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Razdan S, Okhawere KE, Zuluaga L, Saini I, Ucpinar B, Sauer RC, Soputro N, Crivellaro S, Kaouk JH, Ahmed M, Stifelman MD, Badani KK. Comparison of lateral flank approach and low anterior access for single port (SP) retroperitoneal partial nephrectomy: an analysis from the single port advanced research consortium (SPARC). J Robot Surg 2024; 18:216. [PMID: 38761306 DOI: 10.1007/s11701-024-01969-9] [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: 03/16/2024] [Accepted: 05/03/2024] [Indexed: 05/20/2024]
Abstract
Single Port (SP) robotic partial nephrectomy (RPN) can be performed via retroperitoneal and transperitoneal approach. We aim to compare outcomes of two commonly described incisions for retroperitoneal SP RPN: lateral flank approach (LFA) and low anterior access (LAA). We performed a retrospective study of patients who underwent SP retroperitoneal RPN from 2018 to 2023 as part of a large multi-institute collaboration (SPARC). Baseline demographic, clinical, tumor-specific characteristics, and perioperative outcomes were compared using χ2, t test, Fisher exact test, and Mann-Whitney U test. Multivariable analyses were conducted using robust and logistic regressions. A total of 70 patients underwent SP retroperitoneal RPN, with 44 undergoing LAA. Overall, there were no significant differences in baseline characteristics between the two groups. The LAA group exhibited significantly lower median RENAL scores (8 vs. 5, p < 0.001) and more varied tumor locations (p = 0.002). In the bivariate analysis, there were no statistically significant differences in ischemia time, estimated blood loss, or complication rates between the groups. However, the LAA group had longer operative times (101 vs. 134 min, p < 0.001), but was more likely to undergo a same-day discharge (p < 0.001). When controlling for other variables, LAA was associated with shorter ischemia time (p = 0.005), but there was no significant difference in operative time (p = 0.348) and length of stay (p = 0.122). Both LFA and LAA are acceptable approaches for SP retroperitoneal RPN with comparable perioperative outcomes. This early data suggests the LAA is more versatile for varying tumor locations; however, larger cohort studies are needed to ascertain whether there is an overall difference in patient recovery.
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Affiliation(s)
- Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.
| | - Kennedy E Okhawere
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Laura Zuluaga
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Indu Saini
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Burak Ucpinar
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | | | - Nicholas Soputro
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - J H Kaouk
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
| | | | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
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Xu P, Luo J, Shuai H, Cai T, Cui S, Zhou L, Xu Q, Zhao Y, Chen T, Shan W, Wu T. Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis. J Robot Surg 2024; 18:186. [PMID: 38683492 DOI: 10.1007/s11701-024-01963-1] [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: 03/08/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
The study aims to assess the available literature and compare the perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) for posterior-lateral renal tumors using transperitoneal (TP) and retroperitoneal (RP) approaches. Systematically searched the Embase, PubMed, and Cochrane Library databases for literature. Eligible studies were those that compared TP-RAPN and RP-RAPN for posterior-lateral renal tumors. The data from the included studies were analyzed and summarized using Review Manager 5.3, which involved comparing baseline patient and tumor characteristics, intraoperative and postoperative outcomes, and oncological outcomes. The analysis included five studies meeting the inclusion criteria, with a total of 1440 patients (814 undergoing RP-RAPN and 626 undergoing TP-RAPN). Both groups showed no significant differences in age, gender, BMI, R.E.N.A.L. score, and tumor size. Notably, compared to TP-RAPN, the RP-RAPN group demonstrated shorter operative time (OT) (MD: 17.25, P = 0.01), length of hospital stay (LOS) (MD: 0.37, P < 0.01), and lower estimated blood loss (EBL) (MD: 15.29, P < 0.01). However, no significant differences were found between the two groups in terms of warm ischemia time (WIT) (MD: -0.34, P = 0.69), overall complications (RR: 1.25, P = 0.09), major complications (the Clavien-Dindo classification ≥ 3) (RR: 0.97, P = 0.93), and positive surgical margin (PSM) (RR: 1.06, P = 0.87). The systematic review and meta-analysis suggests RP-RAPN may be more advantageous for posterior-lateral renal tumors in terms of OT, EBL, and LOS, but no significant differences were found in WIT, overall complications, major complications, and PSM. Both surgical approaches are safe, but a definitive advantage remains uncertain.
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Affiliation(s)
- Pengjun Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Jia Luo
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Cai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Shu Cui
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Lin Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Qian Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Yuxin Zhao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China
| | - Wang Shan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road,Shunqing, Nanchong, 637000, Sichuan, People's Republic of China.
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China.
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Zhang C, Wang Z, Jing T, Wei Y, Guo F, Zhang Z, Xiao C, Wang Y, Xu H, Wu X, Tang S, Yang B, Wang S, Xu B, Zhu Q, Xia D, Wang L. Robot-assisted single-port retroperitoneal partial nephrectomy with a novel purpose-built single-port robotic system with deformable surgical instruments. World J Urol 2024; 42:134. [PMID: 38478100 PMCID: PMC10937792 DOI: 10.1007/s00345-024-04827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To investigate the safety and feasibility of using a novel purpose-built single-port robotic system (the SHURUI Robotic Surgical System) with deformable surgical instruments to perform retroperitoneal single-port partial nephrectomy. MATERIALS AND METHODS A prospective study was conducted to recruit patients with a single renal tumor no more than 4 cm. Robot-assisted single-port partial nephrectomy was performed by using the novel purpose-built single-port robotic system with deformable surgical instruments. Patients' demographics, tumor characteristics, and perioperative parameters were recorded and analyzed. RESULTS Sixteen patients were recruited to the study. The median tumor size was 2.0 cm (IQR: 1.2-2.4 cm). The median R.E.N.A.L score was 6 (IQR: 4-4.5). In 3 cases, pure single-port surgery was carried out, and all the assistance was through the robotic port. Median docking time was 15.5 min (IQR: 14.25-22.25 min). Median operating time was 148.5 min (IQR: 178-238.5 min). Median console time was 107 min (IQR: 92.75-149.75 min). Median warm ischemic time was 26.5 min (IQR: 24.5-30 min). Median blood loss was 17.5 ml (IQR: 10-50 ml). CONCLUSIONS Retroperitoneal partial nephrectomy can be safely performed with this novel purpose-built single-port robotic system (SHURUI) with deformable surgical instruments. Further studies are needed to fully evaluate the role of this new platform.
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Affiliation(s)
- Chao Zhang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Zheng Wang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Taile Jing
- Department Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yong Wei
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China
| | - Fei Guo
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Zongqin Zhang
- Department Urology, The Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Chengwu Xiao
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Yang Wang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Hong Xu
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Xiaofeng Wu
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Shouyan Tang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Bo Yang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
| | - Shuo Wang
- Department Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Bin Xu
- Department Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200125, China.
| | - Qingyi Zhu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210011, China.
| | - Dan Xia
- Department Urology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Linhui Wang
- Department Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, 200433, China.
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Shrivastava N, Bhargava P, Sharma G, Choudhary GR. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis. World J Urol 2024; 42:83. [PMID: 38358565 DOI: 10.1007/s00345-024-04796-7] [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: 05/24/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) can be performed either by a transperitoneal (TP) or a retroperitoneal (RP) approach. However, the superiority of one approach over the other is not established. Hence, the primary aim of this review was to compare perioperative outcomes between these two surgical approaches. METHODS Literature was systematically searched to identify studies reporting perioperative outcomes following TP RAPN and RP RAPN. The study protocol was registered with PROSPERO (CRD42023399496). The primary outcome was comparing complication rates between the two approaches. RESULTS This review included 22 studies, 5675 patients, 2524 in the RP group, and 3151 in the TP group. The overall complications were significantly lower in the RP group [Odds ratio (OR) 0.80 (0.67, 0.95), p = 0.01]. However, the rate of major complications was similar between the two groups. The operative time was significantly shorter with the RP group [Mean Difference (MD)-16.7 (- 22.3, - 11.0), p = < 0.0001]. Estimated blood loss (EBL) and need for blood transfusion (BT) were significantly lower in the RP group. There was no difference between the two groups for conversion to radical nephrectomy [OR 0.66 (0.33, 1.33), p = 0.25] or open surgery [OR 0.68 (0.24, 1.92, p = 0.47] and positive surgical margins [OR 0.93 (0.66, 1.31, p = 0.69]. Length of stay (LOS) was shorter in the RP group [MD - 0.27 (- 0.45, - 0.08), p = < 0.00001]. CONCLUSIONS RP approach, compared to TP, has significantly lower complication rates, EBL, need for BT and LOS. However, due to the lack of randomized studies on the topic, further data is required.
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Affiliation(s)
- Nikita Shrivastava
- Department of Urology, DKS Super Specialty Hospital and Postgraduate Institute, Raipur, India
| | - Priyank Bhargava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Sharma
- Department of Urologic Oncology and Robotic Surgery, Medanta-The Medicity, Gurugram, Haryana, 122001, India.
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Lanzotti NJ, Felice M, Janakiraman S, Lewer O, James C, Ellis JL, Rac G, Patel HD, Gupta GN. Robotic transperitoneal versus retroperitoneal approach for anterior renal mass nephron-sparing surgery. J Robot Surg 2024; 18:75. [PMID: 38353825 PMCID: PMC11001301 DOI: 10.1007/s11701-023-01798-2] [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: 11/27/2023] [Accepted: 12/16/2023] [Indexed: 02/16/2024]
Abstract
Robotic nephron-sparing surgery is traditionally performed via a transperitoneal (TP) approach. However, the retroperitoneal (RP) approach has gained popularity, particularly for posterolateral renal masses. The RP approach is associated with shorter operative time, less blood loss, and shorter length of stay, while preserving oncologic outcomes in selected masses. Here, we aim to assess the feasibility of the RP approach in excising anterior renal masses. Patients ≥ 18 years of age who underwent robotic nephron-sparing surgery for anterior renal masses were retrospectively identified (2008-2022). Baseline demographics, tumor characteristics, and perioperative data were collected and characterized based on TP vs RP approaches. Wilcoxon rank sum test and Pearson's Chi-squared test were used to compare continuous and categorical variables, respectively. Two hundred and sixteen patients were included-178 (82.4%) underwent TP approach and 38 (17.6%) underwent RP approach. Baseline demographics, preoperative tumor size, and renal nephrometry scores were similar. The RP approach was associated with shorter operative (150 vs 203 min, p < 0.001) and warm ischemia time (12 vs 21 min, p < 0.001), and less blood loss (20 vs 100 cc, p = 0.002) (Table 1). The RP approach was associated with shorter length of stay (1 vs 2 days, p < 0.001) and less total complications (5.3% vs 19.1%, p = 0.038). Major complication (Clavien-Dindo Grade > 3) rates were similar. There was no difference in positive surgical margin rates or pathologic characteristics. Robotic RP approach for nephron-sparing surgery is feasible for eligible anterior tumors and is associated with favorable perioperative outcomes with preserved negative surgical margin rates. Table 1 Patient baseline demographics Overall Transperitoneal Retroperitoneal p value Median/N IQR/% Median/N IQR/% Median/N IQR/% N 216 178 82.4% 38 17.6% Age (years) 60.5 (52.1-67.7) 60.4 (52.8-67.7) 61.6 (49.1-69.2) 0.393 Sex Male 126 58.3% 100 56.2% 26 68.4% Female 90 41.7% 78 43.8% 12 31.6% 0.165 Race White 162 75.0% 137 77.0% 25 65.8% Asian 4 1.9% 2 1.1% 2 5.3% Black 21 9.7% 18 10.1% 3 7.9% Hispanic 26 12.0% 18 10.1% 8 21.1% Other 2 0.9% 2 1.1% 0 0.0% 0.197 Body mass index (kg/m2) < 25 32 14.8% 25 14.0% 7 18.4% 25-30 68 31.5% 55 30.9% 13 34.2% 30-35 60 27.8% 50 28.1% 10 26.3% 35 + 56 25.9% 48 27.0% 8 21.1% 0.808 Prior abdominal surgery Yes 118 54.6% 104 58.4% 14 36.8% No 98 45.4% 74 41.6% 24 63.2% 0.015 Prior kidney surgery Yes 10 4.6% 9 5.1% 1 2.6% No 206 95.4% 169 94.9% 37 97.4% 0.518 Chronic kidney disease stage ≥ 3 Yes 45 20.8% 38 21.3% 7 18.4% No 171 79.2% 140 78.7% 31 81.6% 0.687 Charlson comorbidity index 0 138 63.9% 116 65.2% 22 57.9% 1 46 21.3% 38 21.4% 8 21.1% 2 19 8.8% 13 7.3% 6 15.8% ≥ 3 13 6.0% 11 6.2% 2 5.3% 0.412 Tumor size (cm) 2.7 (2-3.6) 2.8 (2-3.5) 2.55 (2-3.7) 0.796 Tumor laterality Left 100 46.3% 78 43.8% 22 57.9% Right 116 53.7% 100 56.2% 16 42.1% 0.114 Clinical T stage cT1a 186 86.1% 152 85.4% 34 89.5% cT1b 30 13.9% 26 14.6% 4 10.5% 0.509 RENAL Nephrometry score Low (4 to 6) 94 43.5% 76 42.7% 18 47.4% Intermediate (7 to 9) 112 51.9% 94 52.8% 18 47.4% High (≥ 10) 19 4.6% 8 4.5% 2 5.3% 0.829 TE tumor enucleation, SPN standard margin partial nephrectomy, IQR interquartile range.
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Affiliation(s)
- Nicholas J Lanzotti
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA.
| | - Michael Felice
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Sarang Janakiraman
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Owen Lewer
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Christopher James
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Jeffrey L Ellis
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Goran Rac
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
| | - Hiten D Patel
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gopal N Gupta
- Department of Urology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
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Xiong S, Fan S, Chen S, Wang X, Han G, Li Z, Zuo W, Li Z, Yang K, Zhang Z, Shen C, Zhou L, Li X. Robotic urologic surgery using the KangDuo-Surgical Robot-01 system: A single-center prospective analysis. Chin Med J (Engl) 2023; 136:2960-2966. [PMID: 38013503 PMCID: PMC10752469 DOI: 10.1097/cm9.0000000000002920] [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: 06/10/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system. METHODS From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed. RESULTS A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5 min, 157.0 min for pyeloplasty, 151.0 min for ureteral reconstruction, 142.5 min for UR, and 138.0 min for RP. The median intraoperative blood loss was 10 mL for PN, 10 mL for pyeloplasty, 30 mL for ureteral reconstruction, 20 mL for UR, and 50 mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively. CONCLUSION The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.
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Affiliation(s)
- Shengwei Xiong
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Silu Chen
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Guanpeng Han
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Wei Zuo
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Zhenyu Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
- National Urological Cancer Center, Beijing 100034, China
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Sri D, Malki M, Sarkar S, Ni Raghallaigh H, Oakley J, Kalsi M, Emara A, Hussain M, Barber NJ. Long term experience of robotic retroperitoneal partial nephrectomy as the default approach in the management of renal masses: should the paradigm shift? J Robot Surg 2023; 17:2001-2008. [PMID: 37106313 DOI: 10.1007/s11701-023-01582-2] [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: 01/08/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023]
Abstract
Although retroperitoneal surgery has demonstrated a better quality of recovery compared to transperitoneal routes, Retroperitoneal Robot Assisted Partial Nephrectomy (RRAPN) remains proportionally infrequent. As the boundaries of what is achievable robotically continue to be pushed, we present our experience at a high-volume tertiary referral centre that specialises in retroperitoneal surgery, exploring its feasibility as standard of care in the management of small renal masses. A prospective database of 784 RAPNs (2009-2020) was reviewed and 721 RRAPNs (92%) were performed at our centre. In our practice, we utilise a four-port approach to RRAPN. Patient, tumour and operative characteristics were assessed and both oncological outcomes and trifecta and pentafecta achievements were determined. Pentafecta was defined as achieving trifecta (negative surgical margin, no post-operative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Multivariate analysis was conducted to predict peri-operative factors which may prevent achieving a trifecta/pentafecta outcome. From 784 cases, 112 RAPNs were performed for imperative reasons, whilst the remainder were elective. Mean BMI ± s.d amongst our cohort was 28.6 ± 5.7. Mean tumour size was 3.1 cm (range 0.8-10.5 cm) and 47% of cases were stratified as intermediate/high risk using R.E.N.A.L nephrometry scoring. Forty-six patients had lesions in a hilar location, and 31% were anterior. Median blood loss was 30mls, with an open conversion rate of 1% and transfusion rate of 1.6%. Median warm ischaemic time (WIT) was 21 min, positive surgical margins were found in 4% and our post-operative Clavien 3/ > complication rate was 2.6%. We had a 1-day median length of stay with a 30 day readmission rate of 2%. Of 631 patients (80%) with a definitive histological diagnosis of cancer, 23% had T1b/ > disease. Over a mean 15 month follow-up period (range 1-125 months), 2% of patients developed recurrences and our cohort demonstrated a 99% 5 year cancer specific survival. Trifecta was achieved in 67% of cases and pentafecta in 47%. Age (p = 0.05), operative time (p = 0.008), pT1b tumours (p = 0.03), R.E.N.A.L score and blood loss (p = 0.001) were found to statistically significantly influence achievement of trifecta. Pentafecta achievement was influenced by R.E.N.A.L score (p = 0.008), operative time (p = 0.001) and blood loss (p = 0.001). We demonstrate the retroperitoneal approach in RAPN is feasible and safe irrespective of lesion location and complexity. In the hands of high-volume centres that are skilled in the retroperitoneal approach the benefits of retroperitoneal surgery can be extended even to challenging cohorts of patients without compromising their oncological or functional outcomes.
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Affiliation(s)
- D Sri
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK.
| | - M Malki
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - S Sarkar
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - H Ni Raghallaigh
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - J Oakley
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - M Kalsi
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - A Emara
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - M Hussain
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
| | - N J Barber
- Frimley Renal Cancer Centre, Frimley Health NHS Foundation Trust, Surrey, UK
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Chen S, Fan S, Guan H, Yang K, Li Z, Xiong S, Wang X, Li Z, Shen C, Zhou L, Li X. The application of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy with a new robotic system KangDuo Surgical Robot-01: Initial experience. Asian J Urol 2023; 10:482-487. [PMID: 38024439 PMCID: PMC10659978 DOI: 10.1016/j.ajur.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/21/2023] [Accepted: 03/15/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy (rRAPN) with a new robotic platform called KangDuo Surgical Robot-01 (KD-SR-01) system (Suzhou KangDuo Robot Co., Ltd., Suzhou, China) and discuss its surgical technique. Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney. The R.E.N.A.L. nephrometry score of this patient was 4x. This patient underwent rRAPN with KD-SR-01. The perinephric fat between the tumor and Gerota's fascia was preserved, which was used for internal suspension traction during tumor resection. Postoperative follow-up data were collected. Results The surgery was successfully carried out with a duration of 127 min, in which the docking time was 6 min 25 s and console time was 60 min. The warm ischemia time was 19 min 53 s, and the estimated blood loss was 0 mL. The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma, with a negative surgical margin. The World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade of this patient was Grade 2. No recurrence was observed during the 6-month follow-up. Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.
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Affiliation(s)
| | | | | | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhihua Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xiang Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Zhenyu Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Xicheng District, Beijing, China
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9
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Mjaess G, Bernhard JC, Khene ZE, Doumerc N, Vaessen C, Henon F, Bruyere F, Brenier M, Parier B, Albisinni S, Ingels A. Retroperitoneal vs. transperitoneal robotic partial nephrectomy: a multicenter propensity-score matching analysis (PADORA Study - UroCCR n° 68). Minerva Urol Nephrol 2023; 75:434-442. [PMID: 37530660 DOI: 10.23736/s2724-6051.23.05346-6] [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: 08/03/2023]
Abstract
BACKGROUND Robot-assisted partial nephrectomy can be performed through either a transperitoneal or retroperitoneal approach. This study aimed to compare the rate of trifecta achievement between retroperitoneal (RRPN) and transperitoneal (TRPN) robot-assisted partial nephrectomy using a large multicenter prospectively-maintained database and propensity-score matching analysis. METHODS This study was launched by the French Kidney Cancer Research Network, under the UroCCR Project (NCT03293563). Patients who underwent TRPN or RRPN by experienced surgeons in 15 participating centers were included. Data on demographic and clinical parameters, tumor characteristics, renal function, and surgical parameters were collected. The primary outcome was the rate of trifecta achievement, which was defined as a warm ischemia time of less than 25 minutes, negative surgical margins, and no major complications. Secondary outcomes included operative time, hospital length-of-stay, blood loss, postoperative complications, postoperative renal function, and each trifecta item taken alone. Subgroup analysis was done according to tumor location. RESULTS A total of 2879 patients (2581 TRPN vs. 298 RRPN) were included in the study. Before matching, trifecta was achieved in 73.0% of the patients in the TRPN group compared to 77.5% in the RRPN group (P=0.094). After matching 157 patients who underwent TRPN to 157 patients who underwent RRPN, the trifecta rate was 82.8% in the TRPN group vs. 84.0% in the RRPN group (P=0.065). The RRPN group showed shorter operative time (123 vs. 171 min; P<0.001) and less blood loss (161 vs. 293 mL; P<0.001). RRPN showed a higher trifecta achievement for posterior tumors than TRPN (71% vs. 81%; P=0.017). CONCLUSIONS RRPN is a viable alternative to the transperitoneal approach, particularly for posterior renal tumors, and is a safe and effective option for partial nephrectomy.
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Affiliation(s)
- Georges Mjaess
- Department of Urology, Brussels University Hospital, Brussels, Belgium -
| | | | | | | | | | | | | | - Martin Brenier
- Department of Urology, Hôpital Saint Joseph, Paris, France
| | - Bastien Parier
- Department of Urology, Hôpital Kremlin Bicêtre, Paris, France
| | - Simone Albisinni
- Department of Urology, Brussels University Hospital, Brussels, Belgium
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Alexandre Ingels
- Department of Urology, CHU Henri Mondor, Créteil, France
- Inserm, Clinical Investigation Center 1430, Henri Mondor University Hospital, AP-HP, Creteil, France
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10
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Sparwasser P, Frey L, Fischer ND, Thomas A, Dotzauer R, Surcel C, Brandt MP, Mager R, Höfner T, Haferkamp A, Tsaur I. First Comparison of Retroperitoneal Versus Transperitoneal Robot-Assisted Nephroureterectomy with Bladder Cuff: A Single Center Study. Ann Surg Oncol 2023:10.1245/s10434-023-13363-0. [PMID: 37099087 DOI: 10.1245/s10434-023-13363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/27/2023] [Indexed: 04/27/2023]
Abstract
INTRODUCTION After recent presentation of the first complete robot-assisted retroperitoneal nephroureterectomy with bladder cuff (RRNU) for patients with upper tract urothelial cancer (UTUC), we aimed to compare this new surgical technique with robot-assisted transperitoneal nephroureterectomy (TRNU) representing the current standard of care. METHODS Robot-assisted nephroureterectomies (NUs) were retrospectively analyzed and compared based on two groups: transperitoneal versus retroperitoneal approach. Baseline data were collected for patient demographics, tumor characteristics, intra- (EAUiaiC) and postoperative (Clavien-Dindo) complications, and perioperative variables. Tumor characteristics included grade of malignancy, clinical stage, and surgical margin status. Short-term follow-up data including 30-day readmission rates were collected. Statistical analyses were performed assuming a significant p-value of < 0.05. RESULTS The analysis includes perioperative patient data after proven UTUC of 24 TRNU versus 12 RRNU (mean age: 70 versus 71 years; BMI: 25.9 versus 26.1 kg/m2; CCI score ≥ 4: 83% versus 75%; ASA score ≥ 3: 37% vs 33%). Intraoperative (16.4% vs 0%, p = 0.35) and postoperative (25% vs 12.5%, p = 0.64) complications demonstrated no significant discrepancy. Notably, RRNU demonstrated significantly shorter surgery time (p < 0.05) and length of stay (p < 0.05). There was no significant difference in histopathological tumor characteristics, whereas significantly more lymph nodes were removed through RRNU (11.0±3.3 vs. 6.4±5.1, p < 0.05). Finally, no statistical difference was shown in short-term follow-up. CONCLUSION We report the first head-to-head comparison between RRNU and TRNU. RRNU proves to be a safe and feasible approach which appears to be non-inferior to TRNU. RRNU expands the spectrum of minimally invasive treatment options, particularly for patients with major previous abdominal surgery.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany.
| | - L Frey
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - N D Fischer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - C Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Mainz, Germany
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11
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Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients with Completely Lower Pole Renal Tumors. J Clin Med 2023; 12:jcm12020722. [PMID: 36675653 PMCID: PMC9860733 DOI: 10.3390/jcm12020722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
(1) Background: For completely lower pole renal tumors, we compared the perioperative outcomes of robotic partial nephrectomy via transperitoneal and retroperitoneal approaches. (2) Methods: Complete lower pole renal tumors were defined as tumors that received 1 point for the “L” element of the R.E.N.A.L. and located at the lower pole of kidney. After confirming consistency in baseline characteristics, oncological and functional benefits were compared. Pentafecta achievement was used to represent the perioperative optimal outcome, followed by multivariate analysis of factors associated with the lack of pentafecta achievement. (3) Results: Among 151 patients identified, 116 (77%) underwent robotic partial nephrectomy via a transperitoneal approach and 35 (23%) via a retroperitoneal approach. Patients undergoing transperitoneal robotic partial nephrectomy experienced more blood loss than those undergoing retroperitoneal robotic partial nephrectomy (50 mL vs. 40 mL, p = 0.015). No significant differences were identified for operative time (120 min vs. 120 min), ischemia time (19 min vs. 20 min), positive surgical margins (0.0% vs. 2.86%), postoperative rate of complication (12.07% vs. 5.71%). No significant differences were identified in pathologic variables, eGFR decline in postoperative 12-month (3.9% vs. 5.4%) functional follow-up. Multivariate cox analysis showed that tumor size (OR: 0.523; 95% CI: 0.371−0.736; p < 0.001) alone was independently correlated to the achievement of pentafecta. (4) Conclusions: For completely lower pole renal tumors, transperitoneal and retroperitoneal robotic partial nephrectomy provide similar outcomes. These two surgical approaches remain feasible options for these cases.
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12
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Li X, Xu W, Fan S, Xiong S, Dong J, Wang J, Dai X, Yang K, Xie Y, Liu G, Meng C, Zhang Z, Cai L, Zhang C, Zhang Z, Ji Z, Shen C, Zhou L. Robot-assisted Partial Nephrectomy with the Newly Developed KangDuo Surgical Robot Versus the da Vinci Si Surgical System: A Double-center Prospective Randomized Controlled Noninferiority Trial. Eur Urol Focus 2023; 9:133-140. [PMID: 36446724 DOI: 10.1016/j.euf.2022.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The KangDuo surgical robot (KD-SR) was recently developed in China. OBJECTIVE To compare the safety and efficacy of the KD-SR versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted partial nephrectomy (RAPN). DESIGN, SETTING, AND PARTICIPANTS A double-center prospective randomized controlled noninferiority trial of patients aged 18-75 yr with a suspicion of T1a N0M0 renal cancer (RENAL nephrometry score ≤9) was conducted. INTERVENTION RAPN with the KD-SR versus the DV-SS-Si. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the success rate of operation. The operation was successful if (1) there was no open or laparoscopic conversion, (2) the warm ischemia time was <30 min for RENAL nephrometry scores of 4-6 or 40 min for RENAL nephrometry scores of 7-9, and (3) the pathological margin was negative. The secondary endpoint was the estimated glomerular filtration rate (eGFR). A threshold of 10% was set to demonstrate noninferiority. RESULTS AND LIMITATIONS From September 2020 to March 2021, 100 participants were enrolled, of whom 99 (49 in the KD-SR group and 50 in the DV-SS-Si group) were finally included in the full analysis set and 98 (49 in the KD-SR group and -49 in the DV-SS-Si group) in the per-protocol set. Baseline demographic and clinical characteristics were similar between the two groups. All surgeries were completed successfully. The eGFR at postoperative weeks 4-12 and adverse events were similar between the two groups. The docking time and suture time per stitch were longer in the KD-SR group. The main limitation was that a negative margin was considered as the primary outcome rather than survival. CONCLUSIONS The KD-SR achieved noninferior outcomes as compared with the DV-SS-Si regarding safety and efficacy for T1a tumors. PATIENT SUMMARY The first trial comparing the KangDuo surgical robot (KD-SR) versus the da Vinci Si Surgical System for robot-assisted partial nephrectomy showed that the KD-SR is a viable option for minimally invasive treatment of T1a renal tumors.
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Affiliation(s)
- Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Weifeng Xu
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shubo Fan
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Shengwei Xiong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Jie Dong
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Wang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Xiaofei Dai
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
| | - Kunlin Yang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Yi Xie
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guanghua Liu
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chang Meng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Lin Cai
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Cuijian Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Zhongyuan Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China
| | - Zhigang Ji
- Department of urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | - Cheng Shen
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University. National Urological Cancer Center, Beijing, China.
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13
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Comparison of perioperative outcomes following transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a propensity-matched analysis of VCQI database. World J Urol 2022; 40:2283-2291. [PMID: 35867142 DOI: 10.1007/s00345-022-04101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/07/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To compare perioperative outcomes following retroperitoneal robot-assisted partial nephrectomy (RPRAPN) and transperitoneal robot-assisted partial nephrectomy (TPRAPN). METHODS With this Vattikuti Collective Quality Initiative (VCQI) database, study propensity scores were calculated according to the surgical access (TPRAPN and RPRAPN) for the following independent variables, i.e., age, sex, side of the surgery, RENAL nephrometry scores (RNS), estimated glomerular filtration rate (eGFR) and serum creatinine. The study's primary outcome was the comparison of trifecta between the two groups. RESULTS In this study, 309 patients who underwent RPRAPN were matched with 309 patients who underwent TPRAPN. The two groups matched well for age, sex, tumor side, polar location of the tumor, RNS, preoperative creatinine and eGFR. Operative time and warm ischemia time were significantly shorter with RPRAPN. Intraoperative blood loss and need for blood transfusion were lower with RPRAPN. There was a significantly higher number of intraoperative complications with RPRAPN. However, there was no difference in the two groups for postoperative complications. Trifecta outcomes were better with RPRAPN (70.2% vs. 53%, p < 0.0001) compared to TPRAPN. We noted no significant change in overall results when controlled for tumor location (anteriorly or posteriorly). The surgical approach, tumor size and RNS were identified as independent predictors of trifecta on multivariate analysis. CONCLUSION RPRAPN is associated with superior perioperative outcomes in well-selected patients compared to TPRAPN. However, the data for the retroperitoneal approach were contributed by a few centers with greater experience with this technique, thus limiting the generalizability of the results of this study.
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14
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Xu W, Dong J, Xie Y, Liu G, Zhou J, Wang H, Zhang S, Wang H, Ji Z, Cui L. Robot-assisted partial nephrectomy with a new robotic surgical system: feasibility and perioperative outcomes. J Endourol 2022; 36:1436-1443. [PMID: 35838131 DOI: 10.1089/end.2022.0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility and safety of a novel robotic system (KD-SR-01) for partial nephrectomy. METHODS Seventeen patients with small renal mass (SRM) (≤4 cm) underwent KD-SR-01 robotic partial nephrectomy (KD-RPN) from December 2020 to March 2021 in our institution. The operative outcomes and perioperative data, including clinical and histological data, were prospectively collected and analyzed. RESULTS In total, 10 men and 7 women, with a median age of 51 years, underwent KD-RPN. Four transperitoneal procedures and 13 retroperitoneal procedures were successfully performed without conversion to open or conventional laparoscopic surgery. The docking time and robotic operative time were 3.3 min and 68.6 min, respectively. The warm ischemia time was 16.9 min. No major intraoperative or postoperative complications (Clavien grade ≥ III) occurred. The duration of postoperative hospital stay was 5 days. Pathologic examination revealed nine clear cell carcinomas, two papillary cell carcinomas, one oncocytoma, and five angiomyolipoma. All surgical margins were negative. The estimated globular filtration rate (eGFR) on the 1st postoperative day was significantly decreased compared to the preoperative eGFR (91.7±12.9 ml/min vs. 97.9±10.7 ml/min, P =0.036). However, no significant difference was observed between the preoperative eGFR and the value on the 4th postoperative day (95.7±13.4 ml/min vs. 97.9±10.7 ml/min, P=0.427). CONCLUSION KD-RPN was safe and feasible for the treatment of SRM. The early oncologic and functional outcomes were promising. Long-term follow-up and well-designed prospective comparative studies with the da Vinci platform are needed to corroborate these findings.
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Affiliation(s)
- Weifeng Xu
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Jie Dong
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Yi Xie
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Guanghua Liu
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Jingmin Zhou
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Huizhen Wang
- Peking Union Medical College Hospital, 34732, Department of operating room, Beijing, China;
| | - Shengjie Zhang
- Peking Union Medical College Hospital, 34732, Department of operating room, Beijing, China;
| | - Hui Wang
- Peking Union Medical College Hospital, 34732, Department of operating room, Beijing, China;
| | - Zhigang Ji
- Peking Union Medical College Hospital, 34732, Department of Urology, Beijing, China;
| | - Liang Cui
- Civil Aviation General Hospital, 117987, Department of Urology, Beijing, China;
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15
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Jiang XL, OuYang K, Yang R, Yu XY, Yang DD, Wu JT, Zhao HW. The application of internal traction technique in retroperitoneal robot-assisted partial nephrectomy for renal ventral tumors. World J Surg Oncol 2022; 20:213. [PMID: 35739505 PMCID: PMC9219164 DOI: 10.1186/s12957-022-02684-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background For patients with prior intra-abdominal surgery or multiple arteries, the retroperitoneal robot-assisted partial nephrectomy (rRAPN) is a better choice. The renal ventral tumor poses an additional challenge due to poor tumor exposure. This study is determined to assess the feasibility of an internal traction technique (ITT) in rRAPN for the management of renal ventral tumors. Methods From November 2019 to March 2021, a total of 28 patients with renal ventral tumor underwent rRAPN. All patients had prior abdominal surgery or multiple arteries. The ITT group (20 patients), which improved the tumor exposure by traction of the kidney with suture, was compared with the traditional technique group (8 patients) in terms of warm ischemia time, estimated blood loss and postoperative hospital stay, retroperitoneal drainage, R.E.N.A.L. score, and serum creatinine. Differences were considered significant when P < 0.05. Results All rRAPN surgeries were successful without conversion to radical nephrectomy or open partial nephrectomy. The warm ischemia time was lower in the ITT group (17.10 min vs. 24.63 min; P < 0.05). Estimated blood loss in the traditional technique group was 324.88 ± 79.42 mL, and in the ITT group, it was 117.45±35.25 mL (P < 0.05). No significant differences with regard to postoperative hospital stay, retroperitoneal drainage, R.E.N.A.L. score, and serum creatinine were observed between both groups. Surgical margins were negative and no intraoperative complications occurred in all the patients. After 10 months of follow-up, no recurrence or metastasis occurred in all cases. Conclusion ITT is a feasible, safe, and valid procedure in rRAPN for renal ventral tumors. Application of ITT improved the exposure and reduces warm ischemic time in comparison with the conventional procedure. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02684-1.
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Affiliation(s)
- Xiao-Lu Jiang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Kui OuYang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Rui Yang
- Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Xiao-Yang Yu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Dian-Dong Yang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Ji-Tao Wu
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
| | - Hong-Wei Zhao
- Department of Urology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, NO. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
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Retroperitoneal Robot-assisted Partial Nephrectomy: A Systematic Review and Pooled Analysis of Comparative Outcomes. EUR UROL SUPPL 2022; 40:27-37. [PMID: 35515269 PMCID: PMC9062267 DOI: 10.1016/j.euros.2022.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/20/2023] Open
Abstract
Context Robot-assisted partial nephrectomy (RAPN) has gained increasing popularity as primary minimally invasive surgical treatment for localized renal tumors, and it has preferably been performed with a transperitoneal approach. However, the retroperitoneal approach represents an alternative approach given potential advantages. Objective To provide an updated analysis of the comparative outcomes of retroperitoneal RAPN (R-RAPN) versus transperitoneal RAPN (T-RAPN). Evidence acquisition A systematic review of the literature was performed up to September 2021 using MEDLINE, EMBASE, and Web of Science databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. A sensitivity analysis was performed considering only matched-pair studies. Evidence synthesis Seventeen studies, which were published between 2013 and 2021, were retrieved. None of them was a randomized clinical trial. Among the 6,266 patients included in the meta-analysis, 2261 (36.1%) and 4,005 (63.9%) underwent R-RAPN and T-RAPN, respectively. No significant difference was found in terms of baseline features. The T-RAPN group presented a higher rate of male patients (odds ratio [OR]: 0.86, p = 0.03) and larger tumor size (weighted mean difference [WMD]: 0.2 cm; p = 0.003). The R-RAPN group reported more frequent posterior renal masses (OR: 0.23; p < 0.0001). The retroperitoneal approach presented lower estimated blood loss (WMD: 30.41 ml; p = 0.001), shorter operative time (OT; WMD: 20.36 min; p = 0.0001), and shorter length of stay (LOS; WMD: 0.35 d; p = 0.002). Overall complication rates were 13.7% and 16.05% in the R-RAPN and T-RAPN groups, respectively (OR: 1.32; p = 0.008). There were no statistically significant differences between the two groups regarding major (Clavien-Dindo classification ≥3 grade) complication rate, “pentafecta” achievement, as well as positive margin rates. When considering only matched-pair studies, no difference between groups was found in terms of baseline characteristics. Posterior renal masses were more frequent in the R-RAPN group (OR: 0.6; p = 0.03). Similar to the analysis of the entire cohort, R-RAPN reported lower EBL (WMD: 35.56 ml; p < 0.0001) and a shorter OT (WMD: 18.31 min; p = 0.03). Overall and major complication rates were similar between the two groups. The LOS was significantly lower for R-RAPN (WMD: 0.46 d; p = 0.02). No statistically significant difference was found between groups in terms of overall PSM rates. Conclusions R-RAPN offers similar surgical outcomes to T-RAPN, and it carries potential advantages in terms of shorter OT and LOS. Available evidence remains limited by the lack of randomized clinical trials. Patient summary In this review of the literature, we looked at comparative outcomes of two surgical approaches to robot-assisted partial nephrectomy. We found that the retroperitoneal technique offers similar surgical outcomes to the transperitoneal one, with potential advantages in terms of shorter operative time and length of hospital stay.
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17
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Sparwasser P, Epple S, Thomas A, Dotzauer R, Boehm K, Brandt MP, Mager R, Borgmann H, Kamal MM, Kurosch M, Höfner T, Haferkamp A, Tsaur I. First completely robot-assisted retroperitoneal nephroureterectomy with bladder cuff: a step-by-step technique. World J Urol 2022; 40:1019-1026. [PMID: 35037964 PMCID: PMC8994743 DOI: 10.1007/s00345-021-03920-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction While various surgical techniques have been reported for open and minimally invasive treatment of upper tract urothelial cancer (UTUC), the procedure of robot-assisted nephroureterectomy (NU) with bladder cuff has never been reported using only retroperitoneum without entering abdominal cavity. We developed a novel port placement and technique allowing to perform robot-assisted NU by a unique retroperitoneal approach. Methods Between February and June 2021 patients with history of UTUC were treated by robot-assisted NU completely restricted to retroperitoneal space using a singular trocar placement and a two-step docking without relocation of the surgical robot. Patient characteristics, perioperative outcomes and short-term follow-up were prospectively analyzed. Results The analysis included five patients [median age: 73 years; BMI: 27.2 kg/m2; Charlson comorbidity index 5]. All five patients had UTUC with a mean tumor size of 3.02 cm (range 0.9–6.0). UTUC was localized to distal ureter in two and to kidney in three cases. No positive surgical margins were noted for all patients with UTUC [1 low-grade and 4 high-grade]. Retroperitoneal lymphadenectomy in three patients did not reveal positive nodes. No intraoperative adverse events exceeding EAUiaiC classification ≥ 2 were observed, while median EBL was 150 ml (IQR 100–250). No patient experienced postoperative complications exceeding Clavien–Dindo classification ≥ 3a. Median hospital stay was 5.4d without any 30-d readmission. Conclusion We demonstrate safety and feasibility of the first entire robot-assisted retroperitoneal nephroureterectomy (RRNU) with bladder cuff. This surgical technique is easily reproducible, while surgical outcomes are similar to other established techniques. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03920-1.
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Affiliation(s)
- P Sparwasser
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - S Epple
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Thomas
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Dotzauer
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - K Boehm
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M P Brandt
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - R Mager
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - H Borgmann
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M M Kamal
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Kurosch
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - T Höfner
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - A Haferkamp
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - I Tsaur
- Department of Urology, University Medical Center Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Rath L, Jokisch F, Schulz GB, Kretschmer A, Buchner A, Stief CG, Weinhold P. Combined Open Prostatectomy and Kidney Surgery: Feasibility and 12-Month Outcome. Res Rep Urol 2021; 13:815-821. [PMID: 34849371 PMCID: PMC8627302 DOI: 10.2147/rru.s341823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/09/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose There are only a few case reports and case series that investigated combined laparoscopic or robotic surgery for simultaneous prostate and kidney cancer. In this study, we want to close a gap in existing research to assess the feasibility and oncological outcome of combined open prostatectomy and kidney surgery. Methods We retrospectively analyzed patients who underwent a combined open prostatectomy and either a partial or complete nephrectomy from 2013 to 2020. Descriptive statistics were used to assess perioperative parameters and the 12-month functional and oncological outcomes after combined surgery. Results We identified 10 patients undergoing combined open surgery. Partial nephrectomy was performed in 4, radical nephrectomy in 6 patients. For prostate cancer, histopathological analysis showed a tumor stage ≥ pT2c in all 10 patients. For renal tumors, histopathological analysis showed clear cell renal cell carcinoma in 8 patients and oncocytoma in 2 patients. Operating time was 177 ± 36 minutes. Two perioperative complications (Clavien 2a and 3) were observed. Three months postoperatively, the International Index of Erectile Function (IIEF-5) score was 5.6 ± 5.9, the ICIQ-SF score was 7.3 ± 5.6 and were using 1.9 ± 2.2 pads per day. This improved after 12 months postoperatively, as patients had an IIEF-5 score of 6.33 ± 6.5, an ICIQ-SF score of 4.4 ± 5.7 and were using pads 0.9 ± 1.7 per day. Conclusion In this study, we showed that open surgery is a safe and valid approach for combined prostatectomy and renal surgery with acceptable complications and oncological outcomes. The combined open approach could be a good alternative to combined laparoscopic/robotic surgery in this field, especially to treat patients with advanced renal tumors or previous abdominal surgery or radiation.
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Affiliation(s)
- Lukas Rath
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
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Carbonara U, Eun D, Derweesh I, Capitanio U, Celia A, Fiori C, Checcucci E, Amparore D, Lee J, Larcher A, Patel D, Meagher M, Crocerossa F, Veccia A, Hampton LJ, Montorsi F, Porpiglia F, Autorino R. Retroperitoneal versus transepritoneal robot-assisted partial nephrectomy for postero-lateral renal masses: an international multicenter analysis. World J Urol 2021; 39:4175-4182. [PMID: 34050813 DOI: 10.1007/s00345-021-03741-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/20/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To assess the outcomes of retroperitoneal robot-assisted partial nephrectomy (r-RAPN) in a large cohort of patients with postero-lateral renal masses comparing to those of transperitoneal RAPN (t-RAPN). METHODS Patients with posterior (R.E.N.A.L. score grading P) or lateral (grading X) renal mass who underwent RAPN in six high-volume US and European centers were identified and stratified into two groups according to surgical approach: r-RAPN ("study group") and t-RAPN ("control group"). Baseline characteristics, intraoperative, and postoperative data were collected and compared. RESULTS Overall, 447 patients were identified for the analysis. 231 (51.7%) and 216 (48.3%) patients underwent r-RAPN and t-RAPN, respectively. Baseline characteristics were not statistically significantly different between the groups. r-RAPN group reported lower median operative time (140 vs. 170 min, p < 0.001). No difference was found in ischemia time, estimated blood loss, and intraoperative complications. Overall, 47 and 54 postoperative complications were observed in r-RAPN and t-RAPN groups, respectively (20.3 vs. 25.1%, p = 0.9). 1 and 2 patients reported major complications (Clavien-Dindo ≥ III grade) in the retroperitoneal and transperitoneal groups (0.4 vs. 0.9%, p = 0.9). There was no difference in hospital re-admission rate, median length of stay, and PSM rate. Trifecta criteria were achieved in 90.3 and 89.2% of r-RAPN and t-RAPN, respectively (p = 0.7). CONCLUSION r-RAPN and t-RAPN offer similar postoperative, functional, and oncological outcomes for patients with postero-lateral renal tumors. Our analysis suggests an advantage for r-RAPN in terms of shorter operative time, whereas it does not confirm a difference in terms of length of stay, as suggested by previous reports.
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Affiliation(s)
- Umberto Carbonara
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA.,Department of Urology, University of Bari, Bari, Italy
| | - Daniel Eun
- Department of Urology, Temple University, Philadelphia, PA, USA
| | | | - Umberto Capitanio
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Jennifer Lee
- Department of Urology, Temple University, Philadelphia, PA, USA
| | - Alessandro Larcher
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Devin Patel
- Department of Urology, UCSD, San Diego, CA, USA
| | | | | | | | - Lance J Hampton
- Division of Urology, VCU Health, Richmond, VA, 23298-0118, USA
| | - Francesco Montorsi
- Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Italy
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20
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Zhou J, Liu ZH, Cao DH, Peng ZF, Song P, Yang L, Liu LR, Wei Q, Dong Q. Retroperitoneal or transperitoneal approach in robot-assisted partial nephrectomy, which one is better? Cancer Med 2021; 10:3299-3308. [PMID: 33932108 PMCID: PMC8124103 DOI: 10.1002/cam4.3888] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To systematically assess the perioperative outcomes of retroperitoneal (RP) and transperitoneal (TP) approaches in robot‐assisted partial nephrectomy (RAPN), we conducted an updated meta‐analysis. Methods A literature retrieval of multi‐database including PubMed, Web of Science, Embase, Cochrane Library, and CNKI was performed to identify eligible comparative studies from the inception dates to January 2021. Perioperative outcomes included operative time (OT), estimated blood loss (EBL), warm ischemia time (WIT), postoperative length of stay (PLOS), positive surgical margin (PSM), and complications (major complications and overall complications). Outcomes of data were pooled and analyzed with Review Manager 5.4.1. Results Twenty‐one studies involving a total of 2482 RP and 3423 TP approach RAPN patients met the inclusion criteria. Operating time (OT) (weighted mean difference [WMD] −16.60; 95% confidence interval [CI] −23.08, −10.12; p < 0.01) and PLOS (WMD −0.46 days; 95% CI −0.69, −0.23; p < 0.01) were shorter in RP‐RAPN. Besides, lower EBL (WMD −21.67; 95% CI −29.74, −13.60; p < 0.05) was also found in RP‐RAPN. Meanwhile, no significant differences were found in other outcomes. Conclusions RP‐RARN was superior to TP‐RAPN in patients undergoing RAPN in terms of OT, PLOS, and estimated blood loss. Besides these two approaches have no significant differences in PSMs or perioperative complications.
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Affiliation(s)
- Jing Zhou
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - Zheng-Huan Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - De-Hong Cao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhu-Feng Peng
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Song
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - Luchen Yang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - Liang-Ren Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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Farinha R, Rosiello G, Paludo ADO, Mazzone E, Puliatti S, Amato M, De Groote R, Piazza P, Berquin C, Montorsi F, Schatteman P, De Naeyer G, D'Hondt F, Mottrie A. Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis. Eur Urol Focus 2021; 8:506-513. [PMID: 33775611 DOI: 10.1016/j.euf.2021.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/26/2021] [Accepted: 03/14/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Despite efforts aimed at preserving renal function, the functional decline after robot-assisted partial nephrectomy (RAPN) is not negligible. To address the risk of intraparenchymal vessel injuries during renorrhaphy, with consequent loss of functional renal parenchyma, we introduced a new surgical technique for RAPN. OBJECTIVE To compare perioperative patient outcomes between selective-suturing or sutureless RAPN (suRAPN) and standard RAPN (stRAPN). DESIGN, SETTING, AND PARTICIPANTS Ninety-two consecutive patients undergoing RAPN for a renal mass performed by a high-volume surgeon at a European tertiary center were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. INTERVENTION RAPN using a selective-suturing or sutureless technique versus standard RAPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Perioperative outcomes included operative time, blood loss, length of stay, and intraoperative and 30-d postoperative complications. We also evaluated trifecta achievement (warm ischemia time ≤25 min, negative surgical margins, and no perioperative complications) and the incidence of postoperative acute kidney injury (AKI). We applied χ2 tests, t tests, and Kruskal-Wallis tests to assess differences in perioperative outcomes between suRAPN and stRAPN. RESULTS AND LIMITATIONS Overall, 29 patients (31%) were treated with suRAPN. Only one suRAPN patient experienced intraoperative complications (p = 0.9). Two suRAPN patients (6.9%) and four stRAPN patients (13.8%) experienced 30-d postoperative complications (p = 0.3). Operative time (110 vs 150 min; p < 0.01) and length of stay (2 vs 3 d; p = 0.02) were shorter for suRAPN than for stRAPN. The trifecta outcome was achieved in 25 suRAPN patients (86%) and 20 stRAPN patients (70%; p = 0.1). Only one suRAPN patient (3.4%) versus five stRAPN patients (17%) experienced postoperative AKI (p = 0.2). Finally, the decrease in the estimated glomerular filtration rate at 6-mo follow-up was lower in the suRAPN (-5.2%) than in the stRAPN group (-9.1%; p < 0.01). Lack of randomization represents the main study limitation. CONCLUSIONS A selective-suturing or sutureless technique in RAPN is feasible and safe. Moreover, suRAPN is a lower-impact surgical procedure. We obtained promising results for trifecta and functional outcomes, but prospective randomized trials are needed to validate the impact of selective suturing or a sutureless technique on long-term functional outcomes. PATIENT SUMMARY We assessed a new technique in robotic surgery to remove part of the kidney because of kidney cancer. Our new technique involves selective suturing or no suturing of the area from where the tumor is removed. We found that the rate of complications did not increase and the operating time and length of hospital stay were shorter using this new technique.
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Affiliation(s)
- Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Giuseppe Rosiello
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Artur De Oliveira Paludo
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Clinic Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Elio Mazzone
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Puliatti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Amato
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Pietro Piazza
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Bologna, Bologna, Italy
| | - Camille Berquin
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Francesco Montorsi
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Peter Schatteman
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium; ORSI Academy, Melle, Belgium
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