Objective:Nowadays robot-assisted partial nephrectomy(RAPN)represents the standard of care for clinical T1(cT1)renal masses,providing similar oncological outcomes when compared to open or laparoscopic PN with advantag...Objective:Nowadays robot-assisted partial nephrectomy(RAPN)represents the standard of care for clinical T1(cT1)renal masses,providing similar oncological outcomes when compared to open or laparoscopic PN with advantages in terms of functional outcomes and lower perioperative comorbidity,when compared to radical nephrectomy.Methods:We performed an extensive literature review of studies regarding RAPN,its evolution,technical aspects and applications,and new technological tools using different combinations of Medical Subject Headings terms“RAPN”,“partial nephrectomy”,“robot-assisted”,“nephron-sparing surgery”,“renal cell carcinoma”,“complex renal masses”,“endophytic renal masses”,and“bilateral renal tumors”.Results:A consistent body of evidence was selected,including original articles,systematic reviews,meta-analyses,and clinical trials having RAPN as the central focus in adult patients,with all its technical nuances.We started our narrative review with a background on PN and its evolution toward the robotic era with a special spotlight on the extending indications for PN in large and highly complex renal masses.Our review continued with an overview of nephron-sparing surgery in bilateral and recurrent masses.RAPN for bilateral synchronous renal masses represents a challenging scenario with no formal recommendations provided by international guidelines and controversial management and decision-making.Additionally,we reported evidence on redo RAPN which seems to be safe and effective.A final overview of the available technological tools,and in particular on three-dimensional reconstruction was provided.Conclusion:RAPN has been established as the standard of care for cT1 renal masses with an expanding spectrum of applications in different scenarios,including large(cT2),highly complex,and bilateral renal masses,as well as the surgical treatment of local recurrences after nephron-sparing surgery with acknowledged advantages in terms of functional outcomes and perioperative risk profiles while maintaining similar oncological outcomes when compared to open or laparoscopic PN and radical treatment.展开更多
Objective:To highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).Methods:A transper...Objective:To highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).Methods:A transperitoneal RAPN was performed in a 62-year-old male patient presenting with a 4 cm right anterior interpolar renal mass(R.E.N.A.L nephrometry score 7A).An abnormal vasculature was observed,with a single renal vein and two right renal arteries originating superiorly to the vein and anterior,when dividing in their segmental branches.According to the hyper accuracy 3D(HA3D^(®))rainbow model(MEDICS Srl,Turin,Italy),one branch belonging to one of the segmental arteries was feeding the tumor.This allowed for an accurate prediction of the area vascularized by each arterial branch.The 3D model was included in the intraoperative console view during the whole procedure,using the TilePro feature.A step-by-step explanation of the procedure is provided in the video attached to the present article.Results:The operative time was 90 min with a warm ischemia time on selective clamping of 13 min.Estimated blood loss was 180 mL.No intraoperative complication was encountered and no drain was placed at the end of the procedure.The patient was discharged on postoperative Day 2,without any early postoperative complications.The final pathology report showed a pathological tumor stage 1 clear cell renal cell carcinoma with negative surgical margins.Conclusion:The present study and the attached video illustrate the value of 3D rainbow model during the planning and execution of a RAPN with selective clamping.It shows how the surgeon can rely on this model to be more efficient by avoiding unnecessary surgical steps,and to safely adopt a“selective”clamping strategy that can translate in minimal functional impact.展开更多
Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and...Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.展开更多
Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were ...Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were selected,with hospital admission spanning from January 2024 to June 2024.Patients were randomly divided into the study group(n=10)and the control group(n=9).The control group received basic nursing care,while the study group received comprehensive high-quality nursing care.The recovery period,length of hospital stay,complication rates,SCL-90 scores,and nursing quality scores were compared between the two groups.Results:The recovery period and hospital stay were significantly shorter in the study group compared to the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).After the nursing intervention,the SCL-90 scores of the study group were lower than those of the control group(P<0.05).Nursing quality scores were higher in the study group than in the control group(P<0.05).Conclusion:Comprehensive high-quality nursing intervention for patients undergoing prone-position laparoscopic partial nephrectomy can shorten the recovery period and hospital stay,reduce the complication rate,improve mental health,and enhance nursing quality,making it suitable for wider application in medical institutions.展开更多
Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the c...Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the current strategies and further perspectives on this patient setting.Methods:A non-systematic review of the literature was completed.The research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific tools.No clear evidence is reported about these methods.Regarding PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery.Regarding local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN.In this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive alternative.Salvage surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach.Overall,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ablation.Conclusion:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN.Active surveillance is likely to be the optimal first-line management option for most patients with PSMs.Ablation and salvage surgery both represent valid options in patients with local recurrence after PN.Conversely,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA.In this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.展开更多
Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the sur...Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.展开更多
Objectives Transmuscular quadratus lumborum block(TQLB)may provide postoperative analgesia in patients undergoing intraperitoneal surgeries.The purpose of this study was to examine the potential efficacy of TQLB among...Objectives Transmuscular quadratus lumborum block(TQLB)may provide postoperative analgesia in patients undergoing intraperitoneal surgeries.The purpose of this study was to examine the potential efficacy of TQLB among patients undergoing retroperitoneal procedures,such as the laparoscopic partial nephrectomy(LPN).Methods This prospective,randomized,controlled study was conducted from August 2017 to November 2018 at Peking Union Medical College Hospital(Beijing,China).Patients who were scheduled for a LPN,aged 18・70 years old with an ASA physical status score of I-II were randomly assigned to receive either TQLB with 0.6 ml/kg of 0.5%ropivacaine plus general anesthesia(TQLB group)or general anesthesia alone(control group).Patient-controlled intravenous analgesia with morphine was initiated immediately upon surgery completion.The primary outcome was the cumulative consumption of morphine within 8 h after surgery.The secondary outcome included postoperative consump廿ons of morphine at other time points,pain score at rest and during activity,postoperative nausa and vomitting(PONV),and recovery related parameters.Results Totally 30 patients per group were recruited in the study.The 8 h consumption of morphine was lower in theTQLB group than in the control group(median,0.023 mg/kg vs.0.068 mg/kg,U=207.5,P<0.001).No significant differences were observed in postoperative pain scores between the two groups.Patients in the TQLB group had fewer episodes of PONV(20%vs.47%,χ2=4.&P=0.028)in the first 24 h after surgery and higher scores for quality of recovery(mean,13&6 vs.131.9,t=-2.164,P=0.035)120 h after surgery than the controls.Conclusions TQLB resulted in an opioid-sparing effect during the early postoperative period following LPN,as well as a lower incidence of PONV and improved quality of recovery.展开更多
Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outc...Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outcomes.The secondary endpoints were the perioperative and functional outcomes.Methods:A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement.Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.Results:Overall,13 retrospective cohort studies were included in the analysis.Patients undergoing PN were younger(weighted mean difference[WMD]3.49 years,95%confidence interval[CI]5.16 to1.82;p<0.0001)and had smaller masses(WMD0.45 cm,95%CI0.59 to0.31;p<0.0001).There were no differences in the oncological outcome,which was demonstrated by progression-free survival(hazard ratio[HR]0.70;pZ0.22),cancerspecific mortality(HR 0.91;pZ0.57)and all-cause mortality(HR 1.01;pZ0.96).The two procedures were similar in estimated blood loss(WMD16.47 mL;pZ0.53)and postoperative complications(risk ratio[RR]1.32;pZ0.10),and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset(RR 0.38;pZ0.006).Conclusion:PN is an effective treatment for T1b tumours because it offers similar surgical morbidity,equivalent cancer control,and better renal preservation compared to RN.展开更多
ENAL cell carcinoma （RCC） in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy （PN） or nephron-sparing surgery in this condition provides good oncological and renal...ENAL cell carcinoma （RCC） in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy （PN） or nephron-sparing surgery in this condition provides good oncological and renal fuctional outcomes with an acceptable complication rate.1＇ 2 Long-term renal function remains stable in most patients with solitary kidneys after a reduction of more than 50% in renal mass.展开更多
Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze ...Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.展开更多
Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)syste...Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)system(Suzhou KangDuo Robot Co.,Ltd.,Suzhou,China)and discuss its surgical technique.Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney.The R.E.N.A.L.nephrometry score of this patient was 4x.This patient underwent rRAPN with KD-SR-01.The perinephric fat between the tumor and Gerota's fascia was preserved,which was used for internal suspension traction during tumor resection.Postoperative follow-up data were collected.Results The surgery was successfully carried out with a duration of 127 min,in which the docking time was 6 min 25 s and console time was 60 min.The warm ischemia time was 19 min 53 s,and the estimated blood loss was 0 mL.The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma,with a negative surgical margin.The World Health Organization/International Society of Urological Pathology(WHO/ISUP)grade of this patient was Grade 2.No recurrence was observed during the 6-month follow-up.Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.展开更多
BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series ...BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series of laparoscopic partial nephrectomy(LPN)by GreenLight laser enucleation without renal artery clamping.Due to the excellent coagulation and hemostatic properties of the laser,laser-assisted LPN(LLPN)makes it possible to perform a“zero ischemia”resection.METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed.All clinical information,surgical and post-operative data,complications,pathological and functional outcomes were analyzed.RESULTS Surgery was successfully completed in all patients,and no open or radical nephrectomy was performed.The renal artery was not clamped,leading to no ischemic time.No blood transfusions were required,the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred.The mean operation time was 104.3±8.2 min.The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d,and the mean postoperative hospital stay was 6.5±0.7 d.No serious complications occurred.Postoperative pathological results showed clear cell carcinoma in 12 patients,papillary renal cell carcinoma in 2 patients,and hamartoma in 1 patient.The mean creatinine level was 75.0±0.8μmol/L(range 61.0-90.4μmol/L)at 1 mo after surgery,and there were no statistically significant differences compared with pre-operation(P>0.05).The glomerular filtration rate ranged from 45.1 to 60.8 mL/min,with an average of 54.0±5.0 mL/min,and these levels were not significantly different from those before surgery(P>0.05).CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors(exogenous tumors of stage T1a)during LPN.However,use of this technique can lead to the generation of excessive smoke.展开更多
BACKGROUND Hem-o-Lok clip(HOLC)has been widely used in laparoscopic surgery due to its ease of application and secure clamping,though the rare complications associated with this technique should not be ignored.The rar...BACKGROUND Hem-o-Lok clip(HOLC)has been widely used in laparoscopic surgery due to its ease of application and secure clamping,though the rare complications associated with this technique should not be ignored.The rare complications of laparoscopic partial nephrectomy consist of the clip migrating into the renal pelvis and acting as a nidus for stone formation.CASE SUMMARY The case described here involved a 63-year-old woman who was found with stones in the right kidney and upper ureter during a recent reexamination following laparoscopic partial nephrectomy.We performed percutaneous nephrolithotomy for her,but during the operation,it was found that the center of the stone within the kidney was a HOLC,which was removed with forceps.For this reason,we speculate that the HOLC,which was employed to halt tumor wound bleeding,spontaneously drifted into the renal pelvis and formed kidney stones,with the clip being initially misdiagnosed as a kidney stone.CONCLUSION By reviewing related case reports,we conclude that in order to prevent complications related to HOLC,loose clips should be actively searched for and retrieved from the wound during urinary tract surgery,while the deployment of clips in close proximity of anastomotic stoma of collecting systems should be avoided.展开更多
Objective:To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm(RAP)on contrast-enhanced computed tomography(CE-CT)after robot-assisted partial nephrectomy(RAPN)without parenchymal renorrhaphy...Objective:To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm(RAP)on contrast-enhanced computed tomography(CE-CT)after robot-assisted partial nephrectomy(RAPN)without parenchymal renorrhaphy.Methods:From May 2016 to December 2017,78 patients underwent RAPN for renal tumors.Inner suture was performed in the opened collecting system or renal sinus,whereas parenchymal renorrhaphy was not.For hemostasis,the soft coagulation system was used,and absorbable hemostats were placed on the resection bed.CE-CT was carried out within 7 days after surgery.Data on these patients were prospectively collected.A single radiologist determined the diagnosis of RAP.Results:Median(range)data were as follows:Patient age,65(19-82)years;radiographic tumor size,30(12-95)mm;operating time,166(102-294)min;warm ischemic time,16(7-67)min;and blood loss,15(0-4450)mL.One patient(1.6%)required a perioperative blood transfusion.No patient required conversion to open surgery or nephrectomy.CE-CT was carried out at median 6(3-7)days after surgery.CE-CT showed no RAP development in all 61 patients.Urinary leakage was not observed.One patient had acute cholecystitis,a postoperative complication classified as Clavien-Dindo grade higher than 3,which was treated with cholecystectomy.Positive surgical margin was identified in four patients(6.6%).Conclusion:RAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe.Our technique could eliminate the risk of RAP.展开更多
Objective:The present study aims to compare the clinical efficacy of laparoscopic partial nephrectomy using a harmonic scalpel versus traditional scissor.Methods:A retrospective review was conducted in patients with l...Objective:The present study aims to compare the clinical efficacy of laparoscopic partial nephrectomy using a harmonic scalpel versus traditional scissor.Methods:A retrospective review was conducted in patients with localized renal tumors and scheduled for laparoscopic partial nephrectomy from January 2015 to December 2019.Eventually,225 patients joined this retrospective study.Patients were divided into the harmonic scalpel group or scissor group based on the method used,with 71 cases and 154 cases respectively.Propensity score matching(1:1)was performed to adjust for potential baseline confounders,and each group had 57 cases.Patient characteristics,perioperative clinical results,complications,and oncological results were compared between the two groups.Results:After matching,patient characteristics were not significantly different between the two groups.The scissor group was associated with a significantly shorter operative time(105 min vs.130 min,p<0.001),shorter warm ischemia time(19.35 min vs.22.07 min,p?0.005).However,the harmonic scalpel group was associated with significantly less estimated blood loss(20 mL vs.30 mL,p?0.013)and shorter length of stay(8 d vs.10 d,p?0.040).There was no significantly difference in indwelling time of drainage tube,perioperative complication,oncological outcomes or recurrence rates.Conclusions:The harmonic scalpel is used safely and effectively in laparoscopic partial nephrectomy,and has benefits in intraoperative blood loss and length of stay.展开更多
Objective To evaluate the predictive validity of IRIS™(Intuitive Surgical®,Sunnyvale,CA,USA)as a planning tool for robot-assisted partial nephrectomy(RAPN)by assessing the degree of overlap with intraoperative ex...Objective To evaluate the predictive validity of IRIS™(Intuitive Surgical®,Sunnyvale,CA,USA)as a planning tool for robot-assisted partial nephrectomy(RAPN)by assessing the degree of overlap with intraoperative execution.Methods Thirty-one patients scheduled for RAPN by four experienced urologists were enrolled in a prospective study.Prior to surgery,urologists reviewed the IRIS™three-dimensional model on an iphone Operating System(iOS)app and completed a questionnaire outlining their surgical plan including surgical approach,and ischemia technique as well as confidence in executing this plan.Postoperatively,questionnaires assessing the procedural approach,clinical utility,efficiency,and effectiveness of IRIS™were completed.The degree of overlap between the preoperative and intraoperative questionnaires and between the planned approach and actual execution of the procedure was analyzed.Questionnaires were answered on a 5-point Likert scale and scores of 4 or greater were considered positive.Results Mean age was 65.1 years with a mean tumor size of 27.7 mm(interquartile range 17.5-44.0 mm).Hilar tumors consisted of 32.3%;48.4%of patients had R.E.N.A.L.nephrometry scores of 7-9.On preoperative questionnaires,the surgeons reported that in 67.7%cases they were confident that they can perform the procedure successfully,and on intraoperative questionnaires,the surgeons reported that in 96.8%cases IRIS™helped achieve good spatial sensation of the anatomy.There was a high degree of overlap between preoperative and intraoperative questionnaires for the surgical approach,interpreting anatomical details and clinical utility.When comparing plans for selective or off-clamp,the preoperative plan was executed in 90.0%of cases intraoperatively.Conclusion A high degree of overlap between the preoperative surgical approach and intraoperative RAPN execution was found using IRIS™.This is the first study to evaluate the predictive accuracy of IRIS™during RAPN by comparing preoperative plan and intraoperative execution.展开更多
BACKGROUND The majority of renal cell carcinomas are single lesions;unilateral synchronous multifocal renal carcinoma(USMRC)is rarely reported and poses a treatment challenge for urological oncologists.CASE SUMMARY A ...BACKGROUND The majority of renal cell carcinomas are single lesions;unilateral synchronous multifocal renal carcinoma(USMRC)is rarely reported and poses a treatment challenge for urological oncologists.CASE SUMMARY A 56-year-old man was hospitalized for pain and discomfort in the right kidney area for 6 d.Contrast-enhanced computed tomography demonstrated cT1a renal tumors at the lower pole of the right kidney and a cT1b renal tumor at the middle dorsal portion of the right kidney.The patient underwent retroperitoneal laparoscopic partial nephrectomy(RLPN).There were no complications peri-operatively.Histopathology revealed a low-grade,pathologic stage T1a(pT1a),clear cell renal cell carcinoma at the lower pole of the right kidney and a pT1b,chromophobe renal cell carcinoma at the middle dorsal portion of the right kidney.No tumor bed recurrence or metastasis was observed on imaging and his renal function remained stable during the 12-mo follow-up period.CONCLUSION RLPN is a safe,effective,and feasible for the management of USMRC,which can obtain equivalent oncological results with optimal renal function preservation.展开更多
BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas.Rare as it is,pneumothorax is one of the most severe intraoperative ...BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas.Rare as it is,pneumothorax is one of the most severe intraoperative complications which needs immediate recognition.On the other hand,as a rheumatological disease,lupus nephritis requires a long period of hormone therapy.Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.CASE SUMMARY A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy.The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment.Her blood oxygen saturation dropped to 92%during the operation,and pneumothorax was detected by ultrasound.O2 inhalation and lung dilation were performed.Her vital signs were monitored closely throughout the operation.The operation was accomplished,and she regained consciousness smoothly.A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward,while no evidence of further pneumothorax or lib injury was observed.CONCLUSION Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations,especially in retroperitoneal ones.It is easily neglected unless the injury of the diaphragm is found.Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.展开更多
Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternativ...Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis;LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy(LESS-PN),so as to assess its utility, safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases.The mean operative duration was 226.3(210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min(19-48 min).One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days(12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.展开更多
Partial nephrectomy is now a standard approach for small renal masses and tumour recurrences after partial nephrectomy are uncommon.In the absence of spillage,port site recurrences are most commonly reported.We report...Partial nephrectomy is now a standard approach for small renal masses and tumour recurrences after partial nephrectomy are uncommon.In the absence of spillage,port site recurrences are most commonly reported.We report a case of tumour recurrence near the surgical site as well as beyond the posterior renal fascia and Gerotas fascia in a 60-year-old woman who underwent robot-assisted partial ne-phrectomy for a 4.6 cm suspicious left renal tumour despite the absence of gross tumour spillage or rupture intraoperatively.Histology showed a 5 cm clear cell renal cell carcinoma with negative surgical margins,nuclear grade 4 with focal malignant rhabdoid differentiation.The practice of not bagging the specimen immediately after tumour excision especially for higher risk tumours should be reviewed as there may be inadvertent microscopic spillage of tumour cells.展开更多
文摘Objective:Nowadays robot-assisted partial nephrectomy(RAPN)represents the standard of care for clinical T1(cT1)renal masses,providing similar oncological outcomes when compared to open or laparoscopic PN with advantages in terms of functional outcomes and lower perioperative comorbidity,when compared to radical nephrectomy.Methods:We performed an extensive literature review of studies regarding RAPN,its evolution,technical aspects and applications,and new technological tools using different combinations of Medical Subject Headings terms“RAPN”,“partial nephrectomy”,“robot-assisted”,“nephron-sparing surgery”,“renal cell carcinoma”,“complex renal masses”,“endophytic renal masses”,and“bilateral renal tumors”.Results:A consistent body of evidence was selected,including original articles,systematic reviews,meta-analyses,and clinical trials having RAPN as the central focus in adult patients,with all its technical nuances.We started our narrative review with a background on PN and its evolution toward the robotic era with a special spotlight on the extending indications for PN in large and highly complex renal masses.Our review continued with an overview of nephron-sparing surgery in bilateral and recurrent masses.RAPN for bilateral synchronous renal masses represents a challenging scenario with no formal recommendations provided by international guidelines and controversial management and decision-making.Additionally,we reported evidence on redo RAPN which seems to be safe and effective.A final overview of the available technological tools,and in particular on three-dimensional reconstruction was provided.Conclusion:RAPN has been established as the standard of care for cT1 renal masses with an expanding spectrum of applications in different scenarios,including large(cT2),highly complex,and bilateral renal masses,as well as the surgical treatment of local recurrences after nephron-sparing surgery with acknowledged advantages in terms of functional outcomes and perioperative risk profiles while maintaining similar oncological outcomes when compared to open or laparoscopic PN and radical treatment.
文摘Objective:To highlight the role of hyper accuracy three-dimensional(3D)reconstruction in facilitating surgical planning and guiding selective clamping during robot-assisted partial nephrectomy(RAPN).Methods:A transperitoneal RAPN was performed in a 62-year-old male patient presenting with a 4 cm right anterior interpolar renal mass(R.E.N.A.L nephrometry score 7A).An abnormal vasculature was observed,with a single renal vein and two right renal arteries originating superiorly to the vein and anterior,when dividing in their segmental branches.According to the hyper accuracy 3D(HA3D^(®))rainbow model(MEDICS Srl,Turin,Italy),one branch belonging to one of the segmental arteries was feeding the tumor.This allowed for an accurate prediction of the area vascularized by each arterial branch.The 3D model was included in the intraoperative console view during the whole procedure,using the TilePro feature.A step-by-step explanation of the procedure is provided in the video attached to the present article.Results:The operative time was 90 min with a warm ischemia time on selective clamping of 13 min.Estimated blood loss was 180 mL.No intraoperative complication was encountered and no drain was placed at the end of the procedure.The patient was discharged on postoperative Day 2,without any early postoperative complications.The final pathology report showed a pathological tumor stage 1 clear cell renal cell carcinoma with negative surgical margins.Conclusion:The present study and the attached video illustrate the value of 3D rainbow model during the planning and execution of a RAPN with selective clamping.It shows how the surgeon can rely on this model to be more efficient by avoiding unnecessary surgical steps,and to safely adopt a“selective”clamping strategy that can translate in minimal functional impact.
文摘Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.
文摘Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were selected,with hospital admission spanning from January 2024 to June 2024.Patients were randomly divided into the study group(n=10)and the control group(n=9).The control group received basic nursing care,while the study group received comprehensive high-quality nursing care.The recovery period,length of hospital stay,complication rates,SCL-90 scores,and nursing quality scores were compared between the two groups.Results:The recovery period and hospital stay were significantly shorter in the study group compared to the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).After the nursing intervention,the SCL-90 scores of the study group were lower than those of the control group(P<0.05).Nursing quality scores were higher in the study group than in the control group(P<0.05).Conclusion:Comprehensive high-quality nursing intervention for patients undergoing prone-position laparoscopic partial nephrectomy can shorten the recovery period and hospital stay,reduce the complication rate,improve mental health,and enhance nursing quality,making it suitable for wider application in medical institutions.
文摘Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the current strategies and further perspectives on this patient setting.Methods:A non-systematic review of the literature was completed.The research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific tools.No clear evidence is reported about these methods.Regarding PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery.Regarding local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN.In this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive alternative.Salvage surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach.Overall,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ablation.Conclusion:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN.Active surveillance is likely to be the optimal first-line management option for most patients with PSMs.Ablation and salvage surgery both represent valid options in patients with local recurrence after PN.Conversely,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA.In this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.
文摘Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.
文摘Objectives Transmuscular quadratus lumborum block(TQLB)may provide postoperative analgesia in patients undergoing intraperitoneal surgeries.The purpose of this study was to examine the potential efficacy of TQLB among patients undergoing retroperitoneal procedures,such as the laparoscopic partial nephrectomy(LPN).Methods This prospective,randomized,controlled study was conducted from August 2017 to November 2018 at Peking Union Medical College Hospital(Beijing,China).Patients who were scheduled for a LPN,aged 18・70 years old with an ASA physical status score of I-II were randomly assigned to receive either TQLB with 0.6 ml/kg of 0.5%ropivacaine plus general anesthesia(TQLB group)or general anesthesia alone(control group).Patient-controlled intravenous analgesia with morphine was initiated immediately upon surgery completion.The primary outcome was the cumulative consumption of morphine within 8 h after surgery.The secondary outcome included postoperative consump廿ons of morphine at other time points,pain score at rest and during activity,postoperative nausa and vomitting(PONV),and recovery related parameters.Results Totally 30 patients per group were recruited in the study.The 8 h consumption of morphine was lower in theTQLB group than in the control group(median,0.023 mg/kg vs.0.068 mg/kg,U=207.5,P<0.001).No significant differences were observed in postoperative pain scores between the two groups.Patients in the TQLB group had fewer episodes of PONV(20%vs.47%,χ2=4.&P=0.028)in the first 24 h after surgery and higher scores for quality of recovery(mean,13&6 vs.131.9,t=-2.164,P=0.035)120 h after surgery than the controls.Conclusions TQLB resulted in an opioid-sparing effect during the early postoperative period following LPN,as well as a lower incidence of PONV and improved quality of recovery.
文摘Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outcomes.The secondary endpoints were the perioperative and functional outcomes.Methods:A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement.Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.Results:Overall,13 retrospective cohort studies were included in the analysis.Patients undergoing PN were younger(weighted mean difference[WMD]3.49 years,95%confidence interval[CI]5.16 to1.82;p<0.0001)and had smaller masses(WMD0.45 cm,95%CI0.59 to0.31;p<0.0001).There were no differences in the oncological outcome,which was demonstrated by progression-free survival(hazard ratio[HR]0.70;pZ0.22),cancerspecific mortality(HR 0.91;pZ0.57)and all-cause mortality(HR 1.01;pZ0.96).The two procedures were similar in estimated blood loss(WMD16.47 mL;pZ0.53)and postoperative complications(risk ratio[RR]1.32;pZ0.10),and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset(RR 0.38;pZ0.006).Conclusion:PN is an effective treatment for T1b tumours because it offers similar surgical morbidity,equivalent cancer control,and better renal preservation compared to RN.
文摘ENAL cell carcinoma （RCC） in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy （PN） or nephron-sparing surgery in this condition provides good oncological and renal fuctional outcomes with an acceptable complication rate.1＇ 2 Long-term renal function remains stable in most patients with solitary kidneys after a reduction of more than 50% in renal mass.
文摘Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.
文摘Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)system(Suzhou KangDuo Robot Co.,Ltd.,Suzhou,China)and discuss its surgical technique.Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney.The R.E.N.A.L.nephrometry score of this patient was 4x.This patient underwent rRAPN with KD-SR-01.The perinephric fat between the tumor and Gerota's fascia was preserved,which was used for internal suspension traction during tumor resection.Postoperative follow-up data were collected.Results The surgery was successfully carried out with a duration of 127 min,in which the docking time was 6 min 25 s and console time was 60 min.The warm ischemia time was 19 min 53 s,and the estimated blood loss was 0 mL.The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma,with a negative surgical margin.The World Health Organization/International Society of Urological Pathology(WHO/ISUP)grade of this patient was Grade 2.No recurrence was observed during the 6-month follow-up.Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.
基金Supported by the Program of Shanghai Academic/Technology Research Leader,No.19XD1405100the Clinical Research Plan of SHDC,No.SHDC2020CR4025Hospital Funded Clinical Research,Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.21XHDB06.
文摘BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series of laparoscopic partial nephrectomy(LPN)by GreenLight laser enucleation without renal artery clamping.Due to the excellent coagulation and hemostatic properties of the laser,laser-assisted LPN(LLPN)makes it possible to perform a“zero ischemia”resection.METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed.All clinical information,surgical and post-operative data,complications,pathological and functional outcomes were analyzed.RESULTS Surgery was successfully completed in all patients,and no open or radical nephrectomy was performed.The renal artery was not clamped,leading to no ischemic time.No blood transfusions were required,the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred.The mean operation time was 104.3±8.2 min.The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d,and the mean postoperative hospital stay was 6.5±0.7 d.No serious complications occurred.Postoperative pathological results showed clear cell carcinoma in 12 patients,papillary renal cell carcinoma in 2 patients,and hamartoma in 1 patient.The mean creatinine level was 75.0±0.8μmol/L(range 61.0-90.4μmol/L)at 1 mo after surgery,and there were no statistically significant differences compared with pre-operation(P>0.05).The glomerular filtration rate ranged from 45.1 to 60.8 mL/min,with an average of 54.0±5.0 mL/min,and these levels were not significantly different from those before surgery(P>0.05).CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors(exogenous tumors of stage T1a)during LPN.However,use of this technique can lead to the generation of excessive smoke.
文摘BACKGROUND Hem-o-Lok clip(HOLC)has been widely used in laparoscopic surgery due to its ease of application and secure clamping,though the rare complications associated with this technique should not be ignored.The rare complications of laparoscopic partial nephrectomy consist of the clip migrating into the renal pelvis and acting as a nidus for stone formation.CASE SUMMARY The case described here involved a 63-year-old woman who was found with stones in the right kidney and upper ureter during a recent reexamination following laparoscopic partial nephrectomy.We performed percutaneous nephrolithotomy for her,but during the operation,it was found that the center of the stone within the kidney was a HOLC,which was removed with forceps.For this reason,we speculate that the HOLC,which was employed to halt tumor wound bleeding,spontaneously drifted into the renal pelvis and formed kidney stones,with the clip being initially misdiagnosed as a kidney stone.CONCLUSION By reviewing related case reports,we conclude that in order to prevent complications related to HOLC,loose clips should be actively searched for and retrieved from the wound during urinary tract surgery,while the deployment of clips in close proximity of anastomotic stoma of collecting systems should be avoided.
文摘Objective:To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm(RAP)on contrast-enhanced computed tomography(CE-CT)after robot-assisted partial nephrectomy(RAPN)without parenchymal renorrhaphy.Methods:From May 2016 to December 2017,78 patients underwent RAPN for renal tumors.Inner suture was performed in the opened collecting system or renal sinus,whereas parenchymal renorrhaphy was not.For hemostasis,the soft coagulation system was used,and absorbable hemostats were placed on the resection bed.CE-CT was carried out within 7 days after surgery.Data on these patients were prospectively collected.A single radiologist determined the diagnosis of RAP.Results:Median(range)data were as follows:Patient age,65(19-82)years;radiographic tumor size,30(12-95)mm;operating time,166(102-294)min;warm ischemic time,16(7-67)min;and blood loss,15(0-4450)mL.One patient(1.6%)required a perioperative blood transfusion.No patient required conversion to open surgery or nephrectomy.CE-CT was carried out at median 6(3-7)days after surgery.CE-CT showed no RAP development in all 61 patients.Urinary leakage was not observed.One patient had acute cholecystitis,a postoperative complication classified as Clavien-Dindo grade higher than 3,which was treated with cholecystectomy.Positive surgical margin was identified in four patients(6.6%).Conclusion:RAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe.Our technique could eliminate the risk of RAP.
基金This study was funded by Medical Health Science and Technology Project of Zhejiang Provincial Health Commission(2020375998).
文摘Objective:The present study aims to compare the clinical efficacy of laparoscopic partial nephrectomy using a harmonic scalpel versus traditional scissor.Methods:A retrospective review was conducted in patients with localized renal tumors and scheduled for laparoscopic partial nephrectomy from January 2015 to December 2019.Eventually,225 patients joined this retrospective study.Patients were divided into the harmonic scalpel group or scissor group based on the method used,with 71 cases and 154 cases respectively.Propensity score matching(1:1)was performed to adjust for potential baseline confounders,and each group had 57 cases.Patient characteristics,perioperative clinical results,complications,and oncological results were compared between the two groups.Results:After matching,patient characteristics were not significantly different between the two groups.The scissor group was associated with a significantly shorter operative time(105 min vs.130 min,p<0.001),shorter warm ischemia time(19.35 min vs.22.07 min,p?0.005).However,the harmonic scalpel group was associated with significantly less estimated blood loss(20 mL vs.30 mL,p?0.013)and shorter length of stay(8 d vs.10 d,p?0.040).There was no significantly difference in indwelling time of drainage tube,perioperative complication,oncological outcomes or recurrence rates.Conclusions:The harmonic scalpel is used safely and effectively in laparoscopic partial nephrectomy,and has benefits in intraoperative blood loss and length of stay.
文摘Objective To evaluate the predictive validity of IRIS™(Intuitive Surgical®,Sunnyvale,CA,USA)as a planning tool for robot-assisted partial nephrectomy(RAPN)by assessing the degree of overlap with intraoperative execution.Methods Thirty-one patients scheduled for RAPN by four experienced urologists were enrolled in a prospective study.Prior to surgery,urologists reviewed the IRIS™three-dimensional model on an iphone Operating System(iOS)app and completed a questionnaire outlining their surgical plan including surgical approach,and ischemia technique as well as confidence in executing this plan.Postoperatively,questionnaires assessing the procedural approach,clinical utility,efficiency,and effectiveness of IRIS™were completed.The degree of overlap between the preoperative and intraoperative questionnaires and between the planned approach and actual execution of the procedure was analyzed.Questionnaires were answered on a 5-point Likert scale and scores of 4 or greater were considered positive.Results Mean age was 65.1 years with a mean tumor size of 27.7 mm(interquartile range 17.5-44.0 mm).Hilar tumors consisted of 32.3%;48.4%of patients had R.E.N.A.L.nephrometry scores of 7-9.On preoperative questionnaires,the surgeons reported that in 67.7%cases they were confident that they can perform the procedure successfully,and on intraoperative questionnaires,the surgeons reported that in 96.8%cases IRIS™helped achieve good spatial sensation of the anatomy.There was a high degree of overlap between preoperative and intraoperative questionnaires for the surgical approach,interpreting anatomical details and clinical utility.When comparing plans for selective or off-clamp,the preoperative plan was executed in 90.0%of cases intraoperatively.Conclusion A high degree of overlap between the preoperative surgical approach and intraoperative RAPN execution was found using IRIS™.This is the first study to evaluate the predictive accuracy of IRIS™during RAPN by comparing preoperative plan and intraoperative execution.
基金Supported by the Incubation Project of Outstanding Young Scientist Fund of Sichuan Province,No.2019JDJQ0039the Key Research Foundation of Sichuan provincial health commission,No.19ZD015the Interdisciplinary Program of Shanghai Jiao Tong University,No.YG2021QN102.
文摘BACKGROUND The majority of renal cell carcinomas are single lesions;unilateral synchronous multifocal renal carcinoma(USMRC)is rarely reported and poses a treatment challenge for urological oncologists.CASE SUMMARY A 56-year-old man was hospitalized for pain and discomfort in the right kidney area for 6 d.Contrast-enhanced computed tomography demonstrated cT1a renal tumors at the lower pole of the right kidney and a cT1b renal tumor at the middle dorsal portion of the right kidney.The patient underwent retroperitoneal laparoscopic partial nephrectomy(RLPN).There were no complications peri-operatively.Histopathology revealed a low-grade,pathologic stage T1a(pT1a),clear cell renal cell carcinoma at the lower pole of the right kidney and a pT1b,chromophobe renal cell carcinoma at the middle dorsal portion of the right kidney.No tumor bed recurrence or metastasis was observed on imaging and his renal function remained stable during the 12-mo follow-up period.CONCLUSION RLPN is a safe,effective,and feasible for the management of USMRC,which can obtain equivalent oncological results with optimal renal function preservation.
文摘BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas.Rare as it is,pneumothorax is one of the most severe intraoperative complications which needs immediate recognition.On the other hand,as a rheumatological disease,lupus nephritis requires a long period of hormone therapy.Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.CASE SUMMARY A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy.The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment.Her blood oxygen saturation dropped to 92%during the operation,and pneumothorax was detected by ultrasound.O2 inhalation and lung dilation were performed.Her vital signs were monitored closely throughout the operation.The operation was accomplished,and she regained consciousness smoothly.A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward,while no evidence of further pneumothorax or lib injury was observed.CONCLUSION Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations,especially in retroperitoneal ones.It is easily neglected unless the injury of the diaphragm is found.Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.
基金Supported by the Military Major Project for Clinical High-tech and Innovative Technology of China(2010gxjs057)the Municipal Hospitals' Project for Emerging and Frontier Technology of Shanghai(SHDC12010115)the Project for the Key Discipline of Shanghai
文摘Objective:Nephron-sparing surgery(NSS) for small renal masses offers a similar functional and oncological outcome to that of radical surgery.Laparoendoscopic single-site surgery(LESS) emerges as an advanced alternative for reduced invasiveness and improves cosmesis;LESS is developing quickly and its indications have been expanded,but still in its infancy.The aim of this paper is to report our preliminary experience in transumbilical LESS partial nephrectomy(LESS-PN),so as to assess its utility, safety and efficacy.Methods:From August 2009 to October 2010,3 patients underwent transumbilical LESS-PN via a novel multi-channel TriPort by a single experienced urologist in our institution.Patient demographics,perioperative and follow-up data were prospectively collected and analyzed.Results:All the three procedures were successfully completed.A 5-mm ancillary trocar was utilized in all 3 cases.The mean operative duration was 226.3(210-254 min) with an estimated blood loss of 56.7 ml (20-100 ml).Mean warm ischemia time was 35.7 min(19-48 min).One patient was transfused due to postoperative bleeding. The recovery was uneventful and mean length of postoperative stay was 13 days(12-14 days).At the latest follow-up,all patients remained symptom-free and had normal renal function without evidence of recurrence,and they were delighted for a hidden transumbilical scar.Conclusion:Transumbilical LESS-PN is a feasible and safe procedure albeit extremely technically challenging.Surgical outcomes at a median follow-up of 2 years are promising,while currently it should be reserved for highly selected patients with favorable tumor anatomy and performed by a very experienced laparoscopic surgeon.
文摘Partial nephrectomy is now a standard approach for small renal masses and tumour recurrences after partial nephrectomy are uncommon.In the absence of spillage,port site recurrences are most commonly reported.We report a case of tumour recurrence near the surgical site as well as beyond the posterior renal fascia and Gerotas fascia in a 60-year-old woman who underwent robot-assisted partial ne-phrectomy for a 4.6 cm suspicious left renal tumour despite the absence of gross tumour spillage or rupture intraoperatively.Histology showed a 5 cm clear cell renal cell carcinoma with negative surgical margins,nuclear grade 4 with focal malignant rhabdoid differentiation.The practice of not bagging the specimen immediately after tumour excision especially for higher risk tumours should be reviewed as there may be inadvertent microscopic spillage of tumour cells.
