Methods. Surgery. Patient population. Volumetric analysis. Statistical analysis. Ethical approval
|
|
- Quentin Howard
- 5 years ago
- Views:
Transcription
1 International Journal of Urology (2018) 25, doi: /iju Original Article: Clinical Investigation Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume Hidekazu Tachibana, 1 Toshio Takagi, 1 Tsunenori Kondo, 2 Hideki Ishida 1 and Kazunari Tanabe 1 1 Department of Urology, Tokyo Women s Medical University, and 2 Department of Urology, Tokyo Women s Medical University, Medical Center East, Tokyo, Japan Abbreviations & Acronyms AKI = acute kidney injury ASA = American Society of Anesthesiologists BMI = body mass index DM = diabetes EBL = estimated blood loss egfr = estimated glomerular filtration rate HTN = hypertension LPN = laparoscopic partial nephrectomy OT = operative time PLOS = postoperative length of hospital stay PN = partial nephrectomy POD = postoperative day PS = Eastern Cooperative Oncology Group Performance Status RAP = renal artery pseudoaneurysm RAPN = robot-assisted partial nephrectomy RENAL-NS = RENAL nephrometry score SM = surgical margin WIT = warm ischemia time Correspondence: Toshio Takagi M.D., Ph.D., Department of Urology, Tokyo Women s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo , Japan. t.takagi1192@gmail.com Received 13 July 2017; accepted 27 December Online publication 4 February 2018 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. Patients background and tumor factors were adjusted by propensity score matching. Surgical outcomes, including postoperative renal function, complications, warm ischemia time and preserved renal parenchymal volume, evaluated by volumetric analysis, were compared between the surgical procedures. Results: After matching, 64 patients were assigned to each group. The mean age was years, and the mean tumor size was 22 mm. Approximately 50% of patients had low complexity tumors (RENAL nephrometry score 4 7). The incidence rate of acute kidney failure was significantly lower in the robot-assisted laparoscopic partial nephrectomy (11%) than laparoscopic partial nephrectomy (23%) group (P = 0.049), and warm ischemia time shorter in the robot-assisted laparoscopic partial nephrectomy (17 min) than laparoscopic partial nephrectomy (25 min) group (P < ). The preservation rate of renal function, measured by the estimated glomerular filtration rate, at 6 months post-surgery was 96% for robot-assisted laparoscopic partial nephrectomy and 90% for laparoscopic partial nephrectomy (P < ). The preserved renal parenchymal volume was higher for robot-assisted laparoscopic partial nephrectomy (89%) than laparoscopic partial nephrectomy (77%; P < ). The rate of perioperative complications, surgical margin status and length of hospital stay were equivalent for both techniques. Conclusions: Robot-assisted laparoscopic partial nephrectomy allows to achieve better preservation of renal function and parenchymal volume than laparoscopic partial nephrectomy. Key words: kidney neoplasm, nephrectomy, outcome, robotics. Introduction PN is the gold standard for the resection of small renal masses, and is preferred over radical nephrectomy, providing equivalent oncological outcomes, but with greater preservation of renal function. 1 4 In the era of minimally invasive surgery, RAPN is being increasingly used, as it enables precise resection and reconstruction compared with LPN. Hence, the indications for RAPN have been expanded to the treatment of large and more complex tumors, including those located in the renal hilum. Theoretically, RAPN is superior to LPN in terms of preserving renal function, possibly due to the fact that the precise and relatively quick maneuver allows preservation of a greater volume of renal parenchyma and/or a shorter duration of WIT. Furthermore, these benefits of RAPN on renal function are obtained with surgical outcomes that are similar or superior to those obtained with LPN. 5 8 Choi et al. compared perioperative outcomes of RAPN and LPN using a meta-analysis, and showed that RAPN was associated with more favorable results than LPN, including a lower conversion rate to open 2018 The Japanese Urological Association 359
2 H TACHIBANA ET AL. or radical surgery, greater preservation of renal function, shorter length of hospital stay and shorter WIT. 8 The superiority of RAPN over LPN with regard to renal function might result from a shorter WIT and/or enhanced preservation of the normal parenchyma. However, although the shorter WIT for RAPN compared with LPN has been well-described, the important feature of differences in the volume of renal parenchyma that is preserved between RAPN and LPN has not been well evaluated to date. In the present study, we compared surgical outcomes and the volume of preserved vascularized renal parenchyma, calculated by volumetric analysis, between RAPN and LPN, using a propensity score-matching analysis to specifically evaluate differences in surgical precision of excision and reconstruction. Methods Patient population Institutional review board approval was obtained to carry out a retrospective analysis of patient data. Patients who underwent LPN or RAPN for renal tumors between January 2010 and January 2015 were included in this study. Patients with an anatomically or functionally solitary kidney and those without enhanced computed tomography images, before and after surgery, were excluded. In total, 251 patients (LPN, n = 131; RAPN, n = 122) were eligible for the study. The clinical and pathological parameters for each patient were extracted from our electronic medical chart database. Tumor complexity was determined using the RENAL-NS. The following patient-related variables were included in our analysis: age, PS, sex, BMI, presence of DM, presence of HTN, the ASA score, tumor complexity and the preoperative egfr. Perioperative surgical outcomes were defined as follows: preserved volume of vascularized parenchymal mass, preserved egfr, operative time, WIT, EBL, surgical margin status, perioperative complications and PLOS. Postoperative complications were defined according to the Clavien Dindo classification. 9 Urine leakage was defined as a persistent drain output, having a chemical composition consistent with urine, >48 h after PN. 10 The postoperative global renal function was assessed using the nadir egfr postoperatively, at 3 and 6 months post-surgery. egfr was calculated using the Modification of Diet in Renal Disease 2 equation, further modified for Japanese patients as outlined by the Japanese Society of Nephrology (egfr = serum creatinine mg/ dl age 9 [0.739 if female]). 11 Postoperative acute kidney injury was defined as a 25% decrease between the pre- and postoperative nadir egfr, measured on POD 1 7. The selection of the surgical approach, RAPN or LPN, was dependent on the period and patient preference. With regard to the period, we have been carrying out robot-assisted surgery since 2013; therefore, between 2010 and 2013, all LPN procedures were carried out without robotic technology. Furthermore, the cost is greater for RAPN than LPN, which included the patients decision with regard to the selected approach. To minimize the effects of selection bias on measured between-group differences, the following variables were adjusted using 1:1 propensity score matching: age, sex, BMI, presence of HTN, presence of DM, ASA score, preoperative egfr, tumor size and tumor complexity. Ethical approval All procedures involving human participants in this study were carried out in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments, or comparable ethical standards. IRB approved number: Surgery All procedures were carried out by three specialized surgeons. Both LPN and RAPN were carried out using a transperitoneal approach in most cases, with a retroperitoneal approach used in 15 LPN cases and six RAPN cases. LPN and RAPN procedures were carried out using previously described techniques For LPN, four or five ports were placed, whereas RAPN procedures were carried out using da Vinci devices (three or four arms, at the surgeon s preference, and two assistant ports). A total renal arterial clamping technique, without cooling the kidney, was used in all cases. The kidney was mobilized within Gerota s fascia, except for the perirenal fat around the tumor. We used an ultrasound probe to obtain the location, depth and borders of the tumors to determine the excision margins. Selective clamping of the renal artery was carried out in most cases. Renal tumors were resected with a 2 5-mm renal parenchyma margin. After tumor resection, an inner running suture was placed to close visibly bleeding vessels. Incidental openings of the renal sinus or collecting system were closed with absorbable sutures. For the outer sutures, a running suture was placed to approximate the renal parenchyma, with or without a bolster in the defect. Volumetric analysis Three-dimensional dynamic enhanced abdominal computed tomography images, obtained pre- and postoperatively with a Toshiba Aquilion 64 multidetector scanner (Toshiba, Tochigi, Japan), were used for volumetric analysis. The vascularized renal parenchyma, excluding perirenal fat, the collecting system and cyst, were measured (Fig. 1). The volume was estimated from axial scans in the venous phase reconstructed at 5-mm intervals. Manual scripting was used to define the area of interest at each 5-mm level, with the defined areas subsequently summed to yield the total volume. One urologist, who was not involved with the surgery, measured the renal parenchymal volume. Statistical analysis All statistical analyses were calculated with JMP 11 (SAS Institute, Cary, NC, USA). Between-group differences were evaluated using Student s t-test for continuous variables, v 2 - test for unordered categorical variables and Mann Whitney U-test for ordinal categorical variables. A P-value <0.05 was considered statistically significant The Japanese Urological Association
3 Parenchymal preservation in partial nephrectomy Preoperative CT Postoperative CT Fig. 1 Vascularized parenchymal volume, measured by freehand scripting, to accurately remove the volume of the tumor, collecting system and renal cyst. Results The relevant characteristics of the 253 patients forming our study group, before matching, are summarized in Table 1. There were no significant differences between the LPN and RAPN groups with regard to the distribution of age, sex, ASA score, BMI, and presence of HTN and DM. Compared with the LPN group, the RAPN group had a larger mean tumor size (27 mm vs 20 mm, P < 0.001), lower preoperative egfr (65 ml/min/1.73 m 2 vs 71 ml/min/1.73 m 2, P = 0.002) and higher RENAL-NS (6.8 vs 6.0, P < 0.001). After matching, 64 patients were allocated to each operative group. The mean age was years, and 17 20% of patients had DM. The mean tumor diameter was 22 mm, with approximately 95% of patients having low- or intermediate-complexity tumors (RENAL-NS 4 9). The mean preoperative egfr was ml/min/1.73 m 2. Comparisons of surgical outcomes between the LPN and RAPN groups are reported in Table 2. After propensity score matching, the incidence rate of AKI was 23% in the LPN group and 11% in the RAPN group (P = 0.049). The preservation rate of egfr was greater for the RAPN than the LPN group at 3 months (96% vs 90%, respectively, P = ) and 6 months (95% vs 90%, respectively, P = 0.02) after surgery. The mean operative time was longer for the LPN (204 min) than the RAPN (186 min) group (P = 0.01). WIT was significantly shorter in the RAPN (18 min) than the LPN (24 min) group (P < ). Other surgical outcomes, including EBL, surgical margin status, incidence rate of complications and PLOS were not significantly different between the two groups. Between-group differences in the preserved renal parenchymal volume are reported in Table 3. The mean preoperative normal parenchymal volume was 154 cc in the LPN group and 145 cc in the RAPN group (P = 0.09). In contrast, the mean postoperative renal parenchymal volume was lower in the LPN (118 cc) than the RAPN (130 cc) group (P = 0.035). The preservation rate of parenchymal volume was significantly higher in the RAPN (89%) than the LPN (77%) group (P < ). Discussion LPN is a difficult technique to carry out for highly complex tumors because of the limitations in forceps handling and the overall high technical demand of the procedure. Consequently, RAPN has been increasingly used, as it facilitates forceps handling, which leads to precise resection and reconstruction for partial nephrectomy. With the refinement of techniques for robotic surgery, the indication for RAPN is increasingly expanding to include large and more complex tumors located in the renal hilum. 5,15 17 We have preferentially adopted the RAPN technique in our institution since 2013, and the number of patients undergoing RAPN is also increasing in accordance with our experience. 18 In the present study, we showed that RAPN provided a better preservation of renal function and renal parenchymal volume than LPN, with similar surgical margin status and rate of perioperative complications for both techniques. The superiority of RAPN over LPN has previously been reported, and includes a clear, three-dimensional view of the region of interest and fine movement of surgical instruments, with both of these factors likely contributing to the lower incidence of complications, such as open conversion, postoperative bleeding, urine leakage, shorter ischemia time and better preservation of renal function. 5,7,19,20 In several reports, shortened WIT in RAPN has been associated with better preservation of renal function. 7,16,21 The WIT in the present study was similarly shorter for the RAPN (17 min) than the LPN (25 min) procedure (P < ), after propensity matching, suggesting that this difference in ischemia time might contribute to better renal function outcome in the RAPN than LPN group. Only a few previous studies have compared the preservation of renal parenchymal volume between different surgical approaches. Woldu et al. compared renal parenchymal mass preservation among open PN, LPN, RAPN and thermal ablation procedures for 150 cases of small renal masses. 21 A lower mean loss of renal parenchymal volume was reported for thermal ablation compared with PN. However, no differences were identified between modalities of thermal ablation (cryoablation vs radiofrequency) or between approaches to PN (open PN vs LPN vs RAPN). Of note, the study by Woldu et al. included relatively small patient samples (30 cases for RAPN and 30 cases for LPN), with no adjustment for patient- and tumor-related characteristics. Therefore, the possibility of a selection bias according to surgical approaches in their study cannot be discounted. In the present study, we reported a significantly higher renal parenchymal volume preservation for RAPN than LPN 2018 The Japanese Urological Association 361
4 H TACHIBANA ET AL. Table 1 Patient characteristics Pre-matching Post-matching LPN (131) RAPN (122) P LPN (64) RAPN (64) P Mean age, years (SD) Male, n 87 (66%) 95 (78%) (73%) 48 (75%) 0.83 Mean BMI, kg/m 2 (SD) HTN (n) 53 (40%) 56 (50%) (42%) 25 (39%) 0.71 DM (n) 22 (17%) 22 (18%) (20%) 11 (17%) 0.65 ASA score (n) 1 29 (22%) 30 (25%) (23%) 17 (27%) (72%) 87 (71%) 46 (72%) 45 (70%) 3 7 (5%) 5 (4%) 3 (5%) 2 (3%) Tumor complexity (n) Low (4 6) 83 (63%) 50 (41%) (50%) 34 (53%) 0.87 Intermediate (7 9) 45 (34%) 64 (52%) 29 (45%) 28 (44%) High (10 12) 3 (2%) 8 (7%) 3 (5%) 2 (3%) Mean tumor size, mm (SD) < E(n) 1 60 (46%) 35 (29%) (30%) 23 (36%) (48%) 78 (64%) 37 (58%) 35 (55%) 3 8 (6%) 9 (7%) 8 (13%) 6 (9%) N(n) 1 80 (61%) 48 (39%) < (45%) 32 (50%) (21%) 20 (16%) 19 (30%) 17 (27%) 3 23 (18%) 54 (44%) 16 (25%) 15 (23%) L(n) 1 63 (48%) 54 (44%) (44%) 29 (45%) (19%) 24 (20%) 12 (19%) 16 (25%) 3 43 (33%) 44 (36%) 24 (38%) 19 (30%) Mean preoperative egfr, ml/min/1.73 m 2 (SD) Table 2 Surgical outcomes Pre-matching Post-matching LPN (131) RAPN (122) P LPN (64) RAPN (64) P Mean preoperative egfr, ml/min/1.73 m 2 (SD) Mean postoperative nadir egfr, ml/min/1.73 m 2 (SD) Incidence of AKI (>25% decrease in egfr) 28 (21%) 9 (7%) (23%) 7 (11%) Mean postoperative egfr 3 months, ml/min/1.73 m 2 (SD) Mean preservation rate of egfr 3 months, % (SD) Mean postoperative egfr 6 months, ml/min/1.73 m 2 (SD) Mean preservation rate of egfr 6 months, % (SD) < Mean OT, min (SD) Mean ischemia time, min (SD) < < Mean EBL, ml (SD) SM negative (n) 131 (100%) 122 (100%) 1 64 (100%) 64 (100%) 1 Perioperative complication (n) Overall 34 (26%) 28 (23%) (23%) 10 (16%) 0.26 Clavien (12%) 10 (8%) (9%) 5 (8%) 0.75 Clavien 3 18 (14%) 18 (15%) (19%) 9 (14%) 0.33 Postop bleeding (n) 4 (3%) 0 (0%) (3%) 0 (0%) 0.15 Asymptomatic RAP (n) 13 (10%) 16 (13%) (14%) 7 (11%) 0.59 Urine fistula, G3 (n) 2 (2%) 0 (0%) (3%) 0 (0%) 0.15 Mean PLOS, days (SD) Mean follow-up period, months (SD) < (89% vs 77%, P < ) after propensity score matching. Although we did adjust for patient and tumor characteristics, the present study also included several biases. Although three specific surgeons carried out all procedures, the surgical period was earlier for LPN than for RAPN, with the possibility of accumulated experience resulting in a higher The Japanese Urological Association
5 Parenchymal preservation in partial nephrectomy Table 3 Volumetric analysis Mean preoperative normal parenchymal volume, cc (SD) Mean postoperative normal parenchymal volume, cc (SD) Mean preservation rate of parenchymal volume, % (SD) LPN (64) RAPN (64) P < sophistication of the surgical procedure for the RAPN than the LPN group. We reported a significantly better preservation of renal functional with RAPN than LPN (95% vs 90%, P = 0.02), which is likely explained by preservation of a greater volume of renal parenchyma and shorter ischemia time with RAPN than LPN. Predictors of the preservation of renal functional in PN have been discussed in several articles. Zhang et al. analyzed the impact of parenchymal volume reduction and ischemia on subsequent renal function recovery in 83 cases of solitary kidneys managed with PN. They suggested that deleterious effects of ischemia during PN are not as profound as once believed, unless prolonged ischemia is utilized. Nephron quality before surgery and nephron quantity saved (i.e. percentage of parenchymal mass preserved) are the most important determinants of ultimate renal function after PN. 22 In addition, Zhang et al. identified an association between prolonged ischemia time and acute decline in renal function after PN, which can negatively impact subsequent functional recovery. However, most kidneys eventually recover their function, even if their function is sluggish in the first few days after surgery. In the present study, 23% of patients in the LPN group developed AKI, with a mean postoperative nadir egfr of 57 ml/min/1.73 m 2, which recovered to 60 ml/min/1.73 m 2 at 3 months and 61 ml/min/1.73 m 2 at 6 months after surgery. In contrast, 10% of patients in RAPN developed AKI, with a mean postoperative nadir egfr of 64 ml/min/1.73 m 2, which did not differ for the egfr at 3 and 6 months after surgery. From these results, a strong association between AKI development and a lower postoperative nadir egfr and a longer WIT appears likely. Although both shorter WIT and greater parenchymal preservation with RAPN than LPN might be important determinants of resulting renal functional in the present study, parenchymal preservation might have a stronger effect than WIT on long-term renal function. Although we identified a specific superiority of RAPN over LPN with regard to the preservation of renal function and parenchymal volume, Wang et al. reported additional benefits of RAPN for patients with a RENAL-NS 7, including a decrease in EBL and operative time. However, LPN was a more cost-effective approach than RAPN, providing similar perioperative, functional and oncological outcomes. 6 Although we did not compare the costeffectiveness between the two surgical outcomes, the direct cost might be higher for RAPN than LPN because of the higher cost of surgical equipment of RAPN, considering the similar length of hospital stay for both procedures. However, given that renal functional benefit is included in the cost-effectiveness, RAPN might still be considered as being superior to LPN. The present study had several limitations that should be noted. Foremost, is the retrospective nature of our study, with data collected from a single institution and a population of tertiary care patients. Second, kidney function was not evaluated by renal scintigraphy, either before or after surgery, but by the egfr as an index of global kidney function (egfr calculated from biochemical examination of blood). Furthermore, the preservation rate in global renal function was calculated relative to the contralateral kidney, which was considered to be normal in patients included in the study group; however, subtle undetected impairments in function of the normal kidney could have biased our results. Third, we cannot discount that accumulated surgeon experience might have contributed to the better outcomes of RAPN, with LPN being historically carried out in an earlier period compared with RAPN. The present study did have several strengths that warrant being noted. Foremost, we evaluated the preservation of renal parenchymal volume in a relatively large number of patients as a surgical outcome, which reflects the surgical precision of RAPN. In addition, a propensity score-matched analysis was used to adjust between-group comparisons for patient- and tumor-related characteristics. In conclusion, we report a better preservation rate of renal function and parenchymal volume with RAPN than LPN, with a similar complication rate and surgical margin status for both procedures. These results might suggest that robotic surgery is feasible, and provides more sophisticated and precise surgery in PN. Acknowledgment We acknowledge Ms Nobuko Hata for her secretarial work. Conflict of interest None declared. References 1 Weight CJ, Lieser G, Larson BT et al. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. Eur. Urol. 2010; 58: Tan HJ, Norton EC, Ye Z, Hafez KS, Gore JL, Miller DC. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA 2012; 307: Huang WC, Elkin EB, Levey AS, Jang TL, Russo P. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors is there a difference in mortality and cardiovascular outcomes? J. Urol. 2009; 181: Ljungberg B, Cowan NC, Hanbury DC et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur. Urol. 2010; 58: Masson-Lecomte A, Bensalah K, Seringe E et al. A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study. BJU Int. 2013; 111: Wang Y, Ma X, Huang Q et al. Comparison of robot-assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL 2018 The Japanese Urological Association 363
6 H TACHIBANA ET AL. nephrometry score 7: peri-operative and oncological outcomes. BJU Int. 2016; 117: Wu Z, Li M, Song S et al. Propensity-score matched analysis comparing robot-assisted with laparoscopic partial nephrectomy. BJU Int. 2015; 115: Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur. Urol. 2015; 67: Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004; 240: Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND. Risk factors and management of urine leaks after partial nephrectomy. J. Urol. 2008; 180: Matsuo S, Imai E, Horio M et al. Revised equations for estimated GFR from serum creatinine in Japan. Am. J. Kidney Dis. 2009; 53: Kondo T, Takagi T, Morita S et al. Early unclamping might reduce the risk of renal artery pseudoaneurysm after robot-assisted laparoscopic partial nephrectomy. Int. J. Urol. 2015; 22: Gill IS, Desai MM, Kaouk JH et al. Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J. Urol. 2002; 167(2 Pt 1): Omae K, Kondo T, Takagi T et al. Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy. Int. J. Urol. 2015; 22: Satkunasivam R, Tsai S, Syan S et al. Robotic unclamped minimal-margin partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept. Eur. Urol. 2015; 68: Shiroki R, Fukami N, Fukaya K et al. Robot-assisted partial nephrectomy: superiority over laparoscopic partial nephrectomy. Int. J. Urol. 2016; 23: Tanagho YS, Bhayani SB, Sandhu GS, Vaughn NP, Nepple KG, Figenshau RS. Renal functional and perioperative outcomes of off-clamp versus clamped robot-assisted partial nephrectomy: matched cohort study. Urology 2012; 80: Peyronnet B, Baumert H, Mathieu R et al. Early unclamping technique during robot-assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity. BJU Int. 2014; 114: Zargar H, Akca O, Ramirez D et al. The impact of extended warm ischemia time on late renal function after robotic partial nephrectomy. J. Endourol. 2014; 29: Jang HJ, Song W, Suh YS et al. Comparison of perioperative outcomes of robotic versus laparoscopic partial nephrectomy for complex renal tumors (RENAL nephrometry score of 7 or higher). Korean J. Urol. 2014; 55: Woldu SL, Thoreson GR, Okhunov Z et al. Comparison of renal parenchymal volume preservation between partial nephrectomy, cryoablation, and radiofrequency ablation. J. Endourol. 2015; 29: Zhang Z, Zhao J, Dong W et al. Acute kidney injury after partial nephrectomy: role of parenchymal mass reduction and ischemia and impact on subsequent functional recovery. Eur. Urol. 2016; 69: Editorial Comment Editorial Comment to Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume Partial nephrectomy (PN) is considered a challenging procedure regardless of the kind of approach. Nevertheless, robotassisted PN, due to intrinsic advantages of the technique, is able to achieve superior renal function outcomes compared with laparoscopic PN. 1 Renal function mainly depends on the baseline quality of the kidney, on the amount of normal renal parenchyma preserved and on ischemia time. Any approach to PN should aim to avoid damage to the normal healthy kidney and reduce, limit or eliminate global renal ischemia. These goals can be reached by using tumor enucleation or minimal margin PN techniques and minimally ischemic or off-clamp PN whenever feasible. 2 In this setting, preoperative imaging with a standardized method to report tumor location and nephrometry scores is crucial for choosing the most appropriate technique. 3 In the current study, Tachibana et al. showed the superiority of robotassisted PN in terms of surgical outcomes, including renal function and the preserved renal parenchymal volume. 4 Nevertheless, surgical outcomes and volume loss are only part of all the aspects involved in renal function outcomes. To make definitive conclusions, preoperative patient features and tumor complexity should be homogenous. Hence, one of the major limitations of the study was a significant difference in terms of tumor complexity between the laparoscopic and robotic group. Currently, both surgical approaches remain viable options in the management of renal masses, but in several countries robotic surgery is limited by costs. In a similar scenario, after meticulous preoperative imaging, robot-assisted PN should be preferenced for highly complex renal tumors, in which better preservation of the factors involved in renal function outcomes is more difficult to ensure with a laparoscopic approach. Rocco Papalia M.D., Ph.D. and Riccardo Mastroianni M.D. Complex Operative Unit of Urology, Campus Bio-Medico University of Rome, Rome, Italy mpurri@yahoo.it Conflict of interest None declared. References DOI: /iju Masson-Lecomte A, Bensalah K, Seringe E et al. A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study. BJU Int. 2013; 111: The Japanese Urological Association
RAPN. in T1b Renal Masses? A. Mottrie. G. Denaeyer, P. Schatteman, G. Novara
RAPN in T1b Renal Masses? A. Mottrie G. Denaeyer, P. Schatteman, G. Novara Department of Urology O.L.V. Clinic Aalst OLV Vattikuti Robotic Surgery Institute Aalst Belgium Guidelines on Renal Cell Carcinoma
More informationVincenzo Ficarra 1,2,3. Associate Editor BJU International
Partial Nephrectomy for RCC Vincenzo Ficarra 1,2,3 1 Director Department of Urology University of Udine, Italy 2 Associate Editor BJU International 3 Scientific Director OLV Robotic Surgery Institute,
More informationWho are Candidates for Laparoscopic or Open Radical Nephrectomy. Arieh Shalhav
Who are Candidates for Laparoscopic or Open Radical Nephrectomy Arieh Shalhav Fritz Duda Chair of Urologic Surgery Professor of Surgery and the Comprehensive Cancer Research Center Who are Candidates for
More informationRole of computed tomography-calculated intraparenchymal tumor volume in assessment of patients undergoing partial nephrectomy
International Journal of Urology (2018) 25, 436--441 doi: 10.1111/iju.13531 Original Article: Clinical Investigation Role of computed tomography-calculated intraparenchymal tumor volume in assessment of
More informationWhat is the role of partial nephrectomy in the context of active surveillance and renal ablation?
What is the role of partial nephrectomy in the context of active surveillance and renal ablation? Dogu Teber Department of Urology University Hospital Heidelberg Coming from Heidelberg obligates to speak
More informationComplications in robotic surgery!! Review of the literature! RALP, RAPN and RARC!
Complications in robotic surgery Review of the literature RALP, RAPN and RARC Anna Wallerstedt, MD Karolinska University Hospital Stockholm, Sweden Agenda The importance of reporting surgical complications
More informationFlorida Cancer Specialist & Research Institute, Sebastian and Vero Beach, Fl, USA 3
Evaluation of Perioperative Outcomes and Renal Function after Robotic Assisted Laparoscopic Partial Nephrectomy Off/On Clamp: Comparison of ct1a versus ct1b Renal Masses Hugo H Davila 1-4*, Raul E Storey
More informationChallenges in RCC surgery. Treatment Goals. Surgical challenges. Management options in VHL associated RCCs
Management options in VHL associated RCCs Challenges in RCC surgery JJ PATARD, MD, PhD Paris XI University Observation, Radical nephrectomy, Renal parenchymal sparing surgery, Open, laparoscopic, robotic
More informationNephron-sparing surgery (NSS) has become the standard
JOURNAL OF ENDOUROLOGY Volume 27, Number 7, July 2013 ª Mary Ann Liebert, Inc. Pp. 869 874 DOI: 10.1089/end.2013.0023 Robot-Assisted Partial Nephrectomy: A Comparison of the Transperitoneal and Retroperitoneal
More informationRapid communication chronic renal insufficiency after laparoscopic partial nephrectomy and radical nephrectomy for pathologic T1a lesions
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2008 Rapid communication chronic renal insufficiency after laparoscopic partial nephrectomy and radical nephrectomy
More informationAssociation between R.E.N.A.L. nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia
original research Association between R.E.N.A.L. nephrometry score and perioperative outcomes following open partial nephrectomy under cold ischemia Dong Soo Park, MD; * Jin Ho Hwang, MD; * Moon Hyung
More informationOff-clamp robot-assisted partial nephrectomy for complex renal tumors
Washington University School of Medicine Digital Commons@Becker Open Access Publications 8-30-2012 Off-clamp robot-assisted partial nephrectomy for complex renal tumors Eric H. Kim Youssef S. Tanagho Gurdarshan
More informationPartial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches
Partial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches Cary N Robertson MD FACS Associate Professor Division of Urology Associate Director Urologic Oncology Duke Cancer
More informationOncourology COMPLICATIONS OF PARTIAL NEPHRECTOMY AT OPERATIVE TREATMENT OF RENAL CELL CARCINOMA
1 Oncourology COMPLICATIONS OF PARTIAL NEPHRECTOMY AT OPERATIVE TREATMENT OF RENAL CELL CARCINOMA Address: Eduard Oleksandrovych Stakhovsky, 03022, Kyiv, Lomonosova Str., 33/43, National Cancer Institute
More informationDepartment of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Advances in Urology Volume 2016, Article ID 8045210, 6 pages http://dx.doi.org/10.1155/2016/8045210 Clinical Study Radiofrequency Ablation-Assisted Zero-Ischemia Robotic Laparoscopic Partial Nephrectomy:
More informationInitial Clinical Experience with Robot-Assisted Laparoscopic Partial Nephrectomy for Complex Renal Tumors
Initial Clinical Experience with Robot-Assisted Laparoscopic Partial Nephrectomy for Complex Renal Tumors Kyung Hwa Choi, Cheol Kyu Oh, Wooju Jeong, Enrique Ian S. Lorenzo, Woong Kyu Han, Koon Ho Rha From
More informationEUROPEAN UROLOGY 58 (2010)
EUROPEAN UROLOGY 58 (2010) 900 905 available at www.sciencedirect.com journal homepage: www.europeanurology.com Kidney Cancer Renal Damage Caused by Warm Ischaemia During Laparoscopic and Robot-Assisted
More informationIdentifying unrecognized collecting system entry and the integrity of repair during open partial nephrectomy: comparison of two techniques
ORIGINAL ARTICLE Vol. 40 (5): 637-643, September - October, 2014 doi: 10.1590/S1677-5538.IBJU.2014.05.08 Identifying unrecognized collecting system entry and the integrity of repair during open partial
More informationHyeon Jun Jang, Wan Song, Yoon Seok Suh, U Seok Jeong, Hwang Gyun Jeon, Byong Chang Jeong, Seong Soo Jeon, Hyun Moo Lee, Han Yong Choi, Seong Il Seo
www.kjurology.org http://dx.doi.org/0.4/kju.204.55.2.808 Original Article - Laparoscopy/Robotics http://crossmark.crossref.org/dialog/?doi=0.4/kju.204.55.2.808&domain=pdf&date_stamp=204-2-6 Comparison
More informationIndications For Partial
Indications For Partial Nephrectomy Christopher G. Wood, M. D., FACS Professor and Deputy Chairman Douglas E. Johnson, M. D. Endowed Professorship in Urology Department of Urology The University of Texas
More informationRobot-assisted partial nephrectomy: Off-clamp technique
Washington University School of Medicine Digital Commons@Becker Open Access Publications 1-10-2013 Robot-assisted partial nephrectomy: Off-clamp technique Gurdarshan S. Sandhu Eric H. Kim Youssef S. Tanagho
More informationPrecise Segmental Renal Artery Clamping Under the Guidance of Dual-source Computed Tomography Angiography During Laparoscopic Partial Nephrectomy
EUROPEAN UROLOGY 62 (2012) 1001 1008 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Kidney Cancer Editorial by Inderbir S. Gill on pp. 1009 1010 of this
More informationIs renal cryoablation becoming an effective alternative to partial nephrectomy?
Is renal cryoablation becoming an effective alternative to partial nephrectomy? J GARNON 1, G TSOUMAKIDOU 1, H LANG 2, A GANGI 1 1 department of interventional radiology 2 department of urology University
More informationUrine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization
ORIGINAL ARTICLE Vol. 40 (6): 763-771, November - December, 2014 doi: 10.1590/S1677-5538.IBJU.2014.06.07 Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative
More informationNephrometry score-guided off-clamp laparoscopic partial nephrectomy: patient selection and short-time functional results
Wang et al. World Journal of Surgical Oncology (2016) 14:163 DOI 10.1186/s12957-016-0914-5 RESEARCH Open Access Nephrometry score-guided off-clamp laparoscopic partial nephrectomy: patient selection and
More informationSt. Dominic s Annual Cancer Report Outcomes
St. Dominic s 2017 Annual Cancer Report Outcomes Cancer Program Practice Profile Reports (CP3R) St. Dominic s Cancer Committee monitors and ensures that patients treated at St. Dominic Hospital receive
More informationPredictive factors of prolonged warm ischemic time ( 30 minutes) during partial nephrectomy under pneumoperitoneum
Original Article - Urological Oncology pissn 2005-6737 eissn 2005-6745 Predictive factors of prolonged warm ischemic time ( 30 minutes) during partial nephrectomy under pneumoperitoneum Kwang Jin Ko *,
More informationClinical Study A Single Surgeon s Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy
International Scholarly Research Notices, Article ID 430914, 5 pages http://dx.doi.org/10.1155/2014/430914 Clinical Study A Single Surgeon s Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy
More informationELECTIVE PARTIAL NEPHRECTOMY FOR T1B RCC. Vitaly Margulis MD. Associate Professor of Urology
ELECTIVE PARTIAL NEPHRECTOMY FOR T1B RCC Vitaly Margulis MD Associate Professor of Urology NEPHRON SPARING SURGERY WHY? MAXIMIZING NEPHRON MASS SAVES LIVES ELECTIVE PARTIAL NEPHRECTOMY IF: TECHNICALLY
More informationComparison of prognosis between patients with renal cell carcinoma on hemodialysis and those with renal cell carcinoma in the general population
DOI 10.1007/s10147-015-0812-9 ORIGINAL ARTICLE Comparison of prognosis between patients with renal cell carcinoma on hemodialysis and those with renal cell carcinoma in the general population Yasunobu
More informationLaparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 340 patients
Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 3 patients Christopher Springer, M. Raschid Hoda, Harun Fajkovic, Giovannalberto
More informationClinical Symptoms Predict Poor Overall Survival in Chronic-dialysis Patients with Renal Cell Carcinoma Associated with End-stage Renal Disease
Jpn J Clin Oncol 2014;44(11)1096 1100 doi:10.1093/jjco/hyu117 Advance Access Publication 19 August 2014 Clinical Symptoms Predict Poor Overall Survival in Chronic-dialysis Patients with Renal Cell Carcinoma
More informationORIGINAL PAPER. Summary
ORIGINAL PAPER DOI: 10.4081/aiua.2015.1.49 Evaluation of laparoscopic vs robotic partial nephrectomy using the margin, ischemia and complications score system: A retrospective single center analysis Stefano
More informationRenal cryoablation versus robot-assisted partial nephrectomy: Washington University long-term experience
Washington University School of Medicine Digital Commons@Becker Open Access Publications 12-16-2013 Renal cryoablation versus robot-assisted partial nephrectomy: Washington University long-term experience
More informationEXPERIMENTAL AND THERAPEUTIC MEDICINE 10: , Dongguan, Guangdong , P.R. China. Received August 1, 2014; Accepted April 24, 2015
EXPERIMENTAL AND THERAPEUTIC MEDICINE 10: 139-144, 2015 Preoperative evaluation of renal artery anatomy using computed tomography angiography to guide the superselective clamping of renal arterial branches
More informationRenal Tumor Contact Surface Area: A Novel Parameter for Predicting Complexity and Outcomes of Partial Nephrectomy
EUROPEAN UROLOGY 66 (2014) 884 893 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Kidney Cancer Editorial by Homayoun Zargar, Riccardo Autorino, Oktay Akca
More informationOpen versus robotic-assisted partial nephrectomy: a multicenter comparison study of perioperative results and complications
World J Urol (2014) 32:287 293 DOI 10.1007/s00345-013-1136-x ORIGINAL ARTICLE Open versus robotic-assisted partial : a multicenter comparison study of perioperative results and complications Gianni Vittori
More informationThree-Dimensional Reconstruction of Renovascular-Tumor Anatomy to Facilitate Zero-Ischemia Partial Nephrectomy
EUROPEAN UROLOGY 61 (2012) 211 217 available at www.sciencedirect.com journal homepage: www.europeanurology.com Case Series of the Month Three-Dimensional Reconstruction of Renovascular-Tumor Anatomy to
More informationPrediction of complications after partial nephrectomy by RENAL nephrometry score
UROLOGY Ann R Coll Surg Engl 04; 96: 475 479 doi 0.308/00358844X3946849035 Prediction of complications after partial nephrectomy by RENAL nephrometry score UD Reddy, R Pillai, RA Parker, J Weston, NA Burgess,
More informationLaparoscopic Surgery. The Da Vinci Robot. Limits of Laparoscopy. What Robotics Offers. Robotic Urologic Surgery: A New Era in Patient Care
Laparoscopic Surgery Robotic Urologic Surgery: A New Era in Patient Care Laparoscopic technique was introduced in urologic surgery in the 1990s Benefits: Improved recovery time, decreased morbidity Matthew
More informationEnhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm
bs_bs_banner International Journal of Urology (2014) 21, 880 885 doi: 10.1111/iju.12462 Original Article: Clinical Investigation Enhanced computed tomography after partial nephrectomy in early postoperative
More informationRetroperitoneoscopic Radical Nephrectomy: Initial Experience
Retroperitoneoscopic Radical Nephrectomy: Initial Experience A. Hasegan 1, D. Bratu 2, V. Pirvut 1, I. Mihai 1, N. Grigore 1 1 Lucian Blaga University of Sibiu, Department of Urology 2 Lucian Blaga University
More information저작권법에따른이용자의권리는위의내용에의하여영향을받지않습니다.
저작자표시 - 비영리 - 변경금지 2.0 대한민국 이용자는아래의조건을따르는경우에한하여자유롭게 이저작물을복제, 배포, 전송, 전시, 공연및방송할수있습니다. 다음과같은조건을따라야합니다 : 저작자표시. 귀하는원저작자를표시하여야합니다. 비영리. 귀하는이저작물을영리목적으로이용할수없습니다. 변경금지. 귀하는이저작물을개작, 변형또는가공할수없습니다. 귀하는, 이저작물의재이용이나배포의경우,
More informationThe comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis
Shen et al. World Journal of Surgical Oncology (2016) 14:220 DOI 10.1186/s12957-016-0971-9 RESEARCH Open Access The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy:
More informationIntroduction. Original Article: Clinical Investigation
International Journal of Urology (2019) 26, 120--125 doi: 10.1111/iju.13819 Original Article: Clinical Investigation Hypertension and diabetes mellitus are not associated with worse renal functional outcome
More informationROBOTIC PARTIAL NEPHRECTOMY: 15 YRS LATER
ROBOTIC PARTIAL NEPHRECTOMY: 15 YRS LATER Clayton Lau, MD Chief, Division of Urology/Urologic Oncology City of Hope Medical Center Current Trends in Urologic Oncology 2019 Beaver Creek Resort, CO Disclosures
More informationSupplementary Table 2. Surgical prophylaxis: Summary of selected series which included prophylactic management against the risk of bleeding.
Supplementary Tables of the article The Risks of Renal Angiomyolipoma: Reviewing the Evidence. Supplementary Table 2. Surgical prophylaxis: Summary of selected series which included prophylactic management
More informationPatient Selection for Ablative Therapies. Adrian D Joyce Leeds UK
Patient Selection for Ablative Adrian D Joyce Leeds UK Therapy Renal Cell Ca USA: 30,000 new cases annually >12,000 deaths RCC accounts for 3% of all adult malignancy 40% of patients will die from their
More informationLaparoscopic partial nephrectomydoes tumor profile influence the operative performance?
Open Access Archives of Surgery and Clinical Research Research Article ISSN 2576-9537 Laparoscopic partial nephrectomydoes tumor profile influence the operative performance? Krishanu Das*, George P Abraham,
More informationDirectness Consistency Precision Reporting Bias
responsible for the accuracy and presentation of the material. Supplemental Table. Strength of evidence for primary. Key Outcomes* Studies (N) Study limitations Directness Consistency Precision Reporting
More informationSmall Renal Mass Guidelines. Clif Vestal, MD USMD Arlington, Texas
Small Renal Mass Guidelines Clif Vestal, MD USMD Arlington, Texas Evaluation/Diagnosis 1. Obtain high quality, multiphase, cross-sectional abdominal imaging to optimally characterize/stage the renal mass.
More informationSalvage surgery after energy ablation for renal masses
Salvage surgery after energy ablation for renal masses Jose A. Karam, Christopher G. Wood, Zachary R. Compton, Priya Rao*, Raghunandan Vikram, Kamran Ahrar and Surena F. Matin Departments of Urology, *Pathology,
More informationRobotic Partial Nephrectomy Versus Laparoscopic Cryoablation for the Small Renal Mass
EUROPEAN UROLOGY 61 (2012) 899 904 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Kidney Cancer Editorial by Jose A. Karam and Christopher G. Wood on pp.
More informationKilling Tumors with Scans Not Scalpels: Kidney Cancer Ablation. Basics. What is Percutaneous Ablation? Where are your kidneys?
Killing Tumors with Scans Not Scalpels: Kidney Cancer Ablation Ronald J. Zagoria, M.D. UCSF Professor and Vice Chair Abdominal Imaging Section Chief Basics Where are your kidneys? What is ablation? Facts
More informationSaving Nephrons: Current Surgical Options in Partial Nephrectomy
Journal of Analytical Oncology, 0,, 95-0 95 Saving Nephrons: Current Surgical Options in Partial Nephrectomy David Wetherell, Kiran Manya, Nathan Papa, Danny Chui and Nathan Lawrentschuk,,* University
More informationUro-Assiut 2015 Robotic Nephron Sparing Surgery
Uro-Assiut 2015 Robotic Nephron Sparing Surgery Khaled Fareed, MD, MBA Center for Advanced Laparoscopy, Robotics & Minimally Invasive Surgery Glickman Urological & Kidney Institute Associate Professor,
More informationTrend of Surgical Treatment of Localized Renal Cell Carcinoma
Ramzi B Jabaji, MD 1 ; Heidi Fischer, PhD 2 ; Tyler Kern, MD 1 ; Gary W Chien, MD 1 Perm J 2019;23:18-108 E-pub: 01/07/2019 https://doi.org/10.7812/tpp/18-108 ABSTRACT Introduction: Rapid adoption of robotics
More informationRobotic-assisted partial Nephrectomy: initial experience in South America
Clinical Urology International Braz J Urol Vol 37 (4): 461-467, July - August, 2011 Robotic-assisted partial Nephrectomy: initial experience in South America Gustavo C. Lemos, Marcelo Apezzato, Leonardo
More informationLaparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes
ORIGINAL ARTICLE Vol. 43 (5): 857-862, September - October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0642 Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes Matvey Tsivian
More informationwere reduced by the cost of probe. With a median follow-up of 20 months there was no difference in oncological outcome.
Laparoscopy and Robotic LAPAROSCOPIC PARTIAL NEPHRECTOMY VS LAPAROSCOPIC RADIOFREQUENCY ABLATION BENSALAH et al. Evaluation of costs and morbidity associated with laparoscopic radiofrequency ablation and
More informationLaparoendoscopic Single-site Partial Nephrectomy: A Multiinstitutional
EUROPEAN UROLOGY 64 (2013) 314 322 available at www.sciencedirect.com journal homepage: www.europeanurology.com Endo-urology Laparoendoscopic Single-site Partial Nephrectomy: A Multiinstitutional Outcome
More informationComparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses
Original Article http://dx.doi.org/10.3349/ymj.2012.53.1.151 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 53(1):151-157, 2012 Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial
More informationOptimal Treatment of ct1b Renal Mass in Patient with Normal GFR: a Role for Radical Nephrectomy?
Optimal Treatment of ct1b Renal Mass in Patient with Normal GFR: a Role for Radical Nephrectomy? Steven C. Campbell, MD, PhD Program Director, Vice Chairman Department of Urology Center for Urologic Oncology
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of laparoscopic partial nephrectomy 308 Introduction This overview has been
More informationGUIDELINES ON RENAL CELL CARCINOMA
GUIDELINES ON RENAL CELL CARCINOMA B. Ljungberg (chairman), D.C. Hanbury, M.A. Kuczyk, A.S. Merseburger, P.F.A. Mulders, J-J. Patard, I.C. Sinescu Introduction This EAU guideline was prepared to help urologists
More informationOriginal Article A novel approach to locate renal artery during retroperitoneal laparoendoscopic single-site radical nephrectomy
Int J Clin Exp Med 2014;7(7):1752-1756 www.ijcem.com /ISSN:1940-5901/IJCEM0000870 Original Article during radical nephrectomy Lixin Shi, Wei Cai, Juan Dong, Jiangping Gao, Hongzhao Li, Shengkun Sun, Qiang
More informationLaparoscopic and Open Partial Nephrectomy: Complication Comparison Using the Clavien System
SCIENTIFIC PAPER Laparoscopic and Open Partial Nephrectomy: Complication Comparison Using the Clavien System Jennifer E. Reifsnyder, MD, Ranjith Ramasamy, MD, Casey K. Ng, MD, James DiPietro, BS, Benjamin
More informationRobotic-assisted laparoscopic partial nephrectomy: A single centre Indian experience
Original Article Robotic-assisted laparoscopic partial nephrectomy: A single centre Indian experience Arvind P Ganpule, Ashish G Goti, Shashikant K Mishra, Ravindra B Sabnis, Mihir M Desai, Mahesh R Desai
More informationROBOTIC VS OPEN RADICAL CYSTECTOMY
ROBOTIC VS OPEN RADICAL CYSTECTOMY A REVIEW Colin Lundeen December 14, 2016 Objectives Review the history of radical cystectomy Critically analyze recent RCTs comparing open radical cystectomy (ORC) to
More informationLAPAROSCOPIC NEPHRON-SPARING SURGERY IN THE PRESENCE OF RENAL ARTERY DISEASE
SURGICAL TECHNIQUES IN UROLOGY LAPAROSCOPIC NEPHRON-SPARING SURGERY IN THE PRESENCE OF RENAL ARTERY DISEASE ANDREW P. STEINBERG, SIDNEY C. ABREU, MIHIR M. DESAI, ANUP P. RAMANI, JIHAD H. KAOUK, AND INDERBIR
More informationCitation Transplantation Proceedings, 47(3),
NAOSITE: Nagasaki University's Ac Title Author(s) Hybrid Procedure in Living Donor Li Soyama, Akihiko; Takatsuki, Mitsuhi Tomohiko; Kitasato, Amane; Kinoshit Baimakhanov, Zhassulan; Kuroki, Tam Citation
More informationRenal cryoablation of small renal masses: A Korea University experience
Original Article - Urological Oncology Korean J Urol 2015;56:117-124. http://dx.doi.org/10.4111/kju.2015.56.2.117 pissn 2005-6737 eissn 2005-6745 Renal cryoablation of small renal masses: A Korea University
More informationComparison of Partial and Radical Nephrectomy for pt1b Renal Cell Carcinoma
www.kjurology.org DOI:10.4111/kju.2010.51.9.596 Urological Oncology Comparison of Partial and Radical Nephrectomy for pt1b Renal Cell Carcinoma Jong Min Kim, Phil Hyun Song, Hyun Tae Kim, Tong Choon Park
More informationThe association between renal tumour scoring system components and complications of partial nephrectomy
Original research The association between renal tumour scoring system components and complications of partial nephrectomy Darren Desantis, MD, FRCSC;* Luke T. Lavallée, MD, FRCSC; * Kelsey Witiuk, PhD;
More informationRoutine Drain Placement After Partial Nephrectomy is Not Always Necessary
Routine Drain Placement After Partial Nephrectomy is t Always Necessary Guilherme Godoy,* Darren J. Katz,* Ari Adamy, Joseph E. Jamal, Melanie Bernstein and Paul Russo From the Urology Service, Department
More informationIntroduction. Teck Wei Tan 1,2 Rajesh Nair 1 Sanad Saad 1 Ramesh Thurairaja 1 Muhammad Shamim Khan 1
World Journal of Urology (2019) 37:367 372 https://doi.org/10.1007/s00345-018-2386-4 ORIGINAL ARTICLE Safe transition from extracorporeal to intracorporeal urinary diversion following robot assisted cystectomy:
More informationSurgery of Renal Cell Carcinoma Axel Bex, MD, PhD The Netherlands Cancer Institute
Surgery of Renal Cell Carcinoma Axel Bex, MD, PhD The Netherlands Cancer Institute 23 March 2012, Sao Paulo, Brazil Surgery of RCC Locally confined (small) renal tumours Locally advanced disease Metastatic
More informationReview Article. Decline in Renal Function after Partial Nephrectomy: Etiology and Prevention
Review Article Decline in Renal Function after Partial Nephrectomy: Etiology and Prevention Maria C. Mir, Cesar Ercole, Toshio Takagi, Zhiling Zhang, Lily Velet, Erick M. Remer, Sevag Demirjian and Steven
More informationResearch Article Practice Trends in the Surgical Management of Renal Tumors in an Academic Medical Center in the Past Decade
ISRN Endoscopy Volume 2013, Article ID 945853, 5 pages http://dx.doi.org/10.5402/2013/945853 Research Article Practice Trends in the Surgical Management of Renal Tumors in an Academic Medical Center in
More informationRobotic Surgery for Upper Tract Urothelial Carcinoma. Li-Ming Su, MD
Robotic Surgery for Upper Tract Urothelial Carcinoma Li-Ming Su, MD David A. Cofrin Professor of Urology, Associate Chairman of Clinical Affairs, Chief, Division of Robotic and Minimally Invasive Urologic
More informationPartial Nephrectomy Planning: Everybody s s doing it, you can to
Partial Nephrectomy Planning: Everybody s s doing it, you can to Brian R. Herts, MD Associate Professor of Radiology Head, Abdominal Imaging, Imaging Institute & Staff, The Glickman Urological and Kidney
More informationRobot-assisted partial nephrectomy: Evaluation of learning curve for an experienced renal surgeon
Washington University School of Medicine Digital Commons@Becker Open Access Publications 2010 Robot-assisted partial nephrectomy: Evaluation of learning curve for an experienced renal surgeon Mohammed
More informationOverall Survival and Development of Stage IV Chronic Kidney Disease in Patients Undergoing Partial and Radical Nephrectomy for Benign Renal Tumors
EUROPEAN UROLOGY 64 (2013) 600 606 available at www.sciencedirect.com journal homepage: www.europeanurology.com Platinum Priority Kidney Cancer Editorial by Alexander Kutikov, Marc C. Smaldone and Robert
More informationAUA Guidelines Renal Mass and Localized Kidney Cancer
AUA Guidelines Renal Mass and Localized Kidney Cancer Steven C. Campbell, MD, PhD Chair AUA Guidelines Panel Professor Surgery, Vice Chair, Program Director Department of Urology Glickman Urological and
More informationPartial Nephrectomy Is Associated with Improved Overall Survival Compared to Radical Nephrectomy in Patients with Unanticipated Benign Renal Tumours
EUROPEAN UROLOGY 58 (2010) 293 298 available at www.sciencedirect.com journal homepage: www.europeanurology.com Kidney Cancer Partial Nephrectomy Is Associated with Improved Overall Survival Compared to
More informationPartial Nephrectomy: Does Ischemia Matter?
Partial Nephrectomy: Does Ischemia Matter? Karim Touijer, MD, MPH Attending Surgeon Memorial Sloan-Kettering Cancer Center Associate Professor of Urology Weill Cornell Medical College, New York No disclosures
More informationMATERIALS AND METHODS Patients
Yonago Acta medica 216;59:232 236 Original Article Usefulness of T-Shaped Gauze for Precise Dissection of Supra-Pancreatic Lymph Nodes and for Reduced Postoperative Pancreatic Fistula in Patients Undergoing
More informationRenal Cancer Critical Evaluation of Perioperative Complications in Laparoscopic Partial Nephrectomy
Renal Cancer Critical Evaluation of Perioperative Complications in Laparoscopic Partial Nephrectomy Lucas Nogueira, Darren Katz, Rodrigo Pinochet, Guilherme Godoy, Jordan Kurta, Caroline J. Savage, Angel
More informationBilateral Renal Angiomyolipomas with Invasion of the Renal Vein: A Case Report
Case Study TheScientificWorldJOURNAL (2008) 8, 145 148 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2008.29 Bilateral Renal Angiomyolipomas with Invasion of the Renal Vein: A Case Report C. Blick, N. Ravindranath,
More informationOutcomes associated with robotic approach to pancreatic resections
Short Communication (Management of Foregut Malignancies and Hepatobiliary Tract and Pancreas Malignancies) Outcomes associated with robotic approach to pancreatic resections Caitlin Takahashi 1, Ravi Shridhar
More informationMODERN SYSTEM OF EVALUATION OF KIDNEY TUMOR (REVIEW)
MODERN SYSTEM OF EVALUATION OF KIDNEY TUMOR (REVIEW) E.A.Stakhovsky, I.V.Vitruk, O.A.Voilenko, O.Е.Stakhovskyi, P.S. Vukalovich, V.A.Kotov, O.M.Gavrylyuk National Canсer Institute, Kyiv, Ukraine Summary.
More informationCritical evaluation of the PADUA score in a retrospective analysis of open partial nephrectomy
208 Turk J Urol 2018; 44(3): 208-12 DOI: 10.5152/tud.2018.52721 UROONCOLOGY Original Article Critical evaluation of the PADUA score in a retrospective analysis of open partial nephrectomy Desiree Louise
More informationCanadian Guidelines for Management of the Small Renal Mass (SRM)
Canadian Guidelines for Management of the Small Renal Mass (SRM) Michael A.S. Jewett*, Ricardo Rendon, Louis Lacombe, Pierre I. Karakiewicz, Simon Tanguay, Wes Kassouf, Mike Leveridge, Ilias Cagiannos,
More informationComparison of radiographic and pathologic sizes of renal tumors
ORIGINAL Article Vol. 39 (2): 189-194, March - April, 2013 doi: 10.1590/S1677-5538.IBJU.2013.02.06 Comparison of radiographic and pathologic sizes of renal tumors Wei Chen, Linhui Wang, Qing Yang, Bing
More informationGuidelines on Renal Cell
Guidelines on Renal Cell Carcinoma (Text update March 2009) B. Ljungberg (Chairman), D.C. Hanbury, M.A. Kuczyk, A.S. Merseburger, P.F.A. Mulders, J-J. Patard, I.C. Sinescu Introduction Renal cell carcinoma
More informationThe relation between estimated glomerular filtration rate and proteinuria in Okayama Prefecture, Japan
Environ Health Prev Med (2011) 16:191 195 DOI 10.1007/s12199-010-0183-9 SHORT COMMUNICATION The relation between estimated glomerular filtration rate and proteinuria in Okayama Prefecture, Japan Nobuyuki
More informationKey Words: kidney; carcinoma, renal cell; renal insufficiency; nephrectomy; mortality
Comparative Effectiveness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Analysis Simon P. Kim, R. Houston Thompson, Stephen
More informationLaparoscopic Radical Nephrectomy- the current gold standard
Laparoscopic Radical Nephrectomy- the current gold standard Anoop M. Meraney, M.D Director, Urologic Oncology, Helen and Harry Gray Cancer Center, Hartford Hospital and Connecticut Surgical Group. Is it
More informationIndex. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, pancreatic ductal, laparoscopic distal pancreatectomy for, 61 Adrenal cortical carcinoma, laparoscopic adrenalectomy for, 114
More informationSurgical Management of Renal Cancer. David Nicol Consultant Urologist
Surgical Management of Renal Cancer David Nicol Consultant Urologist Roles of Surgery 1. Curative intervention localised disease 2. Symptomatic control advanced disease 3. Augmentation of efficacy of systemic
More information