scholarly journals Evaluation of Hemostatic Aids in Laparoscopic Nephron-Sparing Surgery

2011 ◽  
Vol 11 ◽  
pp. 133-141
Author(s):  
Saleh Binsaleh
Keyword(s):  
Partial Nephrectomy ◽  
Standard Of Care ◽  
The Other ◽  
Energy Sources ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Minimal Invasiveness ◽  
Hemostatic Agents ◽  
Nephron Sparing ◽  
Laparoscopic Techniques

Partial nephrectomy is considered the standard of care for the management of small renal masses, and laparoscopic techniques are becoming popular for multiple reasons, one of which is minimal invasiveness. On the other hand, kidneys are extremely vascular organs, and renal hemorrhage is a major cause of morbidity after laparoscopic partial nephrectomies. Control of bleeding and management of calyceal injuries can be difficult and make the procedure technically challenging. This review looks at the various energy sources and hemostatic agents that are available to reduce bleeding during laparoscopic partial nephrectomies.

scholarly journals Intraoperative ultrasound in robot-assisted partial nephrectomy: State of the art

2018 ◽  
Vol 90 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Giacomo Di Cosmo ◽  
Enrica Verzotti ◽  
Tommaso Silvestri ◽  
Andrea Lissiani ◽  
Roberto Knez ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
State Of The Art ◽  
Short Review ◽  
Robot Assisted ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Ischemia Time ◽  
Oncological Safety ◽  
Nephron Sparing ◽  
Operative Ultrasound

Introduction: Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN). Material and methods: We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure. Results: Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy. Conclusions: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.

A comparison of DAP and RENAL scoring systems in the achievement of trifecta in laparoscopic partial nephrectomy

2021 ◽  
pp. 039156032110199
Author(s):  
Sumanta Kumar Mishra ◽  
Ranil Johann Boaz ◽  
Sudhindra Jayasimha ◽  
Rajiv Paul Mukha ◽  
Nitin Sudhakar Kekre ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Scoring System ◽  
Scoring Systems ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Upper Limits ◽  
Nephron Sparing ◽  
Invasive Techniques ◽  
Warm Ischaemia Time

Purpose: The concept of ‘trifecta’ outcome postulated for radical prostatectomy has been adopted for partial nephrectomy, the gold standard for management of small renal masses. We sought to evaluate the role of nephrometry scores in predicting outcomes in terms of the trifecta. We compared two scoring systems for renal tumour complexity (RENAL and DAP) in the prediction of trifecta outcomes. Materials and methods: Sixty-nine patients who underwent laparoscopic PN (LPN) were evaluated in a single-centre retrospective study (2010–2017). RENAL and DAP scores were measured. Parameters relevant to the trifecta were tabulated. Results: When comparing the two scoring systems in terms of warm ischaemia time (WIT), the DAP score could predict with statistically significant accuracy the completion of resection within 25 mins of WIT. Tumours were more evenly distributed according to anatomical characteristics with the DAP scoring system than with the RENAL scoring system. When comparing these systems in terms of complications, neither predicted complications based on complexity with significant accuracy. A low RENAL score predicted trifecta achievement in three-fourth (71.4%) of patients, while a medium RENAL score predicted trifecta achievement in half (54%) of patients. DAP score predicted trifecta achievement in all tumours with a low score, two-third (66%) in medium and less than half (42%) with a high score. Predictions based on DAP were accurate and significantly so ( p = 0.024). Conclusions: DAP score predicted the outcomes of LPN in terms of trifecta significantly better than the RENAL score. In our experience, the DAP score was able to distribute tumour complexity among its groups more effectively than the RENAL score. There is early evidence that the DAP score may be more useful than the RENAL score for decision-making in nephron sparing surgery. This is especially pertinent for small renal masses at the upper limits of tumour complexity for which minimally invasive techniques can be safely applied.

scholarly journals Open Partial Nephrectomy in the Management of Small Renal Masses

2008 ◽  
Vol 2008 ◽  
pp. 1-7 ◽  
Author(s):  
Ziya Kirkali ◽  
A. Erdem Canda
Keyword(s):  
Partial Nephrectomy ◽  
Research Study ◽  
English Literature ◽  
Clinical Papers ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
Nephron Sparing

Introduction. Most of the kidney masses are being detected incidentally with smaller size due to widespread use of imaging modalities leading to increased RCC incidence worldwide with an earlier stage. This article reviews the role of open partial nephrectomy (PN) in the management of small renal masses.Material and Methods. Review of the English literature using MEDLINE has been performed between 1963–2008 on small renal masses, partial nephrectomy, kidney cancer, nephron sparing surgery (NSS), radical nephrectomy, laparoscopy, and surgical management. Special emphasis was given on the indications of NSS, oncological outcomes and comparison with open and laparoscopic PN.Results. Overall 68 articles including 31 review papers, 35 human clinical papers, 1 book chapter, and 1 animal research study were selected for the purpose of this article and were reviewed by the authors.Conclusions. Currently, open NSS still remains as the gold standard surgical treatment modality in patients with small renal masses.

V708: Partial Nephrectomy for Small Renal Masses: An Emerging Quality of Care Concern?

2006 ◽  
Vol 175 (4S) ◽  
pp. 229-229
Author(s):  
David C. Miller ◽  
John M. Hollingsworth ◽  
Khaled S. Hafez ◽  
Stephanie Daignault ◽  
Brent K. Hollenbeck
Keyword(s):  
Quality Of Care ◽  
Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

scholarly journals Oncological outcomes of partial nephrectomy for tumours larger than 4 cm: A systematic review

2014 ◽  
Vol 8 (1-2) ◽  
pp. 61 ◽  
Author(s):  
Tarek H El-Ghazaly ◽  
Ross J Mason ◽  
Ricardo A Rendon
Keyword(s):  
Systematic Review ◽  
Partial Nephrectomy ◽  
Survival Rates ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Oncological Outcomes ◽  
Medical Associations ◽  
Nephron Sparing ◽  
Pubmed Search ◽  
Exact Size

Introduction: Many medical associations recommend nephron-sparing surgery (NSS) for tumours larger than 4 cm amenable to partial nephrectomy (PN). These recommendations are, however, mostly based on isolated reports. We systematically review the oncological outcomes of partial nephrectomy procedures performed for tumours larger than 4-cm.Methods: A PubMed search was carried out using keywords “partial nephrectomy” and “nephron sparing” for records dating back to 1995. In total, 2136 abstracts were analyzed; from these, 174 studies were scrutinized. We identified 32 manuscripts reporting size-specific cancer-specific survival rates for masses greater than 4 cm. From each of these studies, we recorded the number of PN, tumour diameter, follow-up duration, 5- and 10-year recurrence, overall and cancer-specific survival rates (OS, CSS). We also calculated weighted OS and CSS rates.Results: This systematic review includes 2445 patients with renal tumours larger than 4 cm who underwent PN: 1858 patients with tumours between 4 to 7 cm, 410 patients with tumours larger than 7 cm and 177 patients with tumours greater than 4 cm (exact size unknown). Our analysis revealed weighted 5-year CSS rates of 95.4%, 86.2% and 93.9% for tumours 4 to 7 cm, >7 cm, and all tumours >4 cm, respectively. The respective 5-year OS rates were 84.7%, 76.4%, and 84.7%.Conclusions: We found excellent 5-year CSS and OS rates for patients with tumours 4 to 7 cm treated with PN. These outcomes compare favourably to those reported in historical radical nephrectomy (RN) series for similarly sized tumours. Thus, PN is an acceptable and often preferred treatment for renal masses >4 cm which are amenable to nephron-sparing procedures.

scholarly journals MP14-11 COST IMPLICATIONS OF NEPHRON SPARING OPTIONS FOR THE MANAGEMENT OF SMALL RENAL MASSES

2019 ◽  
Vol 201 (Supplement 4) ◽  
Author(s):  
Jeffrey Leow* ◽  
Ye Wang ◽  
Melissa Huynh ◽  
Alice Yu ◽  
Keng Siang Png ◽  
...  
Keyword(s):  
Small Renal Masses ◽  
Renal Masses ◽  
Nephron Sparing ◽  
Cost Implications
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