scholarly journals Association between R.E.N.A.L nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia

2014 ◽  
Vol 8 (3-4) ◽  
pp. 137
Author(s):  
Dong Soo Park ◽  
Jin Ho Hwang ◽  
Moon Hyung Kang ◽  
Jong Jin Oh
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Renal Neoplasm ◽  
Cold Ischemia ◽  
Ischemic Time ◽  
Open Partial Nephrectomy ◽  
Cold Ischemic Time ◽  
Nephrometry Score ◽  
Estimated Blood Loss

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).

scholarly journals Early Single-Center Experience with Robotic Partial Nephrectomy Using the da Vinci Xi: Comparative Assessment with Conventional Open Partial Nephrectomy

2019 ◽  
Vol 13 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Daisuke Motoyama ◽  
Ryota Aki ◽  
Yuto Matsushita ◽  
Keita Tamura ◽  
Toshiki Ito ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Da Vinci ◽  
Operative Procedure ◽  
Surgical Margin ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Da Vinci Xi ◽  
Ischemic Time ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss

Background: The objective of this study was to evaluate our experience with robot-assisted partial nephrectomy (RAPN) in comparison with conventional open partial nephrectomy (OPN). Patients and Methods: This study included 37 and 50 patients undergoing OPN and RAPN for small renal masses, respectively. A single surgeon performed RAPN for all 50 cases using the da Vinci Xi. Trifecta was defined as satisfying all of the following 3 criteria: ischemic time of ≤ 25 minutes, negative surgical margin and no major postoperative complications. Results: After adjusting patient variables by 1:1 propensity-score matching, 37 patients were included in each group, and no significant differences in major clinicopathological characteristics were noted between these 2 groups. RAPN was significantly superior to OPN with respect to operative time, estimated blood loss and postoperative length of hospital stay. The rate of trifecta achievement was significantly higher in the RAPN group than in the OPN group (91.9 vs. 62.2%). Furthermore, the operative procedure and R.E.N.A.L. nephrometry score were found to be independently associated with trifecta outcome by multivariate analysis of the entire cohort. Conclusions: Although this is our early experience with 50 initial cases, RAPN using the da Vinci Xi resulted in more favorable perioperative outcomes than OPN.

scholarly journals Analysis of predictors of adherent perinephric fat and its impact on perioperative outcomes in laparoscopic partial nephrectomy: a retrospective case–control study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lu Fang ◽  
Huan Li ◽  
Tao Zhang ◽  
Rui Liu ◽  
Taotao Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Perinephric Fat

Abstract Background Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN. Methods A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2017 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results APF was identified in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with the male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P< 0.001), greater perinephric stranding (P< 0.001), and higher Mayo Adhesive Probability (MAP) score (P< 0.001). The MAP score (P< 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P< 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate, or surgical margin between the two groups. Conclusions Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, warm ischemia time, and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

scholarly journals Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

2015 ◽  
Vol 9 (11-12) ◽  
pp. 859 ◽  
Author(s):  
Newaj Abdullah ◽  
Deepansh Dalela ◽  
Ravi Barod ◽  
Jeff Larson ◽  
Michael Johnson ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Independent Predictor ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Obese Patients ◽  
Estimated Blood Loss

<p><strong>Introduction: </strong>We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database.<strong> </strong></p><p><strong>Methods: </strong>We identified 1836 patients who underwent RPN from five academic centres from 2006-2014.  A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m<sup>2</sup>). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes.</p><p><strong>Results: </strong>A total of 806 (44%) patients were obese with median BMI of 33.8kg/m<sup>2</sup>. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p&lt;0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p = 0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p&lt;0.001), operative time (180 vs. 166 min, p&lt;0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001) and male sex was an independent predictor of these outcomes on regression analysis.</p><p><strong>Conclusion: </strong>In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss.  However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT.  Our results indicate that obesity alone should not preclude consideration for RPN.<strong></strong></p>

scholarly journals Analysis of Predictors of Adherent Perinephric fat and its Impact on Perioperative Outcomes in Laparoscopic Partial Nephrectomy: A Retrospective Case-control Study

2021 ◽  
Author(s):  
Lu Fang ◽  
Huan Li ◽  
Tao Zhang ◽  
Rui Liu ◽  
Taotao Zhang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Univariate Analysis ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Perinephric Fat

Abstract Background: Adherent perinephric fat (APF), characterized by inflammatory fat surrounding the kidney, can limit the isolation of renal tumors and increase the operative difficulty in laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the predictors of APF and its impact on perioperative outcomes during LPN.Methods: A total of 215 consecutive patients undergoing LPN for renal cell carcinoma (RCC) from January 2016 to June 2019 at our institute were included. We divided these patients into two groups according to the presence of APF. Radiographic data were retrospectively collected from preoperative cross-sectional imaging. The perioperative clinical parameters were compared between the two groups. Univariate and multivariate analyses were performed to evaluate the predictive factors of APF. Results: APF was observed in 41 patients (19.1%) at the time of LPN. Univariate analysis demonstrated that APF was significantly correlated with male gender (P = 0.001), higher body mass index (P = 0.002), lower preoperative estimated glomerular filtration rate (P = 0.004), greater posterior perinephric fat thickness (P < 0.001), greater perinephric stranding (P < 0.001) and higher Mayo Adhesive Probability (MAP) score (P < 0.001). The MAP score (P < 0.001) was the only variable that remained an independent predictor for APF in multivariate analysis. We found that patients with APF had longer operative times (P < 0.001), warm ischemia times (P = 0.001), and greater estimated blood loss (P = 0.003) than those without APF. However, there were no significant differences in surgical approach, transfusion rate, length of postoperative stay, complication rate or surgical margin between the two groups.Conclusions: Several specific clinical and radiographic factors including the MAP score can predict APF. The presence of APF is associated with an increased operative time, and warm ischemia time and greater estimated blood loss but has no impact on other perioperative outcomes in LPN.

scholarly journals Comparison of Robotic Versus Laparoscopic Partial Nephrectomy For Renal Tumors With A RENAL Nephrometry Score≥7: A System Review and Meta-Analysis

2021 ◽  
Author(s):  
Jin-Biao Zhou ◽  
Xin Xiao ◽  
Tian-Li Shi ◽  
Xiao-Hui Huang ◽  
Yu-Li Jiang
Keyword(s):  
Partial Nephrectomy ◽  
Intraoperative Complications ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Positive Surgical Margin ◽  
Robotic Partial Nephrectomy ◽  
Cochrane Central Register ◽  
Nephrometry Score ◽  
Estimated Blood Loss

Abstract Background To compare the perioperative outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score≥7. Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score≥7. We used RevMan 5.2 to pool the data. Results Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; p=0.54), hospital stay (WMD: -0.59; 95% CI: -1.24–0.06; p=0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65–1.11; p =0.23), major postoperative complications(OR: 0.90; 95% CI: 0.52–1.54; p=0.69) and transfusion (OR: 0.72; 95% CI: 0.48–1.08; p =0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; p=0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73–5.91; p=0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30–-6.62; p <0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p=0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28–0.97; p=0.04).Conclusions RPN showed better perioperative clinical outcomes than LPN for the treatment of complex renal tumors with a RENAL nephrometry score≥7.

scholarly journals Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Syed Ali Ehsanullah ◽  
Abida Sultana ◽  
Brian Kelly ◽  
Charlotte Dunford ◽  
Zaheer Shah
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Tumour Size ◽  
Open Approach ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
The Mean

Introduction. To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time. Methods. A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size. Results. Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%). Conclusion. Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

scholarly journals RENAL nephrometry score: Predicting perioperative outcomes following open partial nephrectomy

2019 ◽  
Vol 11 (2) ◽  
pp. 187
Author(s):  
ImranAhmad Khan ◽  
Supriya Basu ◽  
RanjitK Das ◽  
RanjanK Dey ◽  
Dawood Khan ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Open Partial Nephrectomy ◽  
Nephrometry Score

Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review

2020 ◽  
pp. 000313482094891
Author(s):  
Amber B. Tang ◽  
Margherita Lamaina ◽  
Christopher P. Childers ◽  
Selene S. Mak ◽  
Qiao Ruan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Long Term Outcomes ◽  
Robot Assisted ◽  
Cancer Specific Survival ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss

Background Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Methods A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included. Results RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively. Conclusions RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.

scholarly journals Predictive Factors for Postoperative Renal Function After Off-Clamp, Non-Renorrhaphy Partial Nephrectomy

2021 ◽  
Author(s):  
Masaki Nakamura ◽  
Shuji Kameyama ◽  
Taro Teshima ◽  
Yasushi Inoue ◽  
Tadashi Yoshimatsu ◽  
...  
Keyword(s):  
Renal Function ◽  
Regression Analysis ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Multivariate Regression ◽  
Independent Predictor ◽  
Multivariate Regression Analysis ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
Clinical Records

Abstract Background: There is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy.Therefore, this study aimed to clarify the chronological postoperative changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy.Methods: Clinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy were performed using a soft coagulation system. Perioperativeestimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery.Results: The median operation time was 122 minutes, and the median volume of estimated blood loss was155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Multivariate regression analysis revealed that estimated blood loss was an independent predictor of perioperative eGFR preservation at 5 days and 1 month after surgery, while age was an independent predictor of perioperative eGFR preservation at 3months after surgery.Conclusion: Chronological changes in renal function after off-clamp, non-renorrhaphy open partial nephrectomy have been reported.Ourresults could bea reference in the era of robot-assisted partial nephrectomy.

Comparison of open and robotic nephron sparing surgery: a single centre experience

2016 ◽  
Vol 10 (1) ◽  
pp. 28-35
Author(s):  
Clare R Jelley ◽  
Kurukula ASH Kurukulaarachchi ◽  
Luke Forster ◽  
Harry Bardgett ◽  
Rajindra Singh ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
High Volume ◽  
Robotic Partial Nephrectomy ◽  
Complication Rates ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss

Objective: To compare robotic partial nephrectomy (RAPN) with open partial nephrectomy (OPN) to assess efficacy and impact of learning curve. Methods: From 2010 to 2015 159 patients had a partial nephrectomy (82 OPN and 77 RAPN). All data were collected prospectively. We compared the demographics, peri and postoperative outcomes. Results: Mean age was 60 years in both groups; 59% of patients were men. Tumour size was larger in the open group (34 mm vs 30 mm; P<0.08), but RENAL nephrometry scores greater than 6 were comparable (over 60%). Mean ischaemic time was longer in the RAPN group (18 vs 13 minutes; P<0.04) but complication rates were similar. The RAPN cohort had a reduced estimated blood loss (100 ml vs 300 ml; P<0.01) and shorter median hospital stay (2 vs 5 days; P<0.01). Only two patients in each group were margin positive. The RAPN cohort demonstrated reduced estimated blood loss and a trend towards more complex tumours with increasing learning curve. Conclusion: RAPN is superior to OPN in terms of reduced hospital stay and estimated blood loss without compromising oncological outcomes. This service can be delivered safely and effectively in a low to medium volume cancer centre; these results are similar to published figures from high volume international centres.

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