scholarly journals Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

2013 ◽  
Vol 7 (9-10) ◽  
pp. 348 ◽  
Author(s):  
Guillaume Ploussard ◽  
Richard Haddad ◽  
Evan Kovac ◽  
Patrick Richard ◽  
Maurice Anidjar ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Admission Rate ◽  
Complication Rates ◽  
Robot Assisted ◽  
Nephrometry Score ◽  
Surgeon Experience ◽  
The Mean

Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program.Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months.Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/min without severe postoperative renal failure.Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure. 

scholarly journals Warm ischemic time’ and renal function preservation in robotic partial nephrectomy -evaluating its real impact

2020 ◽  
Vol 8 (6) ◽  
pp. 161-166
Author(s):  
Krishnendu Biswas ◽  
Rohan S Batra ◽  
Abhishek G Singh ◽  
Arvind P Ganpule ◽  
Ravindra B Sabnis ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Robotic Partial Nephrectomy ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Nephrometry Score ◽  
Significant Difference ◽  
One Year

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, <20minutes, 20 minutes to 30 minutes and >30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

scholarly journals Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

2016 ◽  
Vol 88 (3) ◽  
pp. 228 ◽  
Author(s):  
Faruk Ozgor ◽  
Abdulmuttalip Simsek ◽  
Ozgu Aydogdu ◽  
Onur Kucuktopcu ◽  
Omer Sarilar ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Operation Time ◽  
Demographic Characteristics ◽  
Ischemia Time ◽  
Nephrometry Score ◽  
The Mean ◽  
Group 1

Objectives: To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). Materials and methods: Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of &lt; 0.05. Results: The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p &lt; 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. Conclusion: The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

scholarly journals Associations between radiographic characteristics and change in renal function following partial nephrectomy using 24-hour creatinine clearance

2013 ◽  
Vol 5 (1) ◽  
pp. 45
Author(s):  
Rodney H. Breau ◽  
Aaron T.D. Clark ◽  
Chris Morash ◽  
Dean Fergusson ◽  
Ilias Cagiannos
Keyword(s):  
Renal Function ◽  
Creatinine Clearance ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Multivariable Analysis ◽  
Function Change ◽  
Tumour Location ◽  
Function Preservation ◽  
The Mean ◽  
The Impact

Background: Radiographic characteristics may be associated withthe degree of renal function preservation following partial nephrectomy.The purpose of this study was to determine the impact ofpreoperative radiographic variables on change in renal functionusing 24-hour urine creatinine clearance (uCrCl).Methods: Patients with partial nephrectomy performed fromNovember 2003 to 2008 were enrolled in the study. Serum creatinineand 24-hour urine was collected preoperatively and at3, 6 and 12 months postoperatively. Computed tomography ormagnetic resonance imaging was used to determine tumour size,tumour location and renal volume.Results: Of the 36 patients, median age was 62 (range 30-78) and21 (58%) were male. The mean tumour diameter was 2.8±1.4 cm.Twenty-two (61%) tumours were located at the renal pole and11 (31%) were endophytic. Overall, mean preoperative uCrClwas 88.8±34.2 mL/min and mean postoperative uCrCl was82.8±33.6 mL/min (6.8%; p < 0.01). On multivariable analysis,no single characteristic was associated with a clinically prohibitivedecrease in renal function (-9.4% if endophitic, p = 0.06; -0.57%per cm diameter, p = 0.73; and -6.9% if located at the renal pole,p = 0.15). The total renal volume was also not significantly associatedwith renal function change (-1.1% per 100 cc, p = 0.86).Interpretation: Preoperative radiographic characteristics seem tobe associated with small changes in renal function following partialnephrectomy. These data support renal functional benefits of partialnephrectomy regardless of tumour size and location.

Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy

2014 ◽  
Vol 20 (3) ◽  
pp. 586-592 ◽  
Author(s):  
Hideaki Miyake ◽  
Junya Furukawa ◽  
Nobuyuki Hinata ◽  
Mototsugu Muramaki ◽  
Kazushi Tanaka ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Robot Assisted ◽  
Nephrometry Score ◽  
Postoperative Renal Function

Effectiveness of Ultrasound-Guided Radiofrequency Ablation in the Treatment of 36 Renal Cell Carcinoma Tumours Compared with Published Results of Using Computed Tomography Guidance

2012 ◽  
Vol 63 (3_suppl) ◽  
pp. S23-S32 ◽  
Author(s):  
Kellie Davis ◽  
Ania Kielar ◽  
Katayoun Jafari
Keyword(s):  
Computed Tomography ◽  
Radiofrequency Ablation ◽  
Residual Disease ◽  
Tumour Size ◽  
Complication Rates ◽  
Ct Guided ◽  
Renal Lesions ◽  
Contrast Enhanced Ct ◽  
The Mean

This study aimed to analyse the outcomes of ultrasound (US) guided radiofrequency ablation (RFA) in patients with renal lesions and to compare our outcomes with published results of ablations carried out when using computed tomography (CT) guidance. This retrospective study evaluated RFA of 36 renal tumours in 32 patients (M = 21, F = 11). The mean patient age was 70 years (range, 39–89 years). Ablations were performed by using either multi-tined applicators or cooled and/or cluster applicators under US guidance. Applicator size varied from 2–5 cm, depending on the size of the index tumour. Conscious sedation was administered by an anesthetist. Follow-up imaging by using contrast-enhanced CT was performed 1, 3, 6, and 12 months after RFA, and yearly thereafter. The mean tumour follow-up time was 12 months (range, 1–35 months). The mean tumour size was 2.7 cm (range, 1–5 cm). Primary effectiveness was achieved in 31 cases (86.1%), with patients in 5 cases (11.1%) demonstrating residual disease. Three patients had repeated sessions, which were technically successful. The remaining 2 patients were not re-treated because of patient comorbidities. As a result, secondary effectiveness was achieved in 34 patients (94.4%). In 1 patient, a new lesion developed in the same kidney but remote from the 2 prior areas of treatment. Hydrodissection was performed in 3 patients (8.3%), manipulation or electrode repositioning in 11 patients (30.6%), and ureteric cooling in 1 patient (2.8%). Minor and major complications occurred in 3 (8.3%) and 3 (8.3%) patients, respectively. Correlation coefficients were calculated for distance from skin to tumour and risk of complication as well as compared with primary and secondary effectiveness. This study demonstrates that US-guided RFA is an effective treatment for renal lesions, with rates of effectiveness and complication rates comparable with published CT-guided RFA results.

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 Evaluation of the efficacy and patient satisfaction of the intracavernosal alprostadil in the treatment of erectile dysfunction following robot-assisted radical prostatectomy

2021 ◽  
Author(s):  
Hüseyin Kocatürk ◽  
Mehmet Sefa Altay ◽  
Fevzi Bedir ◽  
Banu Bedir
Keyword(s):  
Patient Satisfaction ◽  
Erectile Dysfunction ◽  
Radical Prostatectomy ◽  
Therapeutic Option ◽  
Complication Rates ◽  
Robot Assisted ◽  
General Satisfaction ◽  
The Mean ◽  
Keywords Erectile Dysfunction

Objective: Erectile dysfunction (ED) following robot-assisted radical prostatectomy (RARP) is an important problem. The purpose of this study was to evaluate the effectiveness of and patient satisfaction with intracavernosal alprostadil used in the treatment of ED. Material and Methods: Patients using intracavernosal alprostadil in the treatment of ED following RARP were assessed retrospectively. Patients’ demographic characteristics, pre- and postoperative International Index of Erectile Function (IIEF) scores, and general satisfaction evaluated using questions 13 and 14 of the IIEF form were all recorded. Complications developing during treatment, dosages used, and reasons for discontinuation were investigated. Results: Thirty-four patients with a mean age of 61.73±5.80 years were included in the study. Preoperative ED was determined in 52.9% (n=18) of patients. The mean IEFF of the patients who used preoperative, postoperative 1st month, postoperative 3 months after tadalafil use and intracavernosal alprostadil was 20.64 ± 3.46, 15.08 ± 2.09, 15.32 ± 2.18, 26.67 ± 2.30, respectively. The mean length of use of intracavernosal alprostadil was 8.20±2.48 months, and full erection was achieved in 70.58% of patients. Hematoma associated with intracavernosal alprostadil use developed in 2.9% of patients, ecchymosis in 8.8%, and pain in 8.8%. In addition, 73.5% of patients continued to take their medication during the follow-up process. Patients’ general satisfaction following alprostadil therapy was statistically significantly high. Conclusion: Intracavernosal alprostadil therapy following RARP represents a good therapeutic option due to its high success in achieving full erection, low complication rates, and high patient satisfaction. Keywords: erectile dysfunction, Alprostadil, robot-assisted radical prostatectomy

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