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Robotic partial nephrectomy

Zachary A Hamilton, Robert G Uzzo, Alessandro Larcher, Brian R Lane, Benjamin Ristau, Umberto Capitanio, Stephen Ryan, Sumi Dey, Andres Correa, Madhumitha Reddy, James A Proudfoot, Ryan Nasseri, Kendrick Yim, Sabrina Noyes, Ahmet Bindayi, Francesco Montorsi, Ithaar H Derweesh
BACKGROUND: We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery. METHODS: A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥ CKD Stage III [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 ] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m2 ) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4-6), intermediate (7-9), complex (10-12)]...
March 12, 2018: World Journal of Urology
Benoit Peyronnet, Lauranne Tondut, Jean-Christophe Bernhard, Christophe Vaessen, Nicolas Doumerc, Philippe Sebe, Benjamin Pradere, Bertrand Guillonneau, Zine-Eddine Khene, Francois-Xavier Nouhaud, Nicolas Brichart, Thomas Seisen, Quentin Alimi, Jean-Baptiste Beauval, Romain Mathieu, Adham Rammal, Alexandre De La Taille, Herve Baumert, Stéphane Droupy, Franck Bruyere, Morgan Roupret, Arnaud Mejean, Karim Bensalah
OBJECTIVE: To assess the impact of hospital volume (HV) and surgeon volume (SV) on perioperative outcomes of robot assisted partial nephrectomy (RAPN). PATIENTS AND METHODS: All consecutive patients who underwent a RAPN from 2009 to 2015 at eleven institutions were included in a retrospective study. To evaluate the impact of hospital volume we divided RAPN into four quartiles according to the caseload per year: low HV (<20/year); moderate HV (20-44/year); High HV (45-70/year); very high HV (>70/year)...
March 5, 2018: BJU International
Briony K Varda, Patricia Cho, Andrew A Wagner, Richard S Lee
BACKGROUND: In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions. OBJECTIVES: To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children's hospital...
March 2, 2018: Journal of Pediatric Urology
Roberto Castellucci, Giulia Primiceri, Pietro Castellan, Michele Marchioni, Carlo D'Orta, Francesco Berardinelli, Fabio Neri, Luca Cindolo, Luigi Schips
OBJECTIVES: Robotic-assisted partial nephrectomy (RAPN) is preferred to radical nephrectomy because it guarantees superior functional outcomes in patients with small renal masses (RMs). Only a few studies so far have evaluated the feasibility of RAPN for the treatment of RM ≥4 cm. The aim of this study is to evaluate the safety and feasibility of RAPN based on a comparison of trifecta and pentafecta rates for RMs ≥4 cm. MATERIAL AND METHODS: We retrospectively analyzed prospectively collected data from an institutional database of patients undergoing RAPN from September 2013 to November 2016...
March 1, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Philip Edgcumbe, Rohit Singla, Philip Pratt, Caitlin Schneider, Christopher Nguan, Robert Rohling
A projector-based augmented reality intracorporeal system (PARIS) is presented that includes a miniature tracked projector, tracked marker, and laparoscopic ultrasound (LUS) transducer. PARIS was developed to improve the efficacy and safety of laparoscopic partial nephrectomy (LPN). In particular, it has been demonstrated to effectively assist in the identification of tumor boundaries during surgery and to improve the surgeon's understanding of the underlying anatomy. PARIS achieves this by displaying the orthographic projection of the cancerous tumor on the kidney's surface...
April 2018: Journal of Medical Imaging
Francisco Miguel Sánchez-Margallo, Juan A Sánchez-Margallo
PURPOSE: New laparoscopic devices are being continuously developed to overcome some of the technical and ergonomic limitations of laparoendoscopic single-site (LESS) surgery. This study aims to assess the surgeon's surgical performance and ergonomics during the use of a handheld, robotic-driven, articulating laparoscopic instrument during LESS surgery. METHODS: Seven right-handed experienced surgeons took part in this study. A set of basic suturing tasks and digestive and urological procedures in a porcine model were performed...
February 1, 2018: Surgical Innovation
Olamide O Omidele, Natan Davoudzadeh, Michael Palese
Background and Objectives: The learning curve for achieving desirable perioperative outcomes in robot-assisted partial nephrectomy (RAPN) has not been well studied. Information is available regarding "trifecta" outcomes of no complications, no positive margins, warm ischemia time (WIT) of ≤25 minutes, and a ≤15% decrease in postoperative glomerular filtration rate (GFR). This study was conducted to assess the impact of the learning curve on surgical outcomes in patients undergoing RAPN...
January 2018: JSLS: Journal of the Society of Laparoendoscopic Surgeons
S K Frees, R Mager, H Borgmann, W Jäger, C Thomas, A Haferkamp
BACKGROUND: Several new treatment strategies have emerged in the treatment of small renal masses (<4 cm in diameter). Active surveillance and ablative techniques have been introduced but it remains unclear which patients will benefit the most from these new treatment options. A surgical approach remains standard of care. In recent decades, radical nephrectomy has been replaced by nephron-sparing surgery for the management of small renal masses. RESULTS: In addition to the open partial nephrectomy, which is considered the standard approach, the number of surgeries performed using minimally invasive techniques is increasing...
March 2018: Der Urologe. Ausg. A
Ercan Malkoç, Matthew J Maurice, Oktay Akça, Önder Kara, Homayoun Zargar, Hiury Andrade, Daniel Ramirez, Peter Caputo, Robert Stein, Demirjian Sevag, Jihad H Kaouk
AIM: To describe the pathological characteristics of the peritumoral non-neoplastic renal parenchyma (NNRP) and to investigate their impact on long-term renal function after partial nephrectomy. MATERIALS AND METHODS: In our institutional robotic partial nephrectomy database, we identified 394 cases with pathological assessment of the NNRP and long-term postoperative renal functional follow-up. The NNRP was classified as normal (healthy renal parenchyma) or abnormal, based on the presence of arteriosclerosis, glomerulosclerosis, interstitial fibrosis, interstitial inflammation, and/or tubulopapillary hyperplasia...
February 16, 2018: Journal of Nephrology
Zi Qin Ng, Richard Pemberton, Patrick Tan
Trocar site hernia is not a common acute complication encountered after robot-assisted surgery, especially in the urological cohort of patients. A few case reports of small bowel obstruction secondary to incarceration by trocar site hernia have been described in gynaecological surgery and prostatectomies. As the clinical presentation is non-specific, late diagnosis has significant implication on morbidity and mortality. Here, we present a rare case of a patient with recent robot-assisted laparoscopic partial nephrectomy for a renal cell carcinoma presented with features of impending bowel obstruction secondary to incarcerated small bowel in the trocar site...
February 15, 2018: Journal of Robotic Surgery
Jean-Baptiste Beauval, Benoit Peyronnet, Thibaut Benoit, Bastien Cabarrou, Thomas Seisen, Mathieu Roumiguié, Benjamin Pradere, Zine-Eddine Khene, Quentin Manach, Gregory Verhoest, Mathieu Thoulouzan, Jerome Parra, Nicolas Doumerc, Romain Mathieu, Christophe Vaessen, Michel Soulié, Morgan Roupret, Karim Bensalah
PURPOSE: This study aimed at reporting the long-term oncological outcomes of robotic partial nephrectomy (RPN) for renal cell carcinoma (RCC). METHODS: Data from all consecutive patients who underwent RAPN for RCC from July 2009 to January 2012 in three departments of urology were prospectively collected. Overall survival (OS), cancer-specific survival (CSS) and disease free-survival (DFS) were estimated using the Kaplan-Meier method. Prognostic factors associated with CSS were sought in univariate analysis...
February 9, 2018: World Journal of Urology
Byung Kwan Park, In Hyuck Gong, Min Yong Kang, Hyun Hwan Sung, Hwang Gyun Jeon, Byong Chang Jeong, Seong Soo Jeon, Hyun Moo Lee, Seong Il Seo
OBJECTIVE: To compare oncological and functional mid-term outcomes following robotic partial nephrectomy (RPN) and radiofrequency ablation (RFA) for treating T1a renal cell carcinoma (RCC) using propensity score-matching. METHODS: Between December 2008-April 2016, 63 patients from each treatment group were propensity score-matched for age, sex, American Society of Anesthesiologists score, tumour size, tumour laterality, tumour histology, R.E.N.A.L. nephrometry score and preoperative estimated glomerular filtration rate (eGFR)...
February 9, 2018: European Radiology
Giovanni E Cacciamani, Luis G Medina, Tania S Gill, Alec Mendelsohn, Fatima Husain, Lokesh Bhardwaj, Walter Artibani, Renè Sotelo, Inderbir S Gill
CONTEXT: During robotic partial nephrectomy (RPN), various techniques of hilar control have been described, including on-clamp, early unclamping, selective/super-selective clamping, and completely-unclamped RPN. OBJECTIVE: To evaluate the impact of various hilar control techniques on perioperative, functional, and oncological outcomes of RPN for tumors. EVIDENCE ACQUISITION: We conducted a systematic literature review and meta-analysis of all comparative studies on various hilar control techniques during RPN using PubMed, Scopus, and Web of Science according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement, and Methods and Guide for Effectiveness and Comparative Effectiveness Review of the Agency for Healthcare Research and Quality...
February 5, 2018: European Urology Focus
Steven M Monda, Jonathan R Weese, Barrett G Anderson, Joel M Vetter, Ramakrishna Venkatesh, Kefu Du, Gerald L Andriole, Robert S Figenshau
Objectives To provide a training tool to address the technical challenges of robot-assisted laparoscopic partial nephrectomy, we created silicone renal tumor models using 3D printed molds of a patient's kidney with a mass. In this study, we assessed the face, content, and construct validity of these models. Materials and Methods Surgeons of different training levels completed four simulations on silicone renal tumor models. Participants were surveyed on the usefulness and realism of the model as a training tool...
February 5, 2018: Urology
Hidekazu Tachibana, Toshio Takagi, Tsunenori Kondo, Hideki Ishida, Kazunari Tanabe
OBJECTIVES: To compare surgical outcomes, including renal function and the preserved renal parenchymal volume, between robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy using propensity score-matched analyses. METHODS: In total, 253 patients, with a normal contralateral kidney, who underwent laparoscopic partial nephrectomy (n = 131) or robot-assisted laparoscopic partial nephrectomy (n = 122) with renal arterial clamping between 2010 and 2015, were included...
February 4, 2018: International Journal of Urology: Official Journal of the Japanese Urological Association
Ernest Chan, Shawna L Boyle, Jeffrey Campbell, Patrick P W Luke
INTRODUCTION: The relative impact of preoperative and perioperative variables on renal function following partial nephrectomy (PN) is controversial. To further investigate, we assess the effects of tumour complexity, warm ischemic time (WIT), and volume of resected renal parenchyma on ipsilateral renal function (IRF) outcomes following minimally invasive PN. METHODS: Of patients who underwent laparoscopic or robotic-assisted PN between 2002 and 2011 at our institution, 99 met our inclusion criteria...
October 2017: Canadian Urological Association Journal, Journal de L'Association des Urologues du Canada
Burkhard Ubrig, Alexander Roosen, Christian Wagner, Guenter Trabs, Frank Schiefelbein, Jorn H Witt, Georg Schoen, Nina Natascha Harke
PURPOSE: To demonstrate the surgical feasibility of robot-assisted partial nephrectomy for complex renal masses with comparison of low/intermediate risk versus high-risk tumors according to the PADUA score. METHODS: Since 2008, 538 robot-assisted partial nephrectomies were performed at three German robotic centers. Both the MIC (margin, ischemia, complications) criteria and trifecta were applied. RESULTS: 60.1% of the tumors were of low and intermediate complexity (PADUA score 6-9, n = 326, group A), while 39...
January 29, 2018: World Journal of Urology
Joan C Delto, David Paulucci, Michael W Helbig, Ketan K Badani, Daniel Eun, James Porter, Ronney Abaza, Ashok K Hemal, Akshay Bhandari
OBJECTIVES: To compare peri-operative outcomes after robot-assisted partial nephrectomy (RAPN) for cT2a (7 to <10 cm) to cT1 tumours. MATERIALS AND METHODS: Patients with a cT1a (n = 1 358, 76.4%), cT1b (n = 379, 21.3%) or cT2a (n = 41, 2.3%) renal mass were identified from a multi-institutional RAPN database. Intra- and postoperative outcomes were compared for cT2a masses vs cT1a and cT1b masses using multivariable regression models (linear, logistic, Poisson etc...
January 22, 2018: BJU International
Georges Nasrallah, Fouad G Souki
PURPOSE OF REVIEW: Laparoscopic kidney surgery is commonly used for living donor, partial, and total tumor nephrectomy. The successful emergence of laparoscopic technique was justified by the many benefits offered such as reduced blood loss, tissue trauma, pain, and hospital stay. However, this comes at the expense of physiologic changes and complications secondary to pneumoperitoneum, surgical technique, and patient positioning with significant challenges in anesthetic management. RECENT FINDINGS: A variety of laparoscopic approaches (transperitoneal, retroperitoneal, hand-assisted, robotic) are used with some having advantages over others...
January 18, 2018: Current Urology Reports
Brendan Hermenigildo Dias, Mohammed Shahid Ali, Shiv Dubey, Srinivas Arkalgud Krishnaswamy, Amrith Raj Rao, Deepak Dubey
Introduction: Robot-assisted partial nephrectomy (RAPN) is an established, minimally invasive technique to treat patients with renal masses. The aim of this study was to assess the learning curve (LC) of RAPN, evaluate its impact on perioperative outcomes following RAPN and to study the role of surgeon experience in achieving "trifecta" outcomes following RAPN. Methods: We prospectively analyzed the clinical and pathological outcomes of 108 consecutive patients who underwent RAPN for renal tumors from January 2012 to December 2016 by a laparoscopy trained surgeon with no prior robotic experience...
January 2018: Indian Journal of Urology: IJU: Journal of the Urological Society of India
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