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.

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 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.

scholarly journals Cryoablation for Small Renal Masses

2008 ◽  
Vol 2008 ◽  
pp. 1-10 ◽  
Author(s):  
J. L. Dominguez-Escrig ◽  
K. Sahadevan ◽  
P. Johnson
Keyword(s):  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Imaging Techniques ◽  
Rapid Development ◽  
High Intensity Focused Ultrasound ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Invasive Approach ◽  
Open Partial Nephrectomy ◽  
Ablative Techniques

Advances in imaging techniques (CT and MRI) and widespread use of imaging especially ultrasound scanning have resulted in a dramatic increase in the detection of small renal masses. While open partial nephrectomy is still the reference standard for the management of these small renal masses, its associated morbidity has encouraged clinicians to exploit the advancements in minimally invasive ablative techniques. The last decade has seen the rapid development of laparoscopic partial nephrectomy and novel ablative techniques such as, radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation (CA). In particular, CA for small renal masses has gained popularity as it combines nephron-sparing surgery with a minimally invasive approach. Studies with up to 5-year followup have shown an overall and cancer-specific 5-year survival of 82% and 100%, respectively. This manuscript will focus on the principles and clinical applications of cryoablation of small renal masses, with detailed review of relevant literature.

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 Open Partial Nephrectomy without Ischemia

2019 ◽  
Author(s):  
seyed mohammadreza rabani ◽  
Ali Mousavizadeh ◽  
seyedhossein rabani
Keyword(s):  
Renal Artery ◽  
Partial Nephrectomy ◽  
Tumor Resection ◽  
Polar Regions ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
Standard Procedures ◽  
Zero Ischemia ◽  
The Mean

Abstract Background: Vascular clamping during partial nephrectomy could induce to renal ischemia and kidney’s damage due to reperfusion injuries. Adverse effect on renal function can be eliminated by Zero ischemia techniques.The aim of this study was to assess the feasibility of performing partial nephrectomy under a situation of being ready to clamping renal artery. Methods: 24 patients with solitary small renal masses were recruited to the study between 2013and 2018. Open partial nephrectomy was performed for them. During the time corresponding to hilar vessels clamping in standard procedures, we have reached to the renal artery and ready for clamping if needed, and in this situation resection of the mass was assessed. Results The mean age of patients was 42 years. The tumor resection time was 22 minutes averagely. The median procedure time was 92 minutes, Clear cell RCC was found in 19 patients, papillary RCC in 3 and oncocytoma in 2 with no positive surgical cancerous margin in specimens. Lower pole, midzone and upper pole masses were found consequently in14, 2 and 8 cases. Conclusions: Although this technique could be a dangerous decision making in a well exposed renal artery, especially in Polar Regions, the tumor resection can be safely conducted without ischemia.

scholarly journals Trends in the Management of Small Renal Masses: A Survey of Members of the Endourological Society

2017 ◽  
Vol 4 (3) ◽  
pp. 10-19 ◽  
Author(s):  
Anand Mohapatra ◽  
Aaron Potretzke ◽  
John Weaver ◽  
Barrett Anderson ◽  
Joel Vetter ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Treatment Modalities ◽  
Percutaneous Ablation ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Open Partial Nephrectomy ◽  
The Past

Treatment modalities for small renal masses (SRMs) include open or minimally invasive radical or partial nephrectomy, and laparoscopic or percutaneous ablations. Members of the Endourological Society were surveyed to evaluate how practitioner and clinical practice characteristics may be associated with the management of SRMs over time. The survey assessed characteristics of urologists (recency of residency and fellowship training, clinical practice type and location, and treatment modalities available) and their management of SRMs over the past year and over the course of the year 5 years prior. Of the 1495 surveys e-mailed, there were 129 respondents (8.6%). Comparing the past year to 5 years prior, there was increasing utilization of robotic partial nephrectomy (p < 0.001) and robotic radial nephrectomy (p = 0.031). In contrast, there was decreasing utilization of open partial nephrectomy (p < 0.001), open radical nephrectomy (p = 0.039), laparoscopic partial nephrectomy (p = 0.002), and laparoscopic radical nephrectomy (p = 0.041). Employment of laparoscopic ablation decreased (p = 0.001), but that of percutaneous ablation did not change significantly. For masses treated with image-guided therapy, there was increasing utilization of microwave ablation (p = 0.008) and decreasing usage of radiofrequency ablation (p = 0.002). Future studies should focus on the most effective treatment modalities based on provider, patient, and tumor characteristics.

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
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