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1
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Pokhrel G, Zheng H, Tao J, Fan Y, Liu Y, Dong B, Yu S, Zhang X. Evaluation of the Toumai robotic system in partial nephrectomy and key system features. Sci Rep 2025; 15:13046. [PMID: 40240465 PMCID: PMC12003781 DOI: 10.1038/s41598-025-97124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 04/02/2025] [Indexed: 04/18/2025] Open
Abstract
Robotic partial nephrectomy is a standard procedure in urology, but its widespread use is limited by the high cost and technical constraints of current systems. New robotic systems are being developed to enhance affordability and accessibility, expanding the availability of advanced robotic surgery to a broader range of healthcare facilities and patients. This study evaluates the feasibility and safety of the Toumai system in partial nephrectomy, examining its advanced features and their potential impact on surgical precision and operational efficiency. In this single center study, eleven patients underwent partial nephrectomy using Toumai. Primary endpoints were feasibility and safety, while secondary outcomes included perioperative outcomes. All surgeries were completed successfully without conversion, minimal complications, and no major equipment failures. The median operative time was 107 min, docking time was 8 min, and estimated blood loss was 50 ml. One off-clamp partial nephrectomy was successfully performed and median warm ischemia time was 9 min in the remaining cases. Postoperatively, renal function remained stable, and surgical margins were negative in all cases. These preliminary results suggest that partial nephrectomy can be safely performed using the Toumai robotic system. The system's advanced features, including sensory feedback, high-frequency response, and enhanced imaging technologies, likely contributed to favorable surgical outcomes with minimal complications. However, these initial findings warrant further validation through larger studies and longer follow-up.
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Affiliation(s)
- Gaurab Pokhrel
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Haoke Zheng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jin Tao
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yafeng Fan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yunlong Liu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Biao Dong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Shuanbao Yu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China.
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2
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Pokhrel G, Wang Z, Cui J, Jin B, Zheng H, Tao J, Fan Y, Liu Y, Zhan Y, Yu S, Dong B, Zhang X. Initial experience with the novel modular robotic system Carina in urology: a prospective study on safety feasibility and surgical settings. Sci Rep 2025; 15:12686. [PMID: 40221629 PMCID: PMC11993754 DOI: 10.1038/s41598-025-97411-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2025] [Accepted: 04/04/2025] [Indexed: 04/14/2025] Open
Abstract
Robot-assisted surgery has transformed urology, but widespread adoption remains limited by the high cost, complex setup, and rigid system design. This prospective single-center study evaluates the safety and efficacy of the novel modular Carina in 19 upper and lower urinary tract surgeries. All cases were completed robotically without conversion, with one major complication. For partial nephrectomy (PN), median operative time (OT) was 120 min with 50 mL estimated blood loss (EBL), including one off-clamp PN completed in 77 min (EBL: 50 mL). Pyeloplasty had a median OT of 105 min (EBL: 50 mL), while radical prostatectomy (RP) achieved a median OT of 150 min (EBL: 50 mL). Radical cystectomy was completed in 301 min without major complications, and an uncomplicated postoperative course. Median docking times were 5 and 8 min for upper and lower tract surgeries, with negative margins and preserved renal function in all PN, and social continence post-RP. The Carina system demonstrates procedural safety and feasibility in complex urological procedures. The modular design may enhance workflow and space utilization, suggesting the potential for promising tool and broader clinical applications. Further validation with larger sample sizes and long-term follow-up is needed.
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Affiliation(s)
- Gaurab Pokhrel
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - ZeYuan Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jinshan Cui
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Bingzhai Jin
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Haoke Zheng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Jin Tao
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yafeng Fan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yunlong Liu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Yonghao Zhan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Shuanbao Yu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Biao Dong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, 450052, China.
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3
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Homewood D, Tan N, Fay T, Silagy A, Lawrentschuk N, Corcoran NM, Agarwal DK. An overview of renorrhaphy techniques for partial nephrectomy. Int J Urol 2025; 32:329-340. [PMID: 40062576 DOI: 10.1111/iju.15658] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 12/09/2024] [Indexed: 04/08/2025]
Abstract
Partial nephrectomy aims to provide both effective oncological management and renal function preservation. Surgical complications pertaining to the defect created during a partial nephrectomy include hemorrhage and urinary leak. Over time, approaches have advanced for managing the defect created during a partial nephrectomy. Herein, we explore techniques used for renorrhaphy in partial nephrectomy, its evolution and current state. We review the history of partial nephrectomy and the early techniques used to close the parenchymal defect, highlighting their advantages and disadvantages. The article then investigates the principles of renorrhaphy and the sliding clip technique. Modifications made to the sliding clip technique are depicted with illustrations. Single-layer versus double-layer closure and continuous versus interrupted sutures are evaluated. Non-renorrhaphy techniques, such as sealants and glues, used to seal the renal remnant are explored. By examining the evolution of renorrhaphy techniques, this article provides a comprehensive understanding of the improvements made in a key component of partial nephrectomy. We aim to provide novel insights towards better understanding the history and current state of renorrhaphy techniques in partial nephrectomy.
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Affiliation(s)
- David Homewood
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- International Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Tan
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | - Tayla Fay
- International Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Urology, Frankston Hospital, Melbourne, Victoria, Australia
| | | | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Victoria, Australia
| | - Niall M Corcoran
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Frankston Hospital, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Dinesh K Agarwal
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Mercy Health, Melbourne, Victoria, Australia
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4
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Homewood D, Fay T, Tan N, Silagy A, Corcoran NM, Lawrentschuk N, Agarwal D. Advances in sliding clip renorrhaphy for partial nephrectomy. Nat Rev Urol 2024; 21:703-704. [PMID: 38918524 DOI: 10.1038/s41585-024-00906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- David Homewood
- Department of Urology, Western Health, Melbourne, Victoria, Australia.
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
- International Medical Robotics Academy, Melbourne, Victoria, Australia.
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
| | - Tayla Fay
- International Medical Robotics Academy, Melbourne, Victoria, Australia
- Department of Urology, Frankston Hospital, Melbourne, Victoria, Australia
| | - Nicholas Tan
- Department of Urology, Western Health, Melbourne, Victoria, Australia
| | | | - Niall M Corcoran
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Frankston Hospital, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth Healthcare, Melbourne, Victoria, Australia
| | - Dinesh Agarwal
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Franco A, Riolo S, Tema G, Guidotti A, Brassetti A, Anceschi U, Bove AM, D’Annunzio S, Ferriero M, Mastroianni R, Misuraca L, Guaglianone S, Tuderti G, Leonardo C, Cicione A, Licari LC, Bologna E, Flammia RS, Nacchia A, Trucchi A, Lombardo R, Franco G, Tubaro A, Simone G, De Nunzio C. Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique. Diagnostics (Basel) 2024; 14:1579. [PMID: 39125455 PMCID: PMC11311424 DOI: 10.3390/diagnostics14151579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Sara Riolo
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giorgia Tema
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Alessio Guidotti
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Aldo Brassetti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Alfredo Maria Bove
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Simone D’Annunzio
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Mariaconsiglia Ferriero
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Riccardo Mastroianni
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Leonardo Misuraca
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Salvatore Guaglianone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Gabriele Tuderti
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Costantino Leonardo
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Cicione
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Rocco Simone Flammia
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Antonio Nacchia
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Alberto Trucchi
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Riccardo Lombardo
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giorgio Franco
- Urology Unit, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00185 Rome, Italy; (L.C.L.); (E.B.); (G.F.)
| | - Andrea Tubaro
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
| | - Giuseppe Simone
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (A.B.); (U.A.); (A.M.B.); (S.D.); (M.F.); (R.M.); (L.M.); (S.G.); (G.T.); (C.L.); (R.S.F.); (G.S.)
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00185 Rome, Italy; (A.F.); (S.R.); (G.T.); (A.G.); (A.C.); (A.N.); (A.T.); (A.T.); (C.D.N.)
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Pokhrel G, Zheng H, Tao J, Cui J, Fan Y, Li Z, Dong B, Yu S, Zhang X. Assessing the Feasibility and Safety of the Toumai ® Robotic System in Urologic Surgery: Initial Experience. J Endourol 2024; 38:552-558. [PMID: 38468506 DOI: 10.1089/end.2024.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Introduction: Robotic surgery using da Vinci surgical system has gained prominence in urology; emerging robotic platforms are expanding its applications and increasing affordability. We assess the feasibility and safety of a novel system, the Toumai® robotic system in various urological surgeries. Methods: This prospective study was conducted at the first affiliated hospital of Zhengzhou university. Twenty consecutive patients underwent renal and prostatic surgery with the Toumai. The study assessed technical feasibility (conversion rate) and safety (perioperative complications) of the procedures as primary outcomes. Secondary endpoints included key surgical perioperative outcomes: functional and oncologic results. The Endoscopic Surgical System operates within a master-slave protocol, comprising a Surgeon Console, Patient Platform, and Vision Platform. Results: Seventeen patients underwent various nephrectomy procedures and three underwent radical prostatectomy (RP). There was no conversion to alternative surgical approach; a single (Clavien-Dindo grade ≥3b) complication occurred, and no readmission was recorded within 30 days. The median operative time was 120, 140, and 210 minutes for partial nephrectomy (PN), radical nephrectomy, and RP, respectively. Off-clamp PN was performed in one case, and the warm ischemia time in the remaining two case was 18 minutes. The median docking time was 22 minutes for nephrectomy and 20 minutes for RP; no major robotic malfunction was encountered. At 3-month follow-up, no tumor recurrence was recorded, renal function was well preserved, and the continence status was satisfactory. Conclusions: We present the initial clinical utilization of an innovative robotic platform. Complex urological surgeries were successfully completed without conversions and with minimal complications. Further investigations are warranted to confirm these initial findings.
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Affiliation(s)
- Gaurab Pokhrel
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haoke Zheng
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Tao
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinshan Cui
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafeng Fan
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhenhao Li
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Biao Dong
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuanbao Yu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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7
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Ito H, Nakane K, Hagiwara N, Kawase M, Kato D, Iinuma K, Ishida K, Enomoto T, Nezasa M, Tobisawa Y, Ito T, Koie T. Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function. Curr Oncol 2024; 31:2758-2768. [PMID: 38785490 PMCID: PMC11119443 DOI: 10.3390/curroncol31050209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
We aimed to investigate the differences in renal function between patients who underwent single inner-layer renorrhaphy (SILR) or double-layer renorrhaphy (DLR) among those with renal tumors who underwent robot-assisted partial nephrectomy (RAPN). This retrospective multicenter cohort study was conducted between November 2018 and October 2023 at two institutions and included patients who underwent RAPN. In total, 93 eligible patients who underwent RAPN were analyzed. Preoperative renal function and prevalence of chronic kidney disease were not significantly different between the two groups. Although urinary leakage was observed in three patients (5.9%) in the SILR group, there was no significant difference between the two groups regarding surgical outcomes (p = 0.249). Serum creatinine levels after RAPN were significantly lower in the SILR group than in the DLR group on postoperative days 1 and 365 following RAPN (p = 0.04). The estimated glomerular filtration rate (eGFR) was significantly lower in the DLR group than in the SILR group only on postoperative day 1; however, there was no significant difference between the two groups thereafter. Multivariate analysis showed that the method of renorrhaphy was not a predictor for maintaining renal function after RAPN even though it was associated with eGFR on postoperative day 1.
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Affiliation(s)
- Hiroyuki Ito
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Noriyasu Hagiwara
- JA Gifu Koseiren Seino Kosei Hospital, Gifu 5010532, Japan;
- Department of Urology, Matsunami General Hospital, Gifu 5016062, Japan; (K.I.); (M.N.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Kenichiro Ishida
- Department of Urology, Matsunami General Hospital, Gifu 5016062, Japan; (K.I.); (M.N.)
| | - Torai Enomoto
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Minori Nezasa
- Department of Urology, Matsunami General Hospital, Gifu 5016062, Japan; (K.I.); (M.N.)
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
| | - Takayasu Ito
- Center for Clinical Training and Career Development, Gifu University Graduate School of Medicine, Gifu 5011194, Japan;
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (H.I.); (K.N.); (M.K.); (D.K.); (K.I.); (T.E.); (Y.T.)
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Bertolo R, Ditonno F, Veccia A, DE Marco V, Migliorini F, Porcaro AB, Rizzetto R, Cerruto MA, Autorino R, Antonelli A. Single-layer versus double-layer renorrhaphy technique during robot-assisted partial nephrectomy: impact on perioperative outcomes, complications, and functional outcomes. Minerva Urol Nephrol 2024; 76:176-184. [PMID: 38742552 DOI: 10.23736/s2724-6051.24.05700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The debate between single-layer and double-layer renorrhaphy techniques during robot-assisted partial nephrectomy (RPN) represents a subject of ongoing discourse. The present analysis aims to compare the perioperative and functional outcomes of single- versus double-layer renorrhaphy during RPN. METHODS Study data were retrieved from prospectively maintained institutional database (Jan2018-May2023). Study population was divided into two groups according to the number of layers (single vs. double) used for renorrhaphy. Baseline and perioperative data were compared. Postoperative surgical outcomes included type and grade of complications as classified according to Clavien-Dindo. Serum creatinine and estimated glomerular filtration rate were used to measure renal function. RESULTS Three hundred seventeen patients were included in the analysis: 209 received single-layer closure, while 108 underwent double-layer renorrhaphy. Baseline characteristics were not statistically different between the groups. Comparable low incidence of intraoperative complications was observed between the cohorts (P=0.5). No difference was found in terms of mean (95% CI) Hb level drop postoperation (single-layer: 1.6 g/dL [1.5-1.7] vs. double-layer: 1.4 g/dL [1.2-1.5], P=0.3). Overall and "major" rate of complications were 16% and 3%, respectively, with no difference observed in terms of any grade (P=0.2) and major complications (P=0.7). Postoperative renal function was not statistically different between the treatment modalities. At logistic regression analyses, no difference in terms of probability of overall (OR 0.82 [0.63-1.88]) and major (OR 0.94 [0.77-6.44]) complications for the number of suture layers was observed. CONCLUSIONS Single-layer and double-layer renorrhaphy demonstrated comparable perioperative and functional outcomes within the setting of the present study.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy -
| | - Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Vincenzo DE Marco
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Antonio B Porcaro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Maria A Cerruto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Borgo Trento Hospital, University of Verona, Verona, Italy
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9
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Pandolfo SD, Wu Z, Campi R, Bertolo R, Amparore D, Mari A, Verze P, Manfredi C, Franco A, Ditonno F, Cerrato C, Ferro M, Lasorsa F, Contieri R, Napolitano L, Tufano A, Lucarelli G, Cilio S, Perdonà S, Siracusano S, Autorino R, Aveta A. Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review. Cancers (Basel) 2024; 16:693. [PMID: 38398084 PMCID: PMC10886610 DOI: 10.3390/cancers16040693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Robot-assisted partial nephrectomy (RAPN) is increasingly being employed in the management of renal cell carcinoma (RCC) and it is expanding in the field of complex renal tumors. The aim of this systematic review was to consolidate and assess the results of RAPN when dealing with entirely central hilar masses and to examine the various methods used to address the surgical difficulties associated with them. Methods: A thorough literature search in September 2023 across various databases focused on RAPN for renal hilar masses, adhering to PRISMA guidelines. The primary goal was to evaluate RAPN's surgical and functional outcomes, with a secondary aim of examining different surgical techniques. Out of 1250 records, 13 full-text manuscripts were reviewed. Results: Evidence is growing in favor of RAPN for renal hilar masses. Despite a predominance of retrospective studies and a lack of long-term data, RAPN shows positive surgical outcomes and preserves renal function without compromising cancer treatment effectiveness. Innovative suturing and clamping methods are emerging in surgical management. Conclusions: RAPN is a promising technique for managing renal hilar masses in RCC, offering effective surgical outcomes and renal function preservation. The study highlights the need for more long-term data and prospective studies to further validate these findings.
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Affiliation(s)
- Savio Domenico Pandolfo
- Department of Urology, University of L’Aquila, 67010 L’Aquila, Italy;
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Zhenjie Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China;
| | - Riccardo Campi
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy; (R.C.); (A.M.)
| | - Riccardo Bertolo
- Department of Urology, University of Verona, 37100 Verona, Italy; (R.B.); (F.D.)
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, 10043 Turin, Italy;
| | - Andrea Mari
- Urological Robotic Surgery and Renal Transplantation Unit, Careggi Hospital, University of Florence, 50121 Firenze, Italy; (R.C.); (A.M.)
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, 84081 Fisciano, Italy;
| | - Celeste Manfredi
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
- Department of Urology, Sant’Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Francesco Ditonno
- Department of Urology, University of Verona, 37100 Verona, Italy; (R.B.); (F.D.)
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
| | - Clara Cerrato
- Urology Unit, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK;
| | - Matteo Ferro
- Division of Urology, IRCCS—European Institute of Oncology, 71013 Milan, Italy;
| | - Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy;
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| | - Antonio Tufano
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (A.T.); (S.P.)
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.L.); (G.L.)
| | - Simone Cilio
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
| | - Sisto Perdonà
- Department of Urology, Istituto Nazionale Tumori, IRCCS, “Fondazione G. Pascale”, 80131 Naples, Italy; (A.T.); (S.P.)
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60637, USA; (C.M.); (A.F.); (R.A.)
| | - Achille Aveta
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy; (L.N.); (S.C.); (A.A.)
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