHODS We evaluated 445 consecutive patients who underwent MRASE or RAPN for renal tumors in our institution from September 2014 to July 2017 in terms of perioperative pathologic and oncologic outcome variables. In simple enucleation, the surgeon used the pseudocapsule as the anatomical landmark to enucleate the tumor by blunt dissection, with no visible rim of normal parenchyma. The single layer suture technique was performed for renal reconstruction. RESULTS In total, 310 patients underwent MRASE and 135 underwent RAPN. Mean operative time was 181.3 and 192.3 min, respectively (p=0.038). Warm ischemic time was significantly lower in the MRASE than RAPN group (20.9 vs 24.3 min; p=0.000). The estimated blood loss was similar (p=0.381). Tumor bed suturing was performed in 8.7% and 79.3% of MRASE and RAPN cases (P=0.000). No hilar clamping was performed in 42 MRASE patients (13.5%) and 8 RAPN patients (5.9%) (p=0.019). Grade III and IV complications were reported in 6 (1.9%) MRASE patients and 9 (6.7%) RAPN patients (p=0.024). The incidence of positive surgical margins was comparable between the MRASE and RAPN groups (1.9% and 5.2%, p= 0.118). After a median follow-up of 18 months, recurrence did not differ between the 2 groups: 9 (2.9%) MRASE patients and 5 (3.7%) RAPN patients (p=0.881). CONCLUSIONS MRASE may confer shorter warm ischemic time, almost no need for tumor bed suturing and less Grade III and IV complications than RAPN, with similar oncologic outcomes. MRASE may be safe and acceptable for patients undergoing partial nephrectomy. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e537 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Xiaozhi Zhao More articles by this author Qun Lu More articles by this author Rong Yang More articles by this author Guangxiang Liu More articles by this author Feng Qu More articles by this author Xiaogong Li More articles by this author Weidong Gan More articles by this author Hongqian Guo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Predictive Factors for Achieving Superior Pentafecta Outcomes Following Robot-Assisted Partial Nephrectomy in Patients with Localized Renal Cell Carcinoma.

To examine the perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with localized renal cell carcinoma (RCC) and to identify the predictors of Pentafecta achievement following RAPN. We retrospectively analyzed the data from 362 patients with RCC who underwent RAPN from 2008 to 2016. The criteria for Pentafecta achievement were defined as the Trifecta [warm ischemic time (WIT) ≤25 minutes, negative surgical margin, and no significant perioperative complications]; with the addition of renal function preservation, including over 90% preservation of the estimated glomerular filtration rate (e-GFR); and no stage upgrade of chronic kidney disease at 1 year after surgery. Multivariate logistic regression analysis was performed to determine the predictors of the Pentafecta outcomes. Among 362 patients, 82.3% (n = 298) had clinical T1a tumors. The median tumor size was 2.9 cm [interquartile range (IQR) = 2.1-3.6] and median nephrometry score was 7 (IQR = 6-8). The median operative time was 220 minutes (IQR = 185-270) and median estimated blood loss was 150 mL (IQR = 100-200). The median WIT was 20 minutes (IQR = 16-26). The overall rate of postoperative complications was 18.8% (n = 68). The rates of Trifecta and Pentafecta achievement were 66.6% (n = 241/362) and 33.9% (n = 121/303), respectively. Notably, the preoperative e-GFR, hypertension, tumor size, L-component of the R.E.N.A.L score, and surgeon's experience were identified as the significant predictors of Pentafecta achievement. Additionally, patients with T1a tumors showed higher rates of Pentafecta achievement (45.7% vs 25.9%) compared with those of patients with T1b tumors. However, there was no significant difference in the Pentafecta accomplishment rates between the transperitoneal and retroperitoneal approaches. In summary, our data highlighted that tumor size and nephrometry score, which are tumor-related factors, as well as the surgeon's experience, a surgeon-related factor, appear to be the critical predictive factors for Pentafecta achievement following RAPN.

Off-clamp robot-assisted partial nephrectomy does not benefit short-term renal function: a matched cohort analysis.

In the interest of renal functional preservation, partial nephrectomy has supplanted radical nephrectomy as the preferred treatment for T1 renal masses. This procedure usually involves the induction of renal warm ischemia by clamping the hilar vessels prior to tumor excision. Performing robot-assisted partial nephrectomy (RAPN) "off-clamp" can theoretically prevent renal functional loss associated with warm ischemia. We describe our institutional experience and compare perioperative and renal functional outcomes using a propensity score matched cohort. We conducted a retrospective comparison from a prospectively maintained database of all patients who underwent RAPN from 2009 to 2015. Of those patients, 143 underwent off-clamp RAPN. Fifty off-clamp RAPN patients were propensity score matched with fifty clamped RAPN patients based on renal function, tumor size, and R.E.N.A.L. nephrometry score. The cohorts were compared across demographics, operative information, perioperative outcomes, and renal functional outcomes. For all off-clamp RAPN patients, mean nephrometry score was 7.1, mean estimated blood loss (EBL) was 236.9mL, perioperative complication rate was 7.7%, and mean decrease in estimated glomerular filtration rate (eGFR) was 7.1% at a median follow-up of 9.2months. In the propensity score matched cohorts, off-clamp RAPN resulted in a shorter mean operative time (172.0 versus 196.0min, p=0.025) and a lower mean EBL (179.7 versus 283.2mL, p=0.046). A lower complication rate of 6.0% in the off-clamp group compared with 20.0% in the clamped group approached significance (p=0.071). Mean preoperative eGFR was similar in both cohorts. Importantly, there was no significant difference in decrease in eGFR between the clamped cohort (9.8%) and off-clamp cohort (11.9%) at a median follow-up of 9.0months (p=0.620). Off-clamp RAPN did not result in improved renal functional preservation in our experience. Surprisingly, the off-clamp cohort experienced lower intraoperative blood loss, shorter operative times, and fewer complications.

MP55-19 MINIMALLY INVASIVE CONSERVATIVE TREATMENT OF LOCALIZED RENAL TUMORS: A SINGLE CENTER EXPERIENCE ON PERCUTANEOUS ABLATIONS AND ROBOT-ASSISTED PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2017MP55-19 MINIMALLY INVASIVE CONSERVATIVE TREATMENT OF LOCALIZED RENAL TUMORS: A SINGLE CENTER EXPERIENCE ON PERCUTANEOUS ABLATIONS AND ROBOT-ASSISTED PARTIAL NEPHRECTOMY Yohann GRASSANO, Francois Cornelis, Nicolas Grenier, Clement MICHIELS, Gregoire CAPON, Henri BENSADOUN, Gilles PASTICIER, Gregoire ROBERT, Jean-Marie FERRIERE, and Jean-Christophe BERNHARD Yohann GRASSANOYohann GRASSANO More articles by this author , Francois CornelisFrancois Cornelis More articles by this author , Nicolas GrenierNicolas Grenier More articles by this author , Clement MICHIELSClement MICHIELS More articles by this author , Gregoire CAPONGregoire CAPON More articles by this author , Henri BENSADOUNHenri BENSADOUN More articles by this author , Gilles PASTICIERGilles PASTICIER More articles by this author , Gregoire ROBERTGregoire ROBERT More articles by this author , Jean-Marie FERRIEREJean-Marie FERRIERE More articles by this author , and Jean-Christophe BERNHARDJean-Christophe BERNHARD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1712AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally-invasive treatments of clinically localized renal tumors such as robot-assisted partial nephrectomy (RAPN) and percutaneous Thermal Ablations (TA) are routinely performed in our institution. The objectives were to describe our indications and assess the morbidity and the efficacy of each one of the techniques METHODS From our prospectively maintained database UroCCR (French national Database on Kidney Cancer), we retrospectively reviewed RAPN and TA procedures performed between 2003 and 2016. Pre-operative, intra-operative, postoperative and follow up data were collected. Chi2 and Wilcoxon tests were used for comparisons. Kaplan Meier curves and Log rank test were used to determine survivals and predictive factors of local recurrence. RESULTS We reviewed 397 procedures including, 232 RAPN and 165 TA. RAPN patients were younger (61 vs 73 yo, p<0.001), less often solitary kidney (4.9% vs 34.8%, p<0.001) or bilateral tumor (p<0.001) and had a lower ASA score. Post-operative complications occurred in 34 and 18 cases after RAPN and TA respectively (14.6% vs 10.8%, p=0.08). RAPN patients had more post-operative transfusion (7.7% vs 0.6%, p<0.001) and the Clavien grade of complications was higher (p=0,016). There was no difference on post-operative glomerular filtration rate (GFR) between the 2 groups (-5.3 vs -5.6 ml/min/1.73m2, p=0.32). Among the 342 patients with a proven malignant tumor, the rate of local recurrence, metastatic progression and death were lower with RAPN (3%, 2.4%, 1.9%, respectively) than TA (17.5%, 10.3%, 13.8%, p<0.001). In multivariate analysis, the only independent predictive factor of local recurrence was the endophytic character of the tumor OR 3.51 (1.01-12.20), p=0.04 CONCLUSIONS RAPN and TA allow offering a safe minimally invasive treatment whatever the patients profile is. Post-operative renal function and complication rates were not significantly different between the 2 groups. However, we experienced more major complications after RAPN and more local recurrence after TA © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e738 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yohann GRASSANO More articles by this author Francois Cornelis More articles by this author Nicolas Grenier More articles by this author Clement MICHIELS More articles by this author Gregoire CAPON More articles by this author Henri BENSADOUN More articles by this author Gilles PASTICIER More articles by this author Gregoire ROBERT More articles by this author Jean-Marie FERRIERE More articles by this author Jean-Christophe BERNHARD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Associating the learning curve and tumor anatomical complexity with the margins, ischemia, and complications rate after robot-assisted partial nephrectomy

ObjectivesIn this paper, we report the robot-assisted partial nephrectomy (RAPN) outcomes of our institution by using the margins, ischemia, and complications (MIC) system, which was recently proposed to standardize the evaluation of partial nephrectomy outcomes and observe the effect of learning curve and tumor anatomical complexity on the results. Patients and methodsWe conducted a retrospective analysis of our prospectively maintained database of 144 patients treated with RAPN by one surgeon from May 2013 to May 2014. The MIC system was defined as a combination of negative surgical margins, warm ischemia time<20 min and no major complications. We stratified the patients by quartiles of distribution called RAPN eras 1, 2, 3, and 4 and RENAL score risk group categories. We determined the MIC rate in our study population. The MIC rates in each era and the RENAL score risk group were compared to assess the effect of the learning curve and tumor anatomical complexity on outcomes. ResultsA total of 144 patients were included in this study. The overall MIC rate was 62.5% (90/144), and the MIC was commonly higher in recent eras (38.9%, 55.6%, 72.2%, and 83.3%, p = 0.001). The MIC rate progressively decreased along the RENAL score risk group categories (low, moderate, and high complexity, p = 0.002). When the RAPN eras and RENAL score risk group categories considered simultaneously, we determined that the previous eras showed a lower MIC rate, regardless of the RENAL score risk group categories. However, no significant difference was observed (p = 0.590). ConclusionsThe MIC system was found to be an appropriate, easy and reproducible tool to standardize the evaluation of the early outcomes of RAPN in patients. The MIC rate increased with surgical experience and decreased with tumor anatomical complexity.

412 Outcomes of robot-assisted partial nephrectomy in patients with complex renal tumours and pre-existing chronic kidney disease in a multi-institutional, multinational database

412 Outcomes of robot-assisted partial nephrectomy in patients with complex renal tumours and pre-existing chronic kidney disease in a multi-institutional, multinational database