Robot-assisted Radical Nephrectomy Research Articles

Time-Driven Activity-based Costing and Outcomes of Same-Day Discharge vs Inpatient Robotic Partial and Radical Nephrectomy

ObjectiveTo assess the outcomes, total healthcare utilization, and cost savings for same-day discharge versus inpatient robotic assisted partial nephrectomy (RAPN) and robotic assisted radical nephrectomy (RARN). MethodsWe compared 146 RAPNs and 65 RARNs consecutively performed as same-day discharge (RAPN=21, RARN=9) versus inpatient (RAPN=125, RARN=56) from April 2015 to May 2023 at two academic medical centers. We collected baseline demographics, perioperative characteristics, and 30-day complications. We applied the Time-Driven Activity-Based Costing (TDABC) analysis to compare total costs of RAPN and PARN throughout the cycle of care, including inpatient vs same-day discharge. ResultsBaseline demographics and comorbidities were similar between patients undergoing inpatient versus same-day discharge RAPN and RARN. One Clavien-Dindo grade II complication (3.3%) requiring re-admission due to wound infection for antibiotics occurred after same-day discharge RAPN; no complications occurred after same-day discharge RARN. Two unscheduled office or ED visits (6.7%) occurred after same-day discharge RAPN for surgical-site infection and urinary retention. Same-day discharge versus inpatient RAPN and RARN demonstrated a $3,091 (18%) and $4,003 (25%) overall cost reduction, respectively. ConclusionSame-day discharge RAPN and RARN result in cost savings of 18-25% without a difference in complications, and thereby improves value-based care for appropriately selected patients.

Robot-assisted surgery of renal cell carcinoma in comorbid and frail patients

BACKGROUND: Renal cell carcinoma is predominantly observed in elderly patients. Many of them have multiple comorbidities, which can limit the feasibility of surgical treatment. The search for an optimal approach of radical treatment for comorbid and frail patients remains a current challenge. AIM: To evaluate the perioperative outcomes of robot-assisted partial nephrectomy and radical nephrectomy in comorbid and frail patients with renal cell carcinoma. MATERIALS AND METHODS: At the Almazov National Medical Research Centre we retrospectively studied the results of 118 comorbid and frail patients who underwent robot-assisted surgeries for localized renal cell carcinoma from 2012 to 2022. Mean age of men was 65.7 ± 11.4 years, and women was 61.3 ± 13.1 years. Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Frailty was determined using a modified Frailty index (mFI-11). Robot-assisted partial nephrectomy and radical nephrectomy were perfomed by single experienced robotic surgeon. Perioperative functional outcomes were assessed. Renal function was evaluated based on glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula before surgery and at 1.3, and 6 months after surgery. RESULTS: Among 118 patients, 71 (60.2%) underwent robot-assisted partial nephrectomy, while 47 (39.8%) underwent radical nephrectomy. Postoperative complications occurred in 15 (12.7%) of patients for robot-assisted surgeries. There were no positive surgical margins. Mortality in the early postoperative period amounted to 1.7% and was associated with the development of acute cardiovascular failure. CONCLUSIONS: Robot-assisted partial nephrectomy and radical nephrectomy for renal cell carcinoma in comorbid and “fragile” patients — the safest and optimal method of treatment, accompanied by minimal perioperative complications and mortality.

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.

Concordance between renal tumour biopsy and robotic-assisted partial and radical nephrectomy histology: a 10-year experience.

We aimed to assess concordance between renal tumour biopsy (RTB) and surgical pathology from robotic-assisted partial nephrectomy (RAPN) or robotic-assisted radical nephrectomy (RARN). Patients with preoperative RTB undergoing RAPN or RARN for suspected malignancy (9 September 2013-9 September 2023) were enrolled retrospectively from three sites. Patients were excluded if the tumour had prior cryotherapy or if biopsy or nephrectomy histology were unavailable or inconclusive. The primary outcome was concordance with the presence/absence of malignancy. Secondary outcomes were concordance with tumour subtype, World Health Organisation nuclear grade (patients with RTB clear cell or papillary RCC only), false-negative rate, false-positive rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). In the enrolment period, 332 and 132 patients underwent RAPN and RARN, respectively. Of these, 160 received preoperative RTB, with nine patients excluded, leaving 151 eligible patients. Median age was 63 years, and 49 (32%) were female. On surgical specimens, 144 patients had malignant histology. RTB was highly concordant with presence/absence of malignancy (147/151, 97%). Concordance with tumour subtype occurred in 141 patients (93%), while concordance with nuclear grade was seen in 42/66 patients (64%, RTB grade missing in 53 patients). False-negative rate, false-positive rate, sensitivity, specificity, PPV, and NPV were 2%, 14%, 98%, 86%, 99%, and 67%, respectively. Limitations include absence of complication data and exclusion of patients biopsied without surgery. In patients undergoing RAPN or RARN, preoperative RTB has high concordance with surgical pathology, both in the presence of malignancy and RCC subtype.

Experiences of robot assisted thrombectomy with 2-year follow-up.

No consensus has been reached on operative procedures since a limited case series of robot-assisted inferior vena cava thrombectomy (RA-IVCT) and robot-assisted radical nephrectomy (RA-RN) have been described. The clinical data of 21 patients who underwent RA-IVCT and RA-RN were retrieved from the database. Preoperative preparation was used for assessment of the tumour. Surgical procedures were recorded, and operative skills were summarised. The median IVC clamping time was 23min, and IVC wall invasion was pathologically found in 2 cases. The mean postoperative hospital stay was 8.4days and most patients recovered to full ambulation and oral feeding on the fourth day. None of the patients had liver or kidney dysfunction at the last follow-up (median, 24months). RA-IVCT presents technical challenges to surgeons. IVC control is an important part of the surgical process and different sides require different techniques.

Robot-assisted radical nephrectomy for renal-cell carcinoma during twin pregnancy

Large renal masses are rare findings in pregnant patients and generate complex challenges regarding when and how to treat. We report a case of a 23-year-old woman found to have a large renal mass during twin pregnancy. Here we describe the evaluation and decision making for this patient who was ultimately treated with robot-assisted radical nephrectomy during her pregnancy.

A Literature Review of Perioperative Outcomes of Robotic Radical Nephrectomy (RRN) Versus Laparoscopic Radical Nephrectomy (LRN) for Renal Cell Carcinoma (RCC).

Renal cell carcinoma (RCC) is an adenocarcinoma of the renal cortex. Radical nephrectomy remains the standard of care for managing massive renal tumours. Robotic-assisted radical nephrectomy is an increasing alternative technique to laparoscopic radical nephrectomy (LRN). The da Vinci Surgical System allows for improved dexterity, increased visualisation, tremor filtration and an ergonomic setting to enhance surgeon comfort. The aim was to compare the perioperative outcomes pertaining tooperative time, intraoperative complications, blood loss and length of hospital staybetween the robotic and LRN for RCC. Studies that compared the perioperative findings between robotic radical nephrectomy (RNN) and LRN for RCC were included. The literature review was carried out according to the Cochrane collaboration standards where applicable. Highly sensitive search strategies like MeSH terms and controlled vocabularies were used to identify relevant studies that compare the RNN outcomes to the LRN. Following the literature search, a total of 73 articles were collected, 60 articles were excluded at the stage of reviewing the titles, eight articles were excluded after reading the abstracts, and five articles were included in this paper. Five studies were included in this analysis, with a total sample size of 1770 patients, 735 were in the robotic arm, and 1035 were in the laparoscopic arm. Generally, there were no differences between both arms in terms of demographic data and age of patients. Closer analysis of the perioperative outcomes did not reveal significant differences between the two groups related to the estimated blood loss, length of hospital stay or post-operative complications. The laparoscopic techniques have less operative time than the robotic ones. RRNis an expanding approach for patients with RCCwith some potential technical benefits over laparoscopic ones. RRN is similar to LRN in the perioperative outcomes, with few potential drawbacks of RRN, including higher costs. However, a prospective comparison of RRN with LRN in many cases at multiple centres with long-term oncological results best illustrates the status of RRN versus LRN.

Robot-assisted radical nephrectomy using novel surgical robot platform, hinotori: Report of initial series of 13 cases.

The aims of the present study were to describe the perioperative findings of the first series of patients undergoing robot-assisted radical nephrectomy (RARN) with a newly launched platform, the hinotori surgical robot system, and compare the findings with a similar set receiving RARN with the existing system, da Vinci. This study included 34 patients, consisting of 13 and 21 undergoing RARN using the hinotori and da Vinci robotic systems, respectively. As a rule, RARN was performed via an intraperitoneal approach employing 3 robotic arms, irrespective of the robotic systems. In the hinotori group, the median age, body mass index and tumor diameter were 65 years, 23.3 kg/m2 and 50 mm, respectively. All surgical procedures with hinotori could be completed by a purely robotic approach. In the hinotori group, the median operative time, time using the robotic system, estimated blood loss and length of hospital stay were 157, 83 min, 11 mL and 6 days, respectively, and major perioperative complications did not occur. In this group, 3, 1 and 9 patients were pathologically diagnosed with pT1a, pT1b and pT3a tumors, respectively. No significant differences in baseline characteristics were noted between the hinotori and da Vinci groups, and there were also no significant differences in perioperative findings between them. Despite a case series with a small sample size, this is the first report evaluating RARN using the hinotori surgical robot system, which could be safely conducted and achieved perioperative outcomes similar to that using the da Vinci system.

VE76 - Level 2 vena cava thrombectomy and robot assisted radical nephrectomy following immunotherapy

VE76 - Level 2 vena cava thrombectomy and robot assisted radical nephrectomy following immunotherapy

Sarcomatoid renal cell carcinoma with an inferior vena cava tumor thrombus that was completely resected by robot-assisted laparoscopic radical nephrectomy after neoadjuvant therapy nivolumab plus ipilimumab: a case report.

We here present a patient with a sarcomatoid renal cell carcinoma complicated by inferior vena cava tumor thrombus that we treated with nivolumab plus ipilimumab. This resulted in shrinkage of the tumor, enabling complete resection by robot-assisted laparoscopic radical nephrectomy. The patient is still alive with no evidence of recurrence.

Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses.

There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4min, p = 0.53), estimated blood loss (69.6.0 vs 142.0mL, p = 0.62), and length of stay (1.6 vs 1.8days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.

Robot-assisted radical nephrectomy for Wilms’ tumor in children

Surgical removal of the tumor is a key step in the management of nephroblastoma. Less invasive surgical approaches such as robot-assisted radical nephrectomy (RARN) has gained momentum over the past few years. This video presents a comprehensive step-by-step video for two cases: one uncomplicated left RARN and one more challenging right RARN. Following the UMBRELLA/SIOP protocol, both patients received neoadjuvant chemotherapy. Under general anesthesia, in a lateral decubitus position, four robotic and one assistant port are placed. After mobilization of the colon, the ureter and gonadal vessels are subsequently identified. The renal hilum is dissected, and the renal artery and vein are divided. The kidney is dissected with sparing of the adrenal gland. The ureter and gonadal vessels are divided, and the specimen is removed through a Pfannenstiel incision. Lymph node sampling is performed. Patients were 4 and 5 years old. The total surgical time was 95 and 200min, with an estimated blood loss of 5 and 10cc. The hospital stay was limited to 3 and 4 days. Both pathological reports confirmed the diagnosis of nephroblastoma, with tumour-free resection margins. No complications were observed 2 months postoperatively. RARN is feasible in children.

V04-09 ROBOT-ASSISTED RADICAL NEPHRECTOMY FOR WILMS TUMOR IN CHILDREN

You have accessJournal of UrologyCME1 Apr 2023V04-09 ROBOT-ASSISTED RADICAL NEPHRECTOMY FOR WILMS TUMOR IN CHILDREN Jolien van der Jeugt, Camille Berquin, Caroline Jamaer, Karel Decaestecker, Charles van Praet, and Anne-Françoise Spinoit Jolien van der JeugtJolien van der Jeugt More articles by this author , Camille BerquinCamille Berquin More articles by this author , Caroline JamaerCaroline Jamaer More articles by this author , Karel DecaesteckerKarel Decaestecker More articles by this author , Charles van PraetCharles van Praet More articles by this author , and Anne-Françoise SpinoitAnne-Françoise Spinoit More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical removal of the tumor is a key step in the management of nephroblastoma. Less invasive techniques - such as robot-assisted radical nephrectomy (RARN) - have gained momentum over the past few years, but are still less frequently used in the pediatric population. This video shows our technique in case of left and right RARN in children. METHODS: We present 2 cases of pediatric RARN for Wilms tumor, respectively patients of 3 and 4 years old. Both patients were treated pre-operatively with chemotherapy according to the SIOP guidelines. Repeat imaging is performed after chemotherapy as pre-operative tool to assess the feasibility of a robot-assisted approach. Under general anesthesia, in a lateral decubitus position, four robotic and one assistant port are placed. In case of right RARN an additional assistant port is placed to retract the liver. After mobilization of the colon, the ureter and gonadal vessels are subsequently identified. The renal hilum is dissected, and the renal artery and vein are divided with hem-o-lock clips. The kidney is released with sparing of the adrenal gland. The ureter and gonadal vessels are divided, and the specimen is removed through a Pfannenstiel incision. RESULTS: Total surgical time were respectively 95 and 200 minutes, with an estimated blood loss of 5 cc. The hospital stay was limited to 3 and 4 days. Both pathological reports confirmed the diagnosis of nephroblastoma, with tumor-free surgical margins. No complications were observed 6 months postoperatively. CONCLUSIONS: This video demonstrates the robotic approach for Wilms tumors in children. Although limited series RARN for Wilms tumor is feasible in the pediatrie population. Source of Funding: Non applicable. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e340 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jolien van der Jeugt More articles by this author Camille Berquin More articles by this author Caroline Jamaer More articles by this author Karel Decaestecker More articles by this author Charles van Praet More articles by this author Anne-Françoise Spinoit More articles by this author Expand All Advertisement PDF downloadLoading ...

V05-06 3D AUGMENTED REALITY TECHNOLOGY FOR IDENTIFICATION OF NEOPLASTIC VENOUS THROMBUS DURING ROBOTIC RADICAL NEPHRECTOMY FOR RCC

You have accessJournal of UrologyCME1 Apr 2023V05-06 3D AUGMENTED REALITY TECHNOLOGY FOR IDENTIFICATION OF NEOPLASTIC VENOUS THROMBUS DURING ROBOTIC RADICAL NEPHRECTOMY FOR RCC Daniele Amparore, Federico Piramide, Enrico Checcucci, Alberto Piana, Gabriele Volpi, Paolo Verri, Michele Sica, Mariano Burgio, Giovanni Busacca, Martina Mandaletti, Andrea Bellin, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Daniele AmparoreDaniele Amparore More articles by this author , Federico PiramideFederico Piramide More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Alberto PianaAlberto Piana More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Paolo VerriPaolo Verri More articles by this author , Michele SicaMichele Sica More articles by this author , Mariano BurgioMariano Burgio More articles by this author , Giovanni BusaccaGiovanni Busacca More articles by this author , Martina MandalettiMartina Mandaletti More articles by this author , Andrea BellinAndrea Bellin More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Notwithstanding the increasing of earlier diagnosis, a 6% of renal cell carcinoma (RCC) patients still are diagnosed with a neoplastic thrombus at the level of renal vein or inferior vena cava (IVC). For many years those renal tumors have been treated with open surgery, but with the recent technological development (laparoscopic and robotic surgery) surgeons decided to embark in this challenging procedures with the aim of reducing morbidity and hospitalization without impairing the oncological and perioperative safety. To optimize the intraoperative outcomes a correct estimation of neoplastic thrombus location is essential both in planning the surgical strategy and during the procedure itself. Hence some ancillary technologies such intraoperative ultrasound have been tested to assist surgeon during the intervention. During these last years 3D Augmented reality (AR) guidance has been reported to be a useful tool to correctly identify renal tumor location and assist surgeon during the interventions, especially in case of endophytic or posterior masses, which are therefore “hidden” inside or behind the healthy parenchyma. With the aim to give a contribution in this field, we tested 3D AR guidance during robot-assisted radical nephrectomy (RARN) with tumor thrombi in renal vein and IVC. METHODS: This is a pilot study aiming to explore the safety and feasibility of 3D AR guidance during RARN for tumors with neoplastic thrombi (levels 0-I). From November 2020 all patients scheduled for RARN due to non-metastatic RCC with level 0-I venous thrombus were enrolled. All patients underwent a four-phase contrast-enhanced CT, in order to create the 3D models which were visualized as AR images inside the robotic console. During surgery, AR system was performed overlapping the 3D virtual model over the real anatomy in real time thanks the tile pro technology of Da Vinci Surgical Console. A dedicated assistant performed the hand-assisted overlapping using a 3D mouse. With the AR technology it was possible to hide some elements of the 3D virtual model, from the kidney parecnhyma to the caval wall, increasing the surgeon’s perception of the extension of the thrombus. Perioperative and pathological data were collected and analyzed. RESULTS: 5 patients were prospectively enrolled. Level 0 thrombus was recorded in 3 patients, two patient had level 1 thrombus. Mean lesions size was 75.6 (+21.3) mm. Mean operative time was 123 min (+15 min) with mean IVC clamping time of 9.4 min (+6.8). Mean Estimated blood loss were 750 ml (+150). During the intervention the AR system allowed the surgeon to precisely estimate the correct location of thrombus in all the cases, driving to a more awareness of the surgical strategy. Moreover, no intra- or postoperative complications (>2 according to Clavien-Dindo) were recorded. CONCLUSIONS: In our preliminary experience 3D AR guidance seem to be safe and feasible in correctly estimate the thrombus limits, and able to drive surgeon towards the correct surgical strategy. 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 Daniele Amparore More articles by this author Federico Piramide More articles by this author Enrico Checcucci More articles by this author Alberto Piana More articles by this author Gabriele Volpi More articles by this author Paolo Verri More articles by this author Michele Sica More articles by this author Mariano Burgio More articles by this author Giovanni Busacca More articles by this author Martina Mandaletti More articles by this author Andrea Bellin More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

MP28-20 ROBOT-ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA LEVEL I-III THROMBECTOMY: PERIOPERATIVE AND MID-TERM ONCOLOGIC OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP28-20 ROBOT-ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA LEVEL I-III THROMBECTOMY: PERIOPERATIVE AND MID-TERM ONCOLOGIC OUTCOMES Umberto Anceschi, Aldo Brassetti, Alfredo Maria Bove, Gabriele Tuderti, Mariaconsiglia Ferriero, Leonardo Misuraca, Riccardo Mastroianni, Manuela Costantini, Salvatore Guaglianone, Giovanni Cacciamani, Mihir Desai, Monish Aron, Inderbir Singh Gill, and Giuseppe Simone Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir Singh GillInderbir Singh Gill More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Few series of robot-assisted radical nephrectomy (RARN) with inferior vena cava tumor thrombectomy (IVCT) for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) are available in literature, all with short-term oncologic outcomes. The aim of this study is to describe perioperative and long-term oncologic outcomes of RARN and IVCT performed at a single, high-volume centre. METHODS: Between January 2014 and October 2022, 37 consecutive patients underwent RARN-IVCT for RCC and VTT at a single tertiary-care center. Baseline, demographic and perioperative data were collected. A descriptive statistical analysis was performed. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Overall survival (OS), disease-free survival (DFS) and metastasis-free (MFS) were computed with the Kaplan-Meier method. RESULTS: Overall 37 consecutive patients were included in the analysis, 8 with VTT Mayo level I (21.6%), 11 with level II (29.7%), and 18 with level III (48.7%), respectively. All cases were successfully completed without conversion to open surgery. Median operative time was 360 minutes (IQR 232.5-382.5). Median estimated blood loss was 550 ml (IQR 275-1500). Median hospital stay was 7 days (IQR 4-12.2). Overall, 19 patients (51.3%) had perioperative complications, 15 Clavien grade 2 (40.5%, all blood transfusions) and 4 grade 3-5 (10.8%), respectively. At a median follow-up of 32 months (IQR 17.2-62.5), MFS, DFS and OS probabilities were 37.8%, 59.4%, and 59.4%, respectively. The small series, the high rate of adjuvant targeted therapies (32.4%) as the extreme surgical complexity may affect reproducibility of outcomes. CONCLUSIONS: RARN-IVCT represents a feasible and safe surgical option in tertiary referral centers; mid-term oncologic results seem to be comparable to those reported in open surgery literature. Our results support RARN-IVCT as a feasible and safe surgical option in tertiary referral centers even in the most advanced setting. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e379 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Alfredo Maria Bove More articles by this author Gabriele Tuderti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Riccardo Mastroianni More articles by this author Manuela Costantini More articles by this author Salvatore Guaglianone More articles by this author Giovanni Cacciamani More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Inderbir Singh Gill More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-Assisted Versus Laparoscopic Radical Nephrectomy: A Systematic Review and Meta-Analysis

Background: For the treatment of renal cell carcinoma, robotic-assisted radical nephrectomy (RARN) has been developed as an alternative to laparoscopic radical nephrectomy (LRN) (RCC). The objective of this systematic review and meta-analysis was to compare the perioperative results of RARN and LRN in the treatment of RCC. Methodology: An exhaustive search of electronic databases from their inception until May 2023 was done. The meta-analysis comprised nine trials with a total of 13,676 individuals who underwent either RARN or LRN. Estimated blood loss, length of hospital stay, conversion rate, transfusion rate, and perioperative complications were evaluated as surgical outcomes. Results: The meta-analysis revealed no statistically significant demographic differences between the two surgical techniques. There were no significant differences between RARN and LRN in terms of predicted blood loss, length of hospital stay, conversion rate, or transfusion rate. The meta-analysis of complications revealed no significant differences between the two surgical methods for intraoperative or postoperative problems. Conclusion: This comprehensive review and meta-analysis suggests that RARN and LRN had comparable perioperative results when used to treat RCC. Although RARN may give prospective benefits in the form of enhanced visibility and dexterity, the clinical significance of these benefits remains unknown. Further high-quality studies with long-term follow-up are required to further comprehend the possible advantages and disadvantages of RARN against LRN in the treatment of RCC. Key words: Robot assisted laparoscopic radical nephrectomy, meta-analysis

Robot-Assisted Radical Nephrectomy Using the Novel Avatera Robotic Surgical System: A Feasibility Study in a Porcine Model.

Purpose: To evaluate the feasibility and intraoperative technical parameters of the new robot-assisted surgical system Avatera by performing bilateral nephrectomy in a live porcine model. Materials and Methods: Six pigs underwent bilateral robot-assisted radical nephrectomy using the Avatera robotic system (RS). The operations were performed by experienced open (Group 1) and laparoscopic (Group 2) surgeons. The operating time, docking time, set-up time, and console time were evaluated. Data regarding intraoperative complications (major or not), injury of adjacent organs, and technical difficulties during the operation were also recorded. Results: Robot-assisted bilateral nephrectomy was completed effectively in all sample pigs. The docking time and set-up time were similar among the two groups, whereas the console time and operating time were significantly longer for the open surgeon group. Two intraoperative minor complications occurred in the open surgeon's group. An inadvertent damage of the renal vein occurred in two cases and the bleeding was controlled effectively. Other than the initial two cases, the estimated blood loss was <50 mL in both groups. Injury of the adjacent organs was not noticed. Conclusions: The study demonstrated that radical nephrectomy using the Avatera robotic surgical system is technically feasible, safe, and valid in pigs. Our results warrant the application of the Avatera RS in other urologic procedures, collecting data for further clinical trials.

Review of Robotic-Assisted Radical Nephrectomy with Inferior Vena Cava Thrombectomy in Renal Cell Carcinoma.

Recent advances in minimally invasive technology have compelled surgeons to perform nephrectomy with inferior vena cava thrombectomy using robotic assistance. Here, we aim to review the data comparing open versus robot-assisted nephrectomy with IVC thrombectomy, as well as review operative robotic techniques for nephrectomy with IVC thrombectomy. Over the last decade, there have been increasing reports of successful robotic-assisted IVC thrombectomy among skilled robotic surgeons, with case series detailing operative technique, as well as operative and oncologic outcomes for levels I-IV caval thrombus. While there is immense promise in the future of robotic-assisted IVC thrombectomy, further studies with direct comparison to open surgical intervention will be needed to ensure the oncologic principles and outcomes are non-inferior.

Validation of a surgical workspace scale during robot-assisted surgery.

A sufficient surgical workspace is crucial to avoid complications. Within classic laparoscopy, many subjective surgical rating scales (SRSs) have previously been used to evaluate the surgical workspace. This study aimed to validate a modified version of the 5-point SRS during robot-assisted radical nephrectomy (RARN). Thirty-two intra-operative videos of intraperitoneal spaces were recorded from eight patients who underwent RARN. To attain the visualisation of different types of workspaces, we recorded 20 s panoramic videos of different pneumoperitoneum, namely 3, 5, 7 and 12 mmHg. The videos were randomised and presented two times to eight experienced robotic surgeons to evaluate the workspace using our modified 5-point SRS. Both inter-and intra-rater reliabilities were tested. The results of the validation study showed moderate inter-rater and good to excellent intra-rater reliability. This is a valid tool that can be confidently used by future researchers in the field of robot-assisted surgery.

Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes

BackgroundWe aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique.MethodsOverall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example).ResultsCompared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143–245) min vs. 148 (IQR 108–261) min, p = 0.86], IVC clamping time [18 (IQR 12–20) min vs. 20 (IQR 14–23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100–800) mL vs. 500 (IQR 175–738) mL, p = 0.51] between both groups. During a 16-month (range, 15–23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group.ConclusionsThe modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.