1
|
Morelli L, Morelli J, Palmeri M, D'Isidoro C, Kauffmann EF, Tartaglia D, Caprili G, Pisano R, Guadagni S, Di Franco G, Di Candio G, Mosca F. Robotic surgery and hemostatic agents in partial nephrectomy: a high rate of success without vascular clamping. J Robot Surg 2015; 9:215-222. [PMID: 26531202 DOI: 10.1007/s11701-015-0519-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/16/2015] [Indexed: 02/08/2023]
Abstract
Robot-assisted partial nephrectomy has been proposed as a technique to overcome technical challenges of laparoscopic partial nephrectomy. We prospectively collected and analyzed data from 31 patients who underwent robotic partial nephrectomy with systematic use of hemostatic agents, between February 2009 and October 2014. Thirty-three renal tumors were treated in 31 patients. There were no conversions to open surgery, intraoperative complications, or blood transfusions. The mean size of the resected tumors was 27 mm (median 20 mm, range 5-40 mm). Twenty-seven of 33 lesions (82%) did not require vascular clamping and therefore were treated in the absence of ischemia. All margins were negative. The high partial nephrectomy success rate without vascular clamping suggests that robotic nephron-sparing surgery with systematic use of hemostatic agents may be a safe, effective method to completely avoid ischemia in the treatment of selected renal masses.
Collapse
Affiliation(s)
- Luca Morelli
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - John Morelli
- Department of Radiology, St. John's Medical Center, Tulsa, OK, USA
| | - Matteo Palmeri
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Cristiano D'Isidoro
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Emanuele Federico Kauffmann
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Dario Tartaglia
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giovanni Caprili
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Roberta Pisano
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Simone Guadagni
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gregorio Di Franco
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Giulio Di Candio
- General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| |
Collapse
|
2
|
Comparison of methods for determination of glomerular filtration rate: low and high-dose Tc-99m-DTPA renography, predicted creatinine clearance method, and plasma sample method. Int Urol Nephrol 2008; 40:1059-65. [PMID: 18690545 DOI: 10.1007/s11255-008-9446-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 07/23/2008] [Indexed: 10/21/2022]
Abstract
The gamma camera uptake method with Tc-99m-DTPA (diethylenetriaminepentaacetic acid) is a simple method for determination of glomerular filtration rate (GFR), and is less time-consuming than other methods, but its diagnostic accuracy is debated. Gate's method (low-dose; LD), the high-dose method (HD), the predicted-clearance method, and the plasma-clearance method with Tc-99m-DTPA are compared in this study. We also performed GFR measurement and diuretic renography simultaneously. Tc-99m DTPA renography was performed in 36 patients aged 18-72 years with a wide range of renal function (serum creatinine 1.37 +/- 0.49 mg/dl). GFR was determined by four methods: the gamma camera uptake method with low-dose Tc-99m DTPA (Gates, LD); the gamma camera uptake method with high-dose Tc-99m DTPA (HD); the predicted creatinine clearance method (Cockcroft-Gualt, CG); and the plasma sample clearance (PSC) method using a mono-exponential curve. The PSC method was chosen as reference. The regression equations for the CG, Gates (low-dose), and HD methods against the PSC method were 28.68 + 0.80X (r = 0.72; P value < 0.0001, RMSE = 21.65 ml/min/1.73 m(2)), 6.19 + 0.79X (r = 0.90; P value < 0.0001, RMSE = 10.64 ml/min/1.73 m(2)), and 6.53 + 0.88X (r = 0.93; P value < 0.0001, RMSE = 9.35 ml/min/1.73 m(2)), respectively. In comparison with determination of GFR by the PSC method, the CG method tended to overestimate GFR while, perversely, the LD and HD methods tended to underestimate GFR. The three methods were in agreement with the PSC method but the high-dose GFR method resulted in less error in estimation of GFR. Furthermore, GFR measurement and diuretic renography could be performed at the same time when the high-dose method was used. Because of the low cost and negligible radiation burden, this method might be preferred for routine practice in nuclear medicine.
Collapse
|