Technique For Robotic Partial Nephrectomy Research Articles

V10-10 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL TUMORS; OUR EXPERIENCE AND TIPS AND TRICKS

You have accessJournal of UrologyCME1 May 2022V10-10 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL TUMORS; OUR EXPERIENCE AND TIPS AND TRICKS Burak Ucpinar, Shirin Razdan, Kennedy Okhawere, Indu Saini, Tara Tomy, and Ketan K. Badani Burak UcpinarBurak Ucpinar More articles by this author , Shirin RazdanShirin Razdan More articles by this author , Kennedy OkhawereKennedy Okhawere More articles by this author , Indu SainiIndu Saini More articles by this author , Tara TomyTara Tomy More articles by this author , and Ketan K. BadaniKetan K. Badani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002623.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video, we present our outcomes for patients with complex renal tumors and demonstrate our technique for robotic partial nephrectomy. METHODS: Cases with complex renal tumors (RENAL nephrometry score 10 and higher), treated with robotic partial nephrectomy, were evaluated in terms of age, body mass index, tumor size, baseline eGFR, operative time, warm ischemia time, estimated blood loss, length of hospital stay, post-operative eGFR and tumor characteristics. The surgical steps of robotic partial nephrectomy are demonstrated in 2 separate cases. First case is a 55 year old male, diagnosed with a 8.7 x 7.8 cm solid, enhancing, left renal mass, with a RENAL nephrometry score of 11a and the second case is a 46 year old female, diagnosed with a 5.2 x 4.5 cm solid, enhancing, left renal mass, with a RENAL nephrometry score of 10a. RESULTS: We used the same robotic partial nephrectomy technique in 72 patients with complex renal tumors. The demographic and outcome data are presented in Table 1. CONCLUSIONS: Robotic partial nephrectomy is a safe and reproducible procedure for the treatment of complex renal tumors. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e851 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Burak Ucpinar More articles by this author Shirin Razdan More articles by this author Kennedy Okhawere More articles by this author Indu Saini More articles by this author Tara Tomy More articles by this author Ketan K. Badani More articles by this author Expand All Advertisement PDF DownloadLoading ...

V03-10 ROBOTIC PARTIAL NEPHRECTOMY IN THE PEDIATRIC POPULATION: TIPS AND TRICKS

You have accessJournal of UrologyPediatrics (V03)1 Sep 2021V03-10 ROBOTIC PARTIAL NEPHRECTOMY IN THE PEDIATRIC POPULATION: TIPS AND TRICKS Ali Antar, Vinaya Bhatia, Richard Link, and Chester Koh Ali AntarAli Antar More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , Richard LinkRichard Link More articles by this author , and Chester KohChester Koh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001991.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this video abstract, we aim to demonstrate our specific technique for robotic partial nephrectomy in a pediatric population in conjunction with our adult MIS trained urologic colleagues. We will walk through the procedure step by step, framed by a single case and a review of our most recent cases since we began to perform these cases. We hope to emphasize the feasibility of this procedure as well as the benefits of the collaborative nature of this endeavor. METHODS: One particular case is presented from this past year at Texas Children's Hospital. We performed the case in conjunction with our adult MIS trained urologic faculty at Baylor College of Medicine. We then reviewed our most recent cases to demonstrate their indications and outcomes. RESULTS: 6 total partial nephrectomies were performed in conjunction with the adult urologic faculty in the last 18 months at Texas Children's. 3 were right sided and 3 were left sided. One lymph node dissection was performed which demonstrated no evidence of disease. The pathology was varied between each case, but negative margins were achieved in all cases with no complications. All patients remain on surveillance with urology and hematology/oncology w/ no evidence of disease or recurrence. CONCLUSIONS: Robotic Partial Nephrectomy is feasible in the pediatric population despite the concerns for limited working space. Port placement can be adjusted a number of ways to accommodate the tumor size and the patient’s body habitus. Involving specialists from adult urology can be helpful as their skills directly translate to the surgical management of these pediatric patients. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e225-e225 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Antar More articles by this author Vinaya Bhatia More articles by this author Richard Link More articles by this author Chester Koh More articles by this author Expand All Advertisement Loading ...

Reducing Pseudoaneurysm and Urine Leak After Robotic Partial Nephrectomy: Results Using the Early Unclamping Technique

To present our experience using the early unclamping technique for robotic partial nephrectomy with particular attention to delayed complications, namely pseudoaneurysm and urine leak. We hypothesized that early hilar unclamping allows for improved control of end arteries and renorrhaphy after tumor resection, reducing overall delayed complications after partial nephrectomy with no increased risk of blood transfusion. This single institution retrospective review of a prospectively maintained database includes patients undergoing robotic partial nephrectomy with early unclamping technique for presumed renal malignancy between 2009 and 2018. Patient demographics and perioperative parameters are described, particularly rates of pseudoaneurysm and urine leak. Results are compared to previously published partial nephrectomy studies using various clamping and renorrhaphy techniques. Four hundred and sixty three patients were included in the study. Mean operative time and warm ischemia time were 186 and 14.7 minutes, respectively. Mean estimated blood loss was 242 cc. Thirty-day postoperative complication rate was 14.7%, with 88% of these Clavien I-II. Urine leak occurred in 1 patient (0.2%) undergoing a simultaneous partial nephrectomy and pyelothitotomy for partial staghorn stone. Postoperative transfusion rate was 1.33% and our pseudoaneurysm rate was 0%. The early unclamping technique for robotic partial nephrectomy is reliable and safe, with low pseudoaneurysm and urine leak rates which compare favorably to other published techniques.

VE17 - A surgical technique of robotic partial nephrectomy: Endophytic tumor

VE17 - A surgical technique of robotic partial nephrectomy: Endophytic tumor

Impact of robotic partial nephrectomy with and without ischemia on renal functions: experience in 34 cases.

In this study we aimed to compare renal functions in patients who underwent robotic partial nephrectomy (RPN) with on-clamp and zero- ischemia techniques. Between 2009 and 2015, 12 off-clamp and 22 on-clamp RPN procedures were performed on a total of 34 patients in two centers. The main outcome parameters examined were serum creatinine, and estimated glomerular filtration rate (eGFR) during preoperative, immediate postoperative periods, and at postoperative 3rd months. There were no statistically significant differences between on-clamp and zero- ischemia groups regarding age, ASA score, BMI, PADUA and R.E.N.A.L. nephrometry scores, operation time and tumor size (p>0.05). Significant differences were found in the duration of hospital stay (3.8±0.9 days vs. 3.0±0.9 days) and amount of blood loss (85.9±49.6 mL vs. 183.3±176.2 mL) between the on-clamp and zero-ischemia groups (p<0.05). Statistically significant differences were found between preoperative and immediate post-operative periods, in terms of eGFR and serum creatinine levels in both groups. Moreover, statistically significant differences were found between preoperative and postoperative 3rd month periods, in the on-clamp group in terms of eGFR and serum creatinine levels. In the zero-ischemia group, the decrease in eGFR and serum creatinine levels at postoperative 3rd month relative to the preoperative period was not statistically significant. Off-clamp RPN technique is superior, in short-term outcomes involving renal functions, compared to on clamp approach. However, long- term data regarding the renal functions should be evaluated to arrive at a definitive decision.

V9-11 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC RENAL MASSES: VARIATIONS IN SURGICAL TECHNIQUE

You have accessJournal of UrologyRobotics - Renal1 Apr 2016V9-11 ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC RENAL MASSES: VARIATIONS IN SURGICAL TECHNIQUE Daniel Ramirez, Matthew J. Maurice, Peter A. Caputo, Ryan J. Nelson, Ercan Malkoc, Onder Kara, and Jihad H. Kaouk Daniel RamirezDaniel Ramirez More articles by this author , Matthew J. MauriceMatthew J. Maurice More articles by this author , Peter A. CaputoPeter A. Caputo More articles by this author , Ryan J. NelsonRyan J. Nelson More articles by this author , Ercan MalkocErcan Malkoc More articles by this author , Onder KaraOnder Kara More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1202AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic partial nephrectomy (RPN) for completely endophytic renal masses is feasible with increased robotic surgical experience. In this video we demonstrate our surgical technique for robotic partial nephrectomy, focusing on the technical variations for RPN for completely endophytic tumors. METHODS Between June 2006 and August 2015, our institution performed 1,123 partial nephrectomies. 130 were performed for completely endophytic renal tumors. We present 2 patients with completely endophytic, central renal masses who underwent RPN, one in the left kidney and one in the right. Our approach to surgical removal of completely endophytic renal tumors includes the use of intraoperative ultrasound to delineate the margins of the mass, initial shallow angle of resection to improve visualization of the parenchymal margin and tumor base, and correction of excision trajectory at the renal sinus. This technique is described in detail in our video presentation. RESULTS Of the 1,123 RPN performed at our institution over the last 10 years, 11.6% were performed for completely endophytic renal masses. Mean operative time, warm ischemia and estimated blood loss in this cohort were 180 minutes, 24.5 minutes, and 197 cc, respectively. Minor complicate rate in this group was 13.9%, while major complication rate was 13.9%. 7 patients in this group had positive margins (5.4%). Successfully surgical extirpation of completely endophytic renal masses is optimized by an initially shallow incision in order to obtain a clear view of the parenchymal edge and base of tumor. Once the sinus fat and collecting system are exposed, the trajectory of the excision is corrected and the sides and back of the tumor are excised in a step-wise, circumferential fashion. CONCLUSIONS RPN for completely endophytic renal tumors is feasible and necessitates technical variations in excision in order to optimize outcomes. Excision of the tumor should be performed in a step-wise systematic fashion with a shallow initial incision to improve visualization into the renal defect and to avoid cutting into the tumor. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e863 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Daniel Ramirez More articles by this author Matthew J. Maurice More articles by this author Peter A. Caputo More articles by this author Ryan J. Nelson More articles by this author Ercan Malkoc More articles by this author Onder Kara More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Role of Robotic Partial Nephrectomy in the Treatment of Eenal Cell Carcinoma

Abstract This article lays an emphasis on the Role of Robotic Partial Nephrectomy in the treatment of renal cell carcinoma. The increasing radiological detection of histological low-grade low-stage renal masses has presented a challenging task to the practising urologist. Nephron sparing surgery (NSS) not only preserves the kidney but also allows safe removal of tumour of unknown malignant potential without removing the kidney. Advent of robotic technology and evolution of surgical technique together have offered to serve patients with these tumours, yet a large number of which are asymptomatic at the time of diagnosis. Centres which have the facility for robotic surgery have been offering partial nephrectomy to patients with more and more challenging nephrometric scores. On the other hand, radical nephrectomy is being offered to a large proportion of patients with tumours otherwise suitable for NSS. Advances in technology like firefly and intra operative real time ultrasound have further refined the technique of Robotic Partial Nephrectomy.

Intracorporeal Cooling and Extraction Technique of Robotic Partial Nephrectomy

Abstract Introduction: The ability to ice the kidney and grossly evaluate the excised tumor during open partial nephrectomy has been difficult to replicate in a reliable fashion using a minimally invasive approach. We previously described a robotic partial nephrectomy (RPN) technique with intracorporeal cooling and extraction (I.C.E.) for cold ischemia and intraoperative tumor assessment.1 We present a video of our I.C.E. technique.2 Recent evidence suggests a potential benefit of cold ischemia for preserving renal function.3,4 The total run time for our video is 8 minutes 2 seconds. Materials and Methods: A total of eight patients underwent the I.C.E. modification of RPN by transperitoneal (n=6) and retroperitoneal (n=2) approaches. A GelPOINT® access port (Applied Medical) was used for the camera and assistant ports. After hilar clamping, modified syringes loaded with ice slush were introduced through the GelPOINT and ice slush was applied over the kidney surface. The excised tumor was immediately extra...

Near-infrared Fluorescence Imaging: Emerging Applications in Robotic Upper Urinary Tract Surgery

BackgroundNear-infrared fluorescence (NIRF) imaging is a technology with emerging applications in urologic surgery. ObjectiveTo describe surgical techniques and provide clinical outcomes for robotic partial nephrectomy (RPN) with selective clamping and robotic upper urinary tract reconstruction featuring novel applications of NIRF imaging. Design, setting, and participantsData from 90 patients who underwent successful RPN with selective clamping or upper urinary tract reconstruction utilizing NIRF imaging between April 2011 and October 2012 were reviewed. Surgical procedureWe performed RPN utilizing NIRF imaging to aid with selective clamping and upper tract reconstruction with NIRF imaging, the details of which are outlined in this paper and the accompanying video. Outcome measurements and statistical analysisPatient characteristics, perioperative outcomes, and complications were analyzed. Results and limitationsOf the 48 RPN patients for whom selective clamping was attempted successfully, median estimated blood loss was 200.0ml, warm ischemia time was 17.0min, and median change in estimated glomerular filtration rate was −6.3%. There was a 12.5% complication rate, and all complications were Clavien grade 1–3 (14.3%). The upper urinary tract reconstruction utilizing NIRF imaging was performed in 42 patients and included pyelopasty (n=20), ureteral reimplant (n=13), ureterolysis (n=7), and ureteroureterostomy (n=2). Radiographic and symptomatic improvement was observed in 100% of the pyeloplasty, ureteral reimplant, and ureteroureterostomy patients and 71.4% of ureterolysis patients, for an overall success rate of 95.2%. This study is limited by the small sample size, the short follow-up period, and the lack of a comparative cohort. ConclusionsOur technique of RPN with selective arterial clamping and robotic upper urinary tract reconstruction utilizing NIRF imaging is presented. This technology provides real-time intraoperative angiogram to confirm selective ischemia and may be an adjunct technology to confirm well-perfused tissue within a reconstruction anastomosis. Further investigation is needed to evaluate long-term outcomes of NIRF imaging in robotic upper urinary tract surgery and to delineate its indications.

885 Intracorporeal cooling and extraction (I.C.E.) technique of robotic partial nephrectomy: Emulating the open approach

885 Intracorporeal cooling and extraction (I.C.E.) technique of robotic partial nephrectomy: Emulating the open approach

252 Robotic Partial Nephrectomies: Evolving Renorrhaphy Technique and Surgical Outcomes at a Single Institution

To describe the evolution of robotic partial nephrectomy (PN) technique and to analyze the surgical outcomes in a large single institution experience. Retrospective review of our institutional review board-approved, prospectively maintained, minimally invasive PN database yielded 252 robotic partial nephrectomy (RPN) procedures from June 2007 to October 2010. Our initial experience, adopted from our laparoscopic PN approach included a standard interrupted bolstered renorrhaphy, whereas our contemporary experience included a nonbolstered continuous horizontal mattress stitch for the capsular closure. Perioperative results were evaluated depending on renorrhaphy technique, length of warm ischemia time, and nephrometry scores. Overall, mean tumor size was 3.1 ± 1.6 cm, operative time 190 ± 56 minutes, warm ischemia time 18.2 ± 9.4 minutes, and estimated blood loss 267 ± 275 mL. Significantly better outcomes were noted in the contemporary experience in terms of transfusion rate (8.2% vs 21.9%, P <.001), operative time (181 vs 219 minutes, P <.001), hospital stay (3.6 vs 4.3 days, P = .02), and complication rate (14.4% vs 33.8%, P <.01). Increasing tumor complexity based on RENAL score predicted longer operative time (P <.0001), warm ischemia time (P <.0001), and hospital stay (P <.04), and a greater risk of postoperative complications (P = .003). Of the series, only 2 patients had hemorrhagic complications (0.8%) requiring angioembolization, 4 patients developed urine leaks (1.5%), and 2 positive margins (0.8%) were noted. We report the largest single-institution study with RPN to date. Despite it being a relatively nascent procedure, initial results suggest that RPN is an effective approach for minimally invasive nephron-sparing surgery. As experience is gained and the technique for RPN evolves, further improvement in outcomes will be noted.

VID-01.03 Robotic Partial Nephrectomy: How to Reduce Ischemia Time

Prevention of ischemic renal damage is of utmost importance during partial nephrectomy. Despite the robotic approach, suturing can prolong ischemia time. We describe our robotic partial nephrectomy technique, which allows minimized ischemia time.

Current status of robotic partial nephrectomy (RPN)

• Robotic partial nephrectomy (RPN) is a minimally invasive option for patients undergoing nephron-sparing surgery (NSS). As the technique of RPN develops and matures, intraoperative and perioperative outcomes continue to be reported. In the current review, we discuss safety, efficacy, and recent technical advances in RPN. • A Medline search using the keywords 'partial nephrectomy', 'robotic partial nephrectomy', 'robot partial nephrectomy', 'robot-assisted laparoscopic partial nephrectomy', and 'laparoscopic partial nephrectomy' was conducted to identify original articles, review articles, and editorials on RPN. • There have been multiple recent retrospective studies comparing RPN with laparoscopic PN (LPN). These comparisons suggest a shorter learning curve for RPN and confirm the safety and feasibility of RPN, even for select complex renal masses. • Novel techniques have been developed in efforts to decrease warm ischaemia time. These include use of sliding-clip renorrhaphy, selective renal parenchymal clamping, and 'early unclamping' or 'no-clamp' techniques. • RPN appears to be a viable minimally invasive option for NSS. RPN may reduce some of the technical challenges associated with LPN, and thus, extend the potential benefits of minimally invasive NSS to a larger population. • Further studies of the long-term renal functional outcomes and oncological efficacy of RPN are needed before fully advocating this technique.

Zero‐ischaemia robotic partial nephrectomy (RPN) for hilar tumours

• Robotic partial nephrectomy (RPN) has emerged as an attractive minimally invasive nephron-sparing surgical option. However, on-going concerns about RPN include: (i) prolonged ischaemia time with potential implications on renal functional outcomes, and (ii) questions about the ability of RPN to address technically challenging hilar tumours. • Herein, we detail the technique and present initial perioperative outcomes of our novel technique of zero-ischaemia RPN for complex hilar tumours. • Since May 2010, >100 patients underwent minimally invasive zero-ischaemia PN. Of these, 21 had procedure done robotically. Of these, seven patients had hilar tumours. RPN was offered to all patients irrespective of tumour or reno-vascular anatomy, contralateral kidney characteristics or renal function. • Data were prospectively collected and recorded in an Institutional Review Board-approved database. • We detail our zero-ischaemia RPN technique and present early perioperative outcomes. • Zero-ischaemia RPN was successful in all cases without any hilar clamping. The median (range) tumour size was 4.1 (2.6-6.4) cm and the median RENAL score was 10 (8-10). • The warm ischaemia time was zero in all cases. • The median (range) operative time was 222 (150-330) min, estimated blood loss was 150 (100-500) mL, and the percentage kidney spared was 75 (50-90)%. The median hospital stay was 4 (3-6) days. • There were no intraoperative complications; two patients had postoperative complications (Clavien grade I and II). No patient had a postoperative haemorrhage, urological/renal complication or lost a kidney. All tumour specimens had negative surgical margins on pathology. • The median absolute decrease in serum creatinine and estimated glomerular filtration rate at discharge was 0 (0.2-0.7) mg/dL (P = 0.4) and 5 (-16 to 29) mL/min per 1.73 m(2) (P = 0.8), respectively. • Zero-ischaemia RPN for hilar tumours is safe and feasible and to our knowledge the first report in the literature. • Elimination of warm ischaemia may optimally preserve renal function. Prospective randomized studies are needed to confirm any renal functional advantages of clamp-free RPN. • Global renal ischaemia appears to be unnecessary during RPN for hilar tumours.

Initial results of novel technique for robotic partial nephrectomy adhering to open surgical principles

Initial results of novel technique for robotic partial nephrectomy adhering to open surgical principles

Robotic-assisted partial nephrectomy: Has it come of age?

Surgical resection is the gold standard for the treatment of renal cell carcinoma, and partial nephrectomy (PN) is the treatment of choice for tumors smaller than 4 cm in size. A laparoscopic PN is a viable alternative to a traditional open PN, demonstrating good oncologic and functional outcomes. A laparoscopic PN is a challenging procedure, particularly performing intracorporeal suturing under the time constraints of warm ischemia. The introduction of the da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA) with wristed instruments and magnified, 3-dimensional vision may facilitate the technical challenges of a minimally invasive PN. The technique of robotic partial nephrectomy (RPN) is still evolving and a number of institutions have recently reported their results. In this article, we present a review of the literature and our technique for robotic PN using a transperitoneal approach.