Robot-assisted Laparoscopic Partial Nephrectomy Research Articles

Renal anatomical classification systems cannot predict the occurrence of vascular complications after partial nephrectomy.

To determine the relationship between renal tumor complexity and vascular complications after partial nephrectomy using PADUA, RENAL, and ZS scores. Between January 2007 and December 2018, a total of 1917 patients with available cross-sectional imaging were enrolled in the study. Logistic regressions were used to identify independent predictors of vascular complications. Of 1917 patients, 31 (1.6%) developed vascular complications, including 10 females and 21 males. The high-complexity category was significantly associated with a decreased risk of vascular complication in PADUA (OR = 0.256; 95%CI = 0.086-0.762; P = 0.014) and ZS score (OR = 0.279; 95%CI = 0.083-0.946; P = 0.040). Laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy were independent risk factors for vascular complications. Meanwhile, the incidence was significantly reduced in the recent 4years in the high score tumor group alone in PADUA (0.2% [1/474] vs. 2.2% [3/139], P = 0.038) and ZS score (0.2% [1/469] vs. 2.7% [3/112], P = 0.024). In the first 8years, laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy were the only two independent risk factors for vascular complications. In the recent 4years, only the high-complexity category was significantly associated with a decreased risk of vascular complication in the PADUA score (OR = 0.110; 95%CI = 0.013-0.938; P = 0.044). The renal anatomic classification system cannot predict the occurrence of vascular complications after partial nephrectomy.

Risk factors of recurrence after robot-assisted laparoscopic partial nephrectomy for solitary localized renal cell carcinoma

To evaluate the recurrence rate and risk factors of recurrence after robot-assisted laparoscopic partial nephrectomy for solitary renal cell carcinoma (RCC). A total of 1265 cases of initial solitary localized RCC were analyzed. The baseline characteristics, complexity (REANL nephrometry score), intra- and peri-operative outcomes, and recurrence were evaluated. Logistic regression was performed to evaluate the factors affecting recurrence after RAPN for solitary localized RCC. Recurrence after robot-assisted partial nephrectomy (RAPN) occurred in 29 patients (2.29%). The median follow-up was 36.0 months. The N domain (nearness to collecting system/sinus) (odd ratio (OR) 3.517, 95% confidence interval (CI) 1.557–7.945, p = 0.002), operation time (OR 1.005, 95% CI 1.001–1.010, p = 0.013), and perioperative transfusion (OR 5.450, 95% CI 1.197–24.816, p = 0.028) affected recurrence. Distant metastasis among patients with recurrence was significantly associated with nearness to the collecting system/sinus (OR 2.982, 95% CI 1.162–7.656, p = 0.023) and distance between the mass and collecting system/sinus (OR 0.758, 95% CI 0.594–0.967, p = 0.026). Nearness to the collecting system/sinus, operation time, and perioperative transfusion affect recurrence after RAPN for solitary localized RCC. Moreover, the proximity to the collecting system/sinus and distance between the mass and collecting system/sinus were significantly related to distant metastasis after RAPN.

Comparison of AirSeal versus conventional insufflation system for retroperitoneal robot-assisted laparoscopic partial nephrectomy: a randomized controlled trial

PurposeAirSeal is a valve-less trocar insufflation system which is widely used in robotic urologic surgeries. More evidence is needed concerning the application and cost of AirSeal in retroperitoneal robot-assisted laparoscopic partial nephrectomy.MethodsWe conducted a randomized controlled trial enrolling 62 patients who underwent retroperitoneal robot-assisted laparoscopic partial nephrectomy from February 2022 to February 2023 in the Peking Union Medical College Hospital. Patients were randomly assigned into AirSeal insufflation (AIS) group and conventional insufflation (CIS) group. The primary outcome was the rate of subcutaneous emphysema (SCE).ResultsThe SCE rate in the AIS group (12.9%) was significantly lower than that in the CIS group (35.5%) (P = 0.038). Lower maximum end-tidal carbon dioxide (CO2) (41 vs 45 mmHg, P = 0.011), PaCO2 at the end of the operation (40 vs 45 mmHg, P < 0.001), maximum tidal volume (512 vs 570 ml, P = 0.003), frequency of lens cleaning (3 vs 5, P < 0.001), pain score at 8 h (3 vs 4, P = 0.025), 12 h (2 vs 3, P = 0.029) postoperatively and at time of discharge (1 vs 2, P = 0.002) were observed in the AIS group, despite a higher hospitalization cost (68,197 vs 64658RMB, P < 0.001). Logistic regression analysis identified insufflation approach was the only influencing factor for the occurrence of SCE events.ConclusionAirSeal insufflation system exhibited similar efficacy and improved safety for retroperitoneal robot-assisted laparoscopic partial nephrectomy than conventional insufflation system, despite an affordable increase of hospitalization costs.

A review of robotic-assisted laparoscopic partial nephrectomy in the management of renal duplication anomalies.

Open and purely laparoscopic partial nephrectomy or heminephrectomy has been the standard management for renal duplication anomalies for symptomatic children with non-functional renal moieties. While robotic-assisted laparoscopic partial nephrectomy (RALPN) has been established as a safe and feasible option for the management of renal duplex anomalies, there remains a paucity of data on this topic. The aim of this study is to comprehensively review all available outcomes data and update the use of emerging technologies in robotic surgery which continue to make RALPN a viable and advantageous option in the management of renal duplex anomalies.

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.

Surgical and functional outcomes of repeat robot-assisted laparoscopic partial nephrectomy compared with repeat open partial nephrectomy.

To examine the surgical and functional outcomes of patients who have undergone repeat open partial nephrectomy (reOPN) or robot-assisted laparoscopic partial nephrectomy (reRAPN). Until May 2022, 3310 patients with renal tumors underwent nephron-sparing surgery (NSS) at affiliated institutions. Of these, 22 and 17 patients who underwent reOPN and reRAPN, respectively, were included in this study. No significant differences were found between the groups in terms of sex, age, comorbidities, recurrent tumor size at repeat NSS, interval from recurrence to initial NSS, and nephrometry score. ReRAPN had a shorter operative time (median: 138.0 vs. 214.0 min; p = 0.0023) and less estimated blood loss (median: 50.0 vs. 255.0 mL; p = 0.0261) than reOPN. The incidence of complications with Clavien-Dindo grade ≥ 2 was higher in the reOPN group than in the reRAPN group (31.8 vs. 5.9%; p = 0.0467). The mean decrease in the estimated glomerular filtration rate at 3 months postoperatively was not significantly different between the groups. The trifecta achievement rates in the reRAPN (64.7%) and reOPN (27.3%) groups were significantly different (p = 0.0194). On multivariate analysis, age and surgical method were significant predictors of trifecta achievement after partial nephrectomy. There were no differences in postoperative renal functional outcomes between reOPN and reRAPN. ReRAPN is superior to reOPN in terms of surgical burden. Therefore, ReRAPN is an important minimally invasive surgery for recurrent renal cell carcinoma.

Clinical application of superselective transarterial embolization of renal tumors in zero ischaemia robotic-assisted laparoscopic partial nephrectomy.

To assess the feasibility and safety of zero ischaemia robotic-assisted laparoscopic partial nephrectomy (RALPN) after preoperative superselective transarterial embolization (STE) of T1 renal cancer. We retrospectively analyzed the data of 32 patients who underwent zero ischaemia RALPN after STE and 140 patients who received standard robot-assisted laparoscopic partial nephrectomy (S-RALPN). In addition, we selected 35 patients treated with off-clamp RALPN (O-RALPN) from September 2017 to March 2022 for comparison. STE was performed by the same interventional practitioner, and zero ischaemia laparoscopic partial nephrectomy (LPN) was carried out by experienced surgeon 1-12 hours after STE. The intraoperative data and postoperative complications were recorded. The postoperative renal function, routine urine test, urinary Computed Tomography (CT), and preoperative and postoperative glomerular filtration rate (GFR) data were analyzed. All operations were completed successfully. There were no cases of conversion to opening and no deaths. The renal arterial trunk was not blocked. No blood transfusions were needed. The mean operation time was 91.5 ± 34.28 minutes. The mean blood loss was 58.59 ± 54.11 ml. No recurrence or metastasis occurred. For patients with renal tumors, STE of renal tumors in zero ischaemia RALPN can preserve more renal function, and it provides a safe and feasible surgical method.

The application of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy with a new robotic system KangDuo Surgical Robot-01: Initial experience

ObjectiveTo assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy (rRAPN) with a new robotic platform called KangDuo Surgical Robot-01 (KD-SR-01) system (Suzhou KangDuo Robot Co., Ltd., Suzhou, China) and discuss its surgical technique. MethodsA 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney. The R.E.N.A.L. nephrometry score of this patient was 4x. This patient underwent rRAPN with KD-SR-01. The perinephric fat between the tumor and Gerota's fascia was preserved, which was used for internal suspension traction during tumor resection. Postoperative follow-up data were collected. ResultsThe surgery was successfully carried out with a duration of 127 min, in which the docking time was 6 min 25 s and console time was 60 min. The warm ischemia time was 19 min 53 s, and the estimated blood loss was 0 mL. The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma, with a negative surgical margin. The World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade of this patient was Grade 2. No recurrence was observed during the 6-month follow-up. ConclusionInternal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.

Comparisons of the Safety and Effectiveness of Robot-Assisted vs Laparoscopic Partial Nephrectomy for Central Renal Angiomyolipomas: A Propensity Score-Matched Analysis Study.

Objective: To compare the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) vs laparoscopic partial nephrectomy (LPN) in the treatment of central renal angiomyolipomas (AMLs). Methods: We retrospectively analyzed the clinical data of 103 patients who were treated with either RAPN or LPN for central AMLs between January 2017 and June 2022. Propensity scores were matched according to sex, age, laterality, body mass index, symptoms, diameter of tumor, location of tumor distribution, R.E.N.A.L score, preoperative hemoglobin, preoperative serum creatinine, preoperative estimated glomerular filtration rate, chronic disease, previous abdominal surgery, preoperative selective arterial embolization, American Society of Anesthesiologists scale, and duration of follow-up, and after matching, perioperative and prognostic data of the two groups were compared. Results: A total of 57 patients underwent RAPN, and 46 patients underwent LPN. Before matching, there were more complex AMLs in the RAPN group, and R.E.N.A.L scores differed between the two groups (10 vs 9, p < 0.001). After matching, the median warm ischemic time in the RAPN group was significantly shorter than that in the LPN group (21.5 minutes vs 28 minutes, p = 0.034), as well as the median time of postoperative mobilization (1 day vs 2 days, p < 0.001). The other indicators were not significantly different between the groups. Conclusions: For central AMLs, both RAPN and LPN were safe and feasible surgical treatments, but RAPN might be associated with shorter warm ischemia time and earlier postoperative mobilization.

Early perioperative outcomes of single-port compared to multi-port robot-assisted laparoscopic partial nephrectomy.

Single-port (SP) robot-assisted laparoscopic partial nephrectomy (RAPN) is a promising new technique. The aim of this study was to compare surgical and oncological outcomes of SP-RAPN to the multi-port (MP) surgical platform. This is a retrospective, cohort-based study involving patients undergoing SP-RAPN between 2019 and 2020 at a single institution. Demographic, preoperative, surgical, and postoperative outcomes data were gathered and compared to a 1-to-1 matched MP cohort. A total of 50 SP and 50 matched MP cases were included. Length of surgery and ischemia time were not statistically significant between the two cohorts; however, estimated blood loss (EBL) was significantly lower in the SP group than in the MP (IQR 25-50 vs. IQR 50-100mL, p = 0.002). No differences were seen in regard to the 30-day readmission rate, surgical margin status, pain scores, and complications between the two approaches. We found no statistically significant differences in positive margins, pain score, length of stay, or readmission rate between matched SP and MP patients. These data support the viability of the SP technique as an alternative to MP-RAPN when in the hands of experienced surgeons.

Cumulative sum analysis (CUSUM) for evaluating learning curve (LC) of robotic-assisted laparoscopic partial nephrectomy (RALPN).

Robotic-assisted laparoscopic partial nephrectomy (RALPN) is becoming a standard treatment for localized renal tumors worldwide. Data on the learning curve (LC) of RALPN are still insufficient. In the present study, we have attempted to gain further insight in this area by evaluating the LC using cumulative summation analysis (CUSUM). A series of 127 robotic partial nephrectomies were performed by two surgeons at our center between January 2018 and December 2020. CUSUM analysis was used to evaluate LC for operative time (OT). The different phases of surgical experience were compared in terms of perioperative parameters and pathologic outcomes. In addition, multivariate linear regression analysis was used to confirm the results of the CUSUM analysis by adjusting the phases of surgical experience for the other confounding factors that may affect OT. The median age of patients was 62years, mean BMI was 28, and mean tumor size was 32mm. Tumor complexity was classified as low, intermediate, and high risk according to the PADUA score in 44%, 38%, and 18%, respectively. The mean OT was 205min, and trifecta was achieved in 72.4%. According to the CUSUM diagram, the LC of OT was divided into three phases: initial learning phase (18 cases), plateau phase (20 cases), and mastery phase (subsequent cases). The mean OT was 242, 208, and 190min in the first, second, and third phases, respectively (P < 0.001). Surgeon experience phases were significantly associated with OT in multivariate analysis considering other preoperative and operative parameters. Surgical outcome was comparable between the three phases in terms of complications and achievement of trifecta; hospital stay was shorter in the mastery phase than in the first 2 phases (4days vs 5days, P = 0.02). The LC for RALPN is divided into 3 performance phases with CUSUM. Mastery of surgical technique was achieved after performing 38 cases. The initial learning phase of RALPN has no negative impact on surgical and oncologic outcomes .

Effects of remote ischemic preconditioning on renal protection in patients undergoing robot-assisted laparoscopic partial nephrectomy.

We aimed to evaluate the renoprotective effects of remote ischemic preconditioning (RIPC) in patients undergoing robot-assisted laparoscopic partial nephrectomy (RAPN). Data from 59 patients with solitary renal tumors who underwent RAPN with RIPC comprising three cycles of 5-min inflation to 200mmHg of a blood pressure cuff applied to one lower limb followed by 5-min reperfusion by cuff deflation, from 2018 to 2020 were analyzed. Patients who underwent RAPN for solitary renal tumors without RIPC between 2018 and 2020 were selected as controls. The postoperative estimated glomerular filtration rate (eGFR) at the nadir during hospitalization and the percentage change from baseline were compared using propensity score matching analysis. We performed a sensitivity analysis with imputations for missing postoperative renal function data weighted by the inverse probability of the data being observed. Of the 59 patients with RIPC and 482 patients without RIPC, 53 each were matched based on propensity scores. No significant differences in the postoperative eGFR in mL/min/1.73 m2 at nadir (mean difference 3.8; 95% confidence interval [CI] -2.8 to 10.4) and its percentage change from baseline (mean difference 4.7; 95% CI -1.6 to 11.1) were observed between the two groups. Sensitivity analysis also indicated no significant differences. No complications were associated with the RIPC. In conclusion, we found no significant evidence of the protective effect of RIPC against renal dysfunction after RAPN. Further research is required to determine whether specific patient subgroups benefit from RIPC.Trial registration number: UMIN000030305 (December 8, 2017).

MP47-20 PROGNOSTIC FACTORS FOR RECURRENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: REAL-WORLD DATA FROM JAPANESE SINGLE HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP47-20 PROGNOSTIC FACTORS FOR RECURRENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY: REAL-WORLD DATA FROM JAPANESE SINGLE HIGH-VOLUME CENTER Shun Watanabe, Toshio Takagi, Hiroki Ishihara, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, Tsunenori Kondo, and Hideki Ishida Shun WatanabeShun Watanabe More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , and Hideki IshidaHideki Ishida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted partial nephrectomy has been accepted as a standard treatment option for small renal cell carcinoma. For careful follow-up after surgery, identifying prognostic factors for recurrence is important. However, few studies have investigated the recurrence of renal cell carcinoma after partial nephrectomy, focusing on robotic surgery. Therefore, we investigated post-operative recurrence-free survival and predictive factors that affect tumor recurrence after robot-assisted partial nephrectomy. METHODS: In total, 1039 patients who underwent robot-assisted laparoscopic partial nephrectomy for clinical T1 renal cell carcinoma at a single institution between January 2013 and December 2020 were retrospectively evaluated. RESULTS: The median age was 59 years and the median tumor size was 30 mm. With a median follow-up of 37 months (Interquartile range 24-53 months), 38 patients (3.7%), including 6 with local recurrence, 5 recurrence in the operated kidney, and 27 with other organs or lymph-nude, experienced recurrence. The 3-year recurrence-free survival was 97%. Multivariate analyses revealed high grade tumor (hazard ratio: 2.71, p=0.0047), upstaging to pathological T3a (hazard ratio: 3.47, p=0.0248) and lymphovascular invasion (hazard ratio: 4.03, p=0.0002) were independent prognostic factors for worse recurrence-free survival (Table). CONCLUSIONS: In conclusions, patients after robot-assisted laparoscopic partial nephrectomy with high grade tumor, upstaging to pathological T3a and lymphovascular invasion had a risk of worse recurrence-free survival. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e652 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shun Watanabe More articles by this author Toshio Takagi More articles by this author Hiroki Ishihara More articles by this author Hironori Fukuda More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Hideki Ishida More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-19 VALIDATION OF PREDICTIVE MODEL FOR NEW BASELINE RENAL FUNCTION AFTER RADICAL NEPHRECTOMY OR ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN JAPANESE PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP47-19 VALIDATION OF PREDICTIVE MODEL FOR NEW BASELINE RENAL FUNCTION AFTER RADICAL NEPHRECTOMY OR ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN JAPANESE PATIENTS Hidekazu Tachibana, Kenji Omae, Yuki Kobari, Hiroki Ishihara, Hironori Fukuda, Kazuhiko Yoshida, Junpei Iizuka, Tsunenori Kondo, and Toshio Takagi Hidekazu TachibanaHidekazu Tachibana More articles by this author , Kenji OmaeKenji Omae More articles by this author , Yuki KobariYuki Kobari More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , and Toshio TakagiToshio Takagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The study's aim was to externally validate a new predictive model for the new baseline glomerular filtration rate (NB-GFR) postnephrectomy among Japanese patients. METHODS: Patients with renal tumors who underwent radical nephrectomy (RN) or robot-assisted laparoscopic partial nephrectomy (PN) at a single Japanese institution during the period 2000-2020 were retrospectively analyzed. The NB-GFR is defined as the final estimated glomerular filtration rate within postoperative 3-12 months. The correlation/bias/accuracy/precision of the equation was examined by comparing the calculated NB-GFR with the observed rate. RESULTS: The study included 485 cases of RN and 1030 cases of robot-assisted laparoscopic PN. The correlation/bias/accuracy/precision of the new equation predicting the NB-GFR was 0.86/-0.92/95.9/-5.65-3.62 in robot-assisted laparoscopic PN and 0.79/-1.02/87.8/-6.26-3.91 in RN, respectively. The fractional polynomial regression line approximated zero and its pointwise 95% confidence interval (CI) was considerably tight for the majority of both cohorts. The 95% CI to discriminate NB-GFRs ≥45 mL/min/1.73 m2 from receiver operating curves was 0.96 (0.95-0.97) and 0.89 (0.87-0.92) in robot-assisted laparoscopic PN and RN, respectively. Various preoperative factors, including age, tumor size, complexity, body mass index, hypertension, and diabetes, did not affect the predictive ability (correlation >0.7) of the subgroup analysis. CONCLUSIONS: The novel simple equation can accurately predict NB-GFRs after radical and robot-assisted laparoscopic partial nephrectomies in Japanese patients. This model will help physicians choose surgical treatments for renal tumors in daily clinical practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e652 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hidekazu Tachibana More articles by this author Kenji Omae More articles by this author Yuki Kobari More articles by this author Hiroki Ishihara More articles by this author Hironori Fukuda More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Tsunenori Kondo More articles by this author Toshio Takagi More articles by this author Expand All Advertisement PDF downloadLoading ...

V05-04 APPLICATIONS OF 3-DIMENSIONAL VIRTUAL REALITY MODELS IN UROLOGIC ROBOTIC SURGERY

You have accessJournal of UrologyCME1 Apr 2023V05-04 APPLICATIONS OF 3-DIMENSIONAL VIRTUAL REALITY MODELS IN UROLOGIC ROBOTIC SURGERY Michael Emmerling, Hung Jui Tan, Joseph Shirk, and Marc Bjurlin Michael EmmerlingMichael Emmerling More articles by this author , Hung Jui TanHung Jui Tan More articles by this author , Joseph ShirkJoseph Shirk More articles by this author , and Marc BjurlinMarc Bjurlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Virtual Realtiy (VR) technologies have developed increasing relevance and implementation in the field of medicine, and more specifically in the realm of surgical management for Urologic cancers. Certain VR technologies can develop three-dimensional (3D) digital models from standard computed tomography (CT) and magnetic resonance imaging (MRI) scans to facilitate surgical planning and intra-operative guidance. Use of 3D VR models has been linked to improved patient outcomes. Specifically, the use of 3D VR technology in robotic assisted laparoscopic partial nephrectomy has led to reduced operative times, shorter hospital stay, reduced clamp time, and minimized blood loss. In this video, we will highlight the impact of 3D VR technology on intra-operative planning for patients undergoing partial nephrectomy for renal masses. METHODS: In this video abstract, we explore the use of 3D VR technology in 5 patients undergoing robotic-assisted laparoscopic partial nephrectomy for renal masses. We review the CT findings and subsequently rendered 3D VR images to highlight the impact of VR on clinical decision making regarding partial versus radical nephrectomy, transperitoneal versus retroperitoneal approach, optimal vascular control mechanisms, selective versus global clamping, and depth of tumor resection. RESULTS: The use of 3D VR software impacted operative planning in each of patient undergoing robotic assisted laparoscopic surgery for a renal mass. Pre-operative and intra-operative use of 3D VR software allowed the surgeon to individualize the operative approach for each patient based on specific anatomic considerations that were highlighted or augmented with 3D VR technology. CONCLUSIONS: VR models applied to robotic partial nephrectomy appear to demonstrate improvement in clinical outcomes, surgical planning, and preoperative and intraoperative guidance. The technology is evolving, and cost remains a consideration. Future challenges will be to adopt artificial Intelligence and machine learning to account for tissue deformation, organ mobility, and anatomical changes during dissection. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e425 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Emmerling More articles by this author Hung Jui Tan More articles by this author Joseph Shirk More articles by this author Marc Bjurlin More articles by this author Expand All Advertisement PDF downloadLoading ...

V02-11 ENDOSCOPIC COMBINED INTRARENAL SURGERY FOR REMOVAL OF ERODED HEM-O-LOK CLIPS AFTER ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023V02-11 ENDOSCOPIC COMBINED INTRARENAL SURGERY FOR REMOVAL OF ERODED HEM-O-LOK CLIPS AFTER ROBOTIC PARTIAL NEPHRECTOMY Willian Ito, Bristol Whiles, Daniel Igel, Kenneth Schmanke, Crystal Valadon, Donald Neff, David Duchene, and Wilson Molina Willian ItoWillian Ito More articles by this author , Bristol WhilesBristol Whiles More articles by this author , Daniel IgelDaniel Igel More articles by this author , Kenneth SchmankeKenneth Schmanke More articles by this author , Crystal ValadonCrystal Valadon More articles by this author , Donald NeffDonald Neff More articles by this author , David DucheneDavid Duchene More articles by this author , and Wilson MolinaWilson Molina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although metallic and Hem-O-Lok™ clips have consistently shown their safety and efficacy, especially in laparoscopic surgery, some rare complications may arise, oftentimes requiring complex surgical procedures. This video describes the utilization of miniaturized endoscopic combined intrarenal surgery (mini-ECIRS) to remove Hem-O-Lok™ clips that eroded into the collecting system as a late complication of robotic partial nephrectomy. METHODS: We present a 68-year-old male patient that underwent a robotic-assisted laparoscopic partial nephrectomy in 2015 to address a small renal mass (2.0×1.9 cm) on the right side. Pathology revealed the tumor to be an oncocytoma. Then, the patient was lost to follow-up but returned to the urologic clinic 7 years later due to gross hematuria and right-sided flank pain. Cystoscopy was negative for lesions or tumors, and a CT scan demonstrated a right-sided calculus (1.3×1.4 cm) in the renal pelvis. RESULTS: Considering the size and location of the stone (≤2 cm), the patient underwent a flexible ureteroscopy. However, a calcified Hem-O-Lok clip was found to be free-floating in the right renal pelvis. As the size of the clip precluded its prompt removal through the ureter, we decided to perform right-side mini-percutaneous nephrolithotomy by gaining access through the mid pole with a 15/16Fr access sheath. The clip was then removed with a grasper in one piece. During the routine final endoscopic survey, we found another clip in the process of erosion. This time, we first utilized a holmium-YAG laser to dissect it from the surrounding urothelium to subsequently remove it through the renal tract. The total operative time was 81 min and the laser pedal time 1 min. No complications were noted, and the patient was discharged on the first postoperative day. CONCLUSIONS: Erosion of surgical clips is a rare complication in modern-era surgery, although it may require complex surgical procedures to address it. This case demonstrates the safety and feasibility of mini-ECIRS to remove surgical clips after partial nephrectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e171 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Willian Ito More articles by this author Bristol Whiles More articles by this author Daniel Igel More articles by this author Kenneth Schmanke More articles by this author Crystal Valadon More articles by this author Donald Neff More articles by this author David Duchene More articles by this author Wilson Molina More articles by this author Expand All Advertisement PDF downloadLoading ...

Better specificity and less ischemia: three-dimensional reconstruction is superior to routine computed tomography angiography in navigation of super-selective clamping robot-assisted laparoscopic partial nephrectomy.

Available technologies could be used to guide surgeons in controlling highly selective tumor-bearing arteries robot-assisted laparoscopic partial nephrectomy (RALPN). Patients undergoing RALPN (from September 2018 to January 2020) for intermediate-high complex renal tumor (R.E.N.A.L. score ≥7) who underwent abdominal computed tomography (CT) scan with angiography and hyper-accuracy 3-dimensional reconstruction (H3DR). All patients underwent high-resolution CT scan with angiography and H3DR with special software, based on which two kinds of highly selective arterial clamp protocols were made for each patient and analyzed independently by two urologists and two radiologists to confirm which renal arterial branch was supplying the tumor. We chose the optimized clamping protocol with the principle of the minimized ischemic regions. During the operation, meticulous microdissection and clip ligation of the specific vascular branch was guided by optimized protocol [H3DR or computed tomography angiography (CTA) reconstruction], according to the in vivo anatomy (identified by intraoperative ultrasound). Of 82 patients, the minimum-ischemic regions planning completed rate (MIRPCR) of preoperative planning with H3DR (90.2%) was higher than that with CTA (34.1%) (P<0.01). H3DR identified 78 high-order arteries (70.3%), whereas CTA identified 33 (29.7%) high-order arteries (P<0.001). H3DR detected a more optimal blocking option in 51 cases that were either missed (n=13) or misclassified by CTA (n=38). A total of 18 cases (56.3%) were converted to H3DR-guided occurred in CTA-guided surgery [5 (10.0%) occurred in group H3DR to CTA, P<0.01]. Moreover, in the CTA-guided group, the separation of renal hilum was avoided in 14 of 19 (73.7%) cases, whereas in the H3DR-guided group, it was avoided in 60 of 63 (95.3%) cases. For patients undergoing RALPN, H3DR-guided surgery compared with standard CTA-guided surgery has higher accuracy and feasibility in controlling arterial branches supplying the tumor and intraoperative surgical navigation. Additionally, it reduces the ischemic lesion area and simplifies vascular isolation steps, thus decreasing procedural difficulty.

Retrospective comparison of clinical outcomes of robotic-assisted laparoscopic partial nephrectomy through transabdominal or retroperitoneal approaches in patients with T1b renal tumor

BackgroundWe compared the intraoperative and postoperative outcomes of robotic-assisted laparoscopic partial nephrectomy (RALPN) via transabdominal or retroperitoneal approaches in patients with stage T1b renal cell carcinoma.MethodsThe medical records for 92 patients who underwent RALPN were retrospectively collected and data on their baseline demographics, duration of operation, duration of renal artery clamping, intraoperative blood loss, recovery time of intestinal functions, surgical margin positive rate, as well as postoperative complications were analyzed.ResultsOf the 92 enrolled patients, 43 and 49 patients were subjected to RALPN via the transabdominal and retroperitoneal approaches, respectively. All patients successfully completed the operation. Baseline characteristics for the transabdominal and retroperitoneal groups were comparable. Differences in operative time, renal artery clamping time, intraoperative blood loss, positive rate of surgical margin, and incidences of postoperative complications between the two approaches were insignificant. The recovery time of intestinal function after operation was significantly shorter in patients subjected to the retroperitoneal approach, relative to those subjected to transabdominal approach (p < 0.001).ConclusionsApplication of RALPN via transabdominal or retroperitoneal approaches showed comparable clinical outcomes in patients with stage T1b renal cell carcinoma. The retroperitoneal approach was superior to the transabdominal approach in terms of postoperative intestinal function recovery.

Rare renal cell carcinoma with haemangioblastoma-like features and leiomyomatous stroma: report of a unique case with TSC2 and SETD2 variations

BackgroundRenal cell carcinoma (RCC) with haemangioblastoma-like characteristics is a type of RCC reported in recent years. RCC with (angio) leiomyomatous stroma (RCCLMS) was included as a provisional entity of the 2016 World Health Organization (WHO) classification. RCC with haemangioblastoma-like characteristics and leiomyomatous stroma is extremely rare. This is the first report of a rare tumour harbouring TSC2 and SETD2 variations.Case presentationThe patient was a 38-year-old woman who presented with discomfort in the area of her right kidney. Ultrasound and enhanced CT showed a right renal mass, and clear cell renal cell carcinoma (CCRCC) was suspected; hence, robot-assisted laparoscopic nephron-sparing partial nephrectomy was performed. Gross examination revealed a well-circumscribed tumour measuring 2.0 cm × 1 cm × 0.7 cm under the renal capsule adjacent to the stripping edge that was greyish yellow and greyish red in colour. Histologic examination showed that the tumour consisted of three different structures: a CCRCC-like region, a haemangioblastoma-like region, and a focal leiomyomatous stroma component. Based on immunohistochemistry, the CCRCC-like region was diffusely strongly positive for AE1/AE3, vimentin, CAIX, PAX8, PAX2, CK7, and CAM5.2, partly positive for HNF1α, and negative for CD10, α-inhibin, NSE, S-100, CD34, and TFE3. The haemangioblastoma-like area was diffusely positive for vimentin, CAIX; partly positive for PAX8, PAX2, α-inhibin, and S-100; mostly positive for NSE; and slightly positive for HNF1α; the CD34 staining highlighted the complex capillary network. The Ki67 index was approximately 1–2% in the two above areas, and the leiomyomatous stroma was strongly positive for SMA. The whole-exon sequencing (WES) showed TSC2 and SETD2 variations. There was no progression after 18 months of follow-up.ConclusionWe report for the first time a unique case of RCC with haemangioblastoma-like features and leiomyomatous stroma accompanied by rare molecular abnormalities. Whether this is a new tumour entity or a variant of clear cell carcinoma remains to be determined. The biological behaviour and clinical characteristics need to be further examined.

Development and In Vitro Assessment of a Novel Vacuum-Based Tissue-Holding Device for Laparoscopic and Robotic Kidney Cancer Operations.

Simple SummaryDepending on the location and configuration of renal tumors, it is sometimes difficult to grasp, excise, and properly remove them. We have designed and developed a device to improve robotic laparoscopic partial nephrectomy. We tested the device on porcine kidneys and livers and embalmed human cadavers. A preliminary evaluation of this surgical tool showed satisfactory device setup, suction, and tissue handling characteristics. In this paper, we describe the development and evaluation of a novel tissue-holding device (THD) for use during robotic-assisted laparoscopic partial nephrectomy. The THD is a vacuum-based apparatus made of either 3D-printed polyethylene or stainless steel. The proximal end connects to suction tubing routed outside the body, while the distal end is conically shaped and designed to firmly interface with the tumor. Device feasibility studies were performed on six porcine kidneys, two porcine livers, and two embalmed human cadavers. A Likert-scale rating was used to assess device setup, suction, and tissue handling. Additional tests were performed using the daVinci Xi® robotic system. Finally, the holding force of the THD was assessed using different standard vacuum systems and pressure settings. In porcine tissue, the device setup, tissue suction, and handling were rated as “good”. THD insertion and removal was uncomplicated. In a simulated transabdominal approach on fixed human cadavers, the device setup, suction, and tissue handling were also rated as “good”. No macroscopic tissue compromise or device deterioration was noted. The handling and holding abilities using the daVinci Xi® robotic system were also rated “good”. The device was able to successfully hold over 300 g of tissue at a suction pressure of −600 mmHg. The preliminary evaluation of the THD demonstrated satisfactory results.