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Song Z, Xing J, Sun Z, Kang X, Li H, Ren G, Wang Y. Time trends in surgical provision and cancer-specific outcomes in patients with stage T2-3 kidney cancer: a SEER-based study. Front Surg 2024; 11:1370702. [PMID: 38742149 PMCID: PMC11089187 DOI: 10.3389/fsurg.2024.1370702] [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: 01/15/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Background and objective Surgery is the primary therapy that crucially affects the survival of patients with kidney cancer (KC). However, pertinent surgical decision criteria for individuals with stage T2-3 KC are lacking. This study aimed to display the practical choices and evolving trends of surgical procedures and elucidate their implied value. Methods Through the Surveillance, Epidemiology, and End Results (SEER) dataset, the levels and evolving trends of different surgical methods were examined to determine cancer-specific risk of death (CSRD). Additionally, stratification analysis and survival rate analysis were performed to explore the effectiveness of partial nephrectomy (PN). Results In this study, 9.27% of patients opted for PN. Interestingly, an upward trend was observed in its decision, with an average annual percentage change (AAPC) of 7.0 (95% CI: 4.8-9.3, P < 0.05). Patients who underwent PN and were in a relatively less severe condition exhibited more favorable CSRD levels (0.17-0.36 vs. 0.50-0.67) and an improvement trend compared with those who underwent radical nephrectomy (RN) (AAPC: -1.9 vs. -0.8). Further analysis showed that the levels of CSRD and survival rates for patients opting for different surgical methods followed a similar pattern. Conclusions This study showed that RN was still the most common surgical method. Patients with stage T2-3 KC had an increasing preference for PN and exhibited more favorable cancer-related survival outcomes, which underscores the need for further investigation and validation.
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Affiliation(s)
- Zhuo Song
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jizhang Xing
- Department of Urology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Zhijia Sun
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Xiaoli Kang
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Hongzhao Li
- Department of Urology, The General Hospital of the People’s Liberation Army, Beijing, China
| | - Gang Ren
- Department of Radiotherapy, Peking University Shougang Hospital, Beijing, China
| | - Yingjie Wang
- Department of Radiotherapy, Air Force Medical Center, Air Force Medical University, Beijing, China
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Zhang TR, Thorogood SL, Sze C, Fisch R, Chughtai B, Te A, Lee RK, Hu JC. Current Practice Patterns in the Surgical Management of Benign Prostatic Hyperplasia. Urology 2023; 175:157-162. [PMID: 36863599 DOI: 10.1016/j.urology.2023.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To use American Board of Urology (ABU) case log data to elucidate practice patterns for benign prostatic hyperplasia (BPH) surgery. Several surgical modalities have been introduced in recent decades causing significant practice variation. MATERIALS AND METHODS We retrospectively analyzed ABU case logs from 2008-2021 to assess trends in BPH surgery. We created logistic regression models to identify surgeon-sided factors associated with utilization of each surgical modality. RESULTS We identified 6,632 urologists who logged 73,884 surgeries for BPH. Transurethral resection of the prostate (TURP) was the most commonly performed BPH surgery in all but 1 year, and odds of performing a TURP increased year-over-year (OR 1.055, 95% CI [1.013,1.098], P = .010). The use of holmium laser enucleation of the prostate (HoLEP) did not change over time. HoLEP was more likely to be performed by urologists with higher BPH surgical volume (OR 1.017, CI [1.013, 1.021], P < .001) and with endourology subspecialization (OR 2.410, CI [1.45, 4.01], P = .001). Prostatic urethral lift (PUL) utilization increased significantly since its introduction in 2015 (OR 1.663, CI [1.540, 1.796], P < .001). PUL currently comprises over one third of all BPH surgeries logged. CONCLUSION In the face of newer technologies, TURP remains the most common surgery for BPH in the United States. PUL has been rapidly adopted while HoLEP comprises a consistent minority of cases. Surgeon age, patient age, and urologist subspecialization were associated with use of certain BPH surgical approaches.
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Affiliation(s)
- Tenny R Zhang
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Samantha L Thorogood
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Christina Sze
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Robert Fisch
- Department of Urology, NewYork-Presbyterian Hospital, New York, NY; Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Alexis Te
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical Center, New York, NY
| | - Jim C Hu
- Department of Urology, Weill Cornell Medical Center, New York, NY.
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Chae D, Kim NY, Kim KJ, Park K, Oh C, Kim SY. Predictive models for chronic kidney disease after radical or partial nephrectomy in renal cell cancer using early postoperative serum creatinine levels. J Transl Med 2021; 19:307. [PMID: 34271916 PMCID: PMC8283951 DOI: 10.1186/s12967-021-02976-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Several predictive factors for chronic kidney disease (CKD) following radical nephrectomy (RN) or partial nephrectomy (PN) have been identified. However, early postoperative laboratory values were infrequently considered as potential predictors. Therefore, this study aimed to develop predictive models for CKD 1 year after RN or PN using early postoperative laboratory values, including serum creatinine (SCr) levels, in addition to preoperative and intraoperative factors. Moreover, the optimal SCr sampling time point for the best prediction of CKD was determined. Methods Data were retrospectively collected from patients with renal cell cancer who underwent laparoscopic or robotic RN (n = 557) or PN (n = 999). Preoperative, intraoperative, and postoperative factors, including laboratory values, were incorporated during model development. We developed 8 final models using information collected at different time points (preoperative, postoperative day [POD] 0 to 5, and postoperative 1 month). Lastly, we combined all possible subsets of the developed models to generate 120 meta-models. Furthermore, we built a web application to facilitate the implementation of the model. Results The magnitude of postoperative elevation of SCr and history of CKD were the most important predictors for CKD at 1 year, followed by RN (compared to PN) and older age. Among the final models, the model using features of POD 4 showed the best performance for correctly predicting the stages of CKD at 1 year compared to other models (accuracy: 79% of POD 4 model versus 75% of POD 0 model, 76% of POD 1 model, 77% of POD 2 model, 78% of POD 3 model, 76% of POD 5 model, and 73% in postoperative 1 month model). Therefore, POD 4 may be the optimal sampling time point for postoperative SCr. A web application is hosted at https://dongy.shinyapps.io/aki_ckd. Conclusions Our predictive model, which incorporated postoperative laboratory values, especially SCr levels, in addition to preoperative and intraoperative factors, effectively predicted the occurrence of CKD 1 year after RN or PN and may be helpful for comprehensive management planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02976-2.
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Affiliation(s)
- Dongwoo Chae
- Department of Pharmacology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyemyung Park
- Department of Pharmacology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chaerim Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Grimaud LW, Chen FV, Chang J, Ziogas A, Sfakianos J, Badani KK, Uchio E, Anton-Culver H, Gin G. Comparison of Perioperative Outcomes for Radical Nephrectomy Based on Surgical Approach for Masses Greater than 10cm. J Endourol 2021; 35:1785-1792. [PMID: 34148404 DOI: 10.1089/end.2020.1164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objective Robotic-assisted radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and objective benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, perioperative outcomes of RRN, LRN, and ORN for very large renal masses are compared. Methods Using the National Cancer Database, patients were identified who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. Patients were analyzed according to surgical approach. Perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. Results A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). Compared to ORN, recipients of RRN or LRN had similar rates of 30-day readmission and 30- and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ±0.19; p<0.0001) and LRN (-1.40 days ±0.12; p<0.0001) compared to ORN. LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. Conclusions Minimally invasive approaches are increasingly utilized in very large renal masses. RRN has lower rates of conversion to open but produces comparable perioperative outcomes to LRN. Minimally invasive approaches have a shorter length of inpatient stay but otherwise report similar surgical margin status, readmission rates, and mortality rates compared to open radical nephrectomy.
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Affiliation(s)
- Logan Wilson Grimaud
- University of California Irvine, 8788, Urology, 101 The City Drive South, Orange, California, United States, 92868;
| | - Felix V Chen
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jenny Chang
- University of California Irvine, 8788, Medicine, 301 Med Surge II, Irvine, California, United States, 92697;
| | - Argyrios Ziogas
- University of California Irvine School of Medicine, 12219, Medicine, Irvine, California, United States;
| | - John Sfakianos
- Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States;
| | - Ketan K Badani
- Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States;
| | - Edward Uchio
- UCI Health, 14447, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868-3201;
| | - Hoda Anton-Culver
- University of California Irvine School of Medicine, 12219, Medicine , Irvine, California, United States;
| | - Greg Gin
- UCI, 8788, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.,VA Medical Center Long Beach, 19974, Long Beach, California, United States, 90822-5201;
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Arroyo NA, Gessert T, Hitchcock M, Tao M, Smith CD, Greenberg C, Fernandes-Taylor S, Francis DO. What Promotes Surgeon Practice Change? A Scoping Review of Innovation Adoption in Surgical Practice. Ann Surg 2021; 273:474-482. [PMID: 33055590 PMCID: PMC10777662 DOI: 10.1097/sla.0000000000004355] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The goal of this scoping review was to summarize the literature on facilitators and barriers to surgical practice change. This information can inform research to implement best practices and evaluate new surgical innovations. BACKGROUND In an era of accelerated innovations, surgeons face the difficult decision to either acknowledge and implement or forgo new advances. Although changing surgical practice to align with evidence is an imperative of health systems, evidence-based guidelines have not translated into consistent change. The literature on practice change is limited and has largely focused on synthesizing information on methods and trials to evaluate innovative surgical interventions. No reviews to date have grounded their analysis within an implementation science framework. METHODS A systematic review of the literature on surgical practice change was performed. Abstracts and full-text articles were reviewed for relevance using inclusion and exclusion criteria and data were extracted from each article. Cited facilitators and barriers were then mapped across domains within the implementation science Theoretical Domains Framework and expanded to the Capability, Opportunity, Motivation, and Behavior model. RESULTS Components of the Capability, Opportunity, Motivation, and Behavior model were represented across the Theoretical Domains Framework domains and acted as both facilitators and barriers to practice change depending on the circumstances. Domains that most affected surgical practice change, in order, were: opportunity (environmental context and resources and social influences), capability (knowledge and skills), and motivation (beliefs about consequences and reinforcement). CONCLUSIONS Practice change is predicated on a conducive environment with adequate resources, but once that is established, the surgeon's individual characteristics, including skills, motivation, and reinforcement determine the likelihood of successful change. Deficiencies in the literature underscore the need for further study of resource interventions and the role of surgical team dynamics in the adoption of innovation. A better understanding of these areas is needed to optimize our ability to disseminate and implement best practices in surgery.
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Affiliation(s)
- Natalia A. Arroyo
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Thomas Gessert
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mary Hitchcock
- Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael Tao
- Department of Otolaryngology, The State University of New York, Syracuse, New York
| | - Cara Damico Smith
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Caprice Greenberg
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sara Fernandes-Taylor
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - David O. Francis
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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6
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Hupe MC, Büttner M, Tabrizi PF, Merseburger AS, Kuczyk MA, Imkamp F. Hemopatch ® as a Hemostatic Agent is Safe in Partial Nephrectomy: A Large, Single-Surgeon Retrospective Evaluation. Adv Ther 2021; 38:1024-1034. [PMID: 33277680 PMCID: PMC7889526 DOI: 10.1007/s12325-020-01584-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/19/2020] [Indexed: 01/20/2023]
Abstract
Introduction Partial nephrectomy (PN) has evolved into the surgical standard of care for localized renal lesions. Hemostatic agents (HA) support the surgeon in achieving local hemostasis during PN. We previously reported initial results with the HA Hemopatch® in PN. We now report our experiences with Hemopatch® in a larger and more challenging single-surgeon PN cohort. Methods Our study included 45 patients who underwent PN due to suspicious renal lesions between December 2013 and March 2018. All surgeries were performed by a single surgeon using the HA Hemopatch®. Preoperative, intraoperative, and postoperative parameters were assessed. Results Preoperative median tumor diameter was 27 mm. Median PADUA and RENAL nephrometry scores were 7 and 6, respectively. In 13.3% of the cases an additional HA was applied. Intraoperative and postoperative bleeding occurred in 2.2% and 8.9%, respectively. Median total blood loss was 200 ml. Urgent pedicle clamping due to bleeding was necessary in 2 (4.4%) patients. The transfusion rate was 8.9%. There were no conversions. Conclusion We confirmed our initial results demonstrating feasibility and reliability of Hemopatch® during PN. Notably, the cohort consists of selected patients. Prospective randomized studies are needed for comparison of different types of HA with regard to perioperative outcome.
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Affiliation(s)
- Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee, Luebeck, Germany
| | | | | | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee, Luebeck, Germany
| | - Markus A Kuczyk
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Florian Imkamp
- Department of Urology, Hannover Medical School, Hannover, Germany.
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Lin V, Mai HC, Wu CH, Lin YY, Kuo WT, Lee YH, Li RC, Wu R. Using R.E.N.A.L. nephrometry and preoperative aspects and dimensions employed for anatomical classification to evaluate perioperative outcomes of renal tumors greater than 4 cm in patients who underwent minimally invasive partial nephrectomy in a single center. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_78_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Kalapara AA, Frydenberg M. The role of open radical nephrectomy in contemporary management of renal cell carcinoma. Transl Androl Urol 2020; 9:3123-3139. [PMID: 33457285 PMCID: PMC7807349 DOI: 10.21037/tau-19-327] [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] [Indexed: 12/24/2022] Open
Abstract
Radical nephrectomy (RN) remains a cornerstone of the management of localised renal cell carcinoma (RCC). RN involves the en bloc removal of the kidney along with perinephric fat enclosed within Gerota's fascia. Key principles of open RN include appropriate incision for adequate exposure, dissection and visualisation of the renal hilum, and early ligation of the renal artery and subsequently renal vein. Regional lymph node dissection (LND) facilitates local staging but its therapeutic role remains controversial. LND is recommended in patients with high risk clinically localised disease, but its benefit in low risk node-negative and clinically node-positive patients is unclear. Concomitant adrenalectomy should be reserved for patients with large tumours with radiographic evidence of adrenal involvement. Despite a recent downtrend in utilisation of open RN due to nephron-sparing and minimally invasive alternatives, there remains a vital role for open RN in the management of RCC in three domains. Firstly, open RN is important to the management of large, complex tumours which would be at high risk of complications if treated with partial nephrectomy (PN). Secondly, open RN plays a crucial role in cytoreductive nephrectomy (CN) for metastatic RCC, in which the laparoscopic approach achieves similar results but is associated with a high reoperation rate. Finally, open RN is the current standard of care in the management of inferior vena caval (IVC) tumour thrombus. Management of tumour thrombus requires a multidisciplinary approach and varies with cranial extent of thrombus. Higher level thrombus may require hepatic mobilisation and circulatory support, whilst the presence of bland thrombus may warrant post-operative filter insertion or ligation of the IVC.
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Affiliation(s)
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Australia.,Cabrini Institute, Cabrini Health, Melbourne, Australia
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9
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Complex robotic nephrectomy and inferior vena cava tumor thrombectomy: an evolving landscape. Curr Opin Urol 2020; 30:83-89. [PMID: 31725003 DOI: 10.1097/mou.0000000000000690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Robotic nephrectomy for complex renal masses and in the setting of inferior vena cava (IVC) tumor thrombus has been shown to be a well tolerated and reproducible surgical option. Recent developments in such procedures will be discussed as they continue to evolve. RECENT FINDINGS Multiple case series have demonstrated the application of robotic surgery in the management of the most complex renal tumors and for IVC thrombi with acceptable oncologic and perioperative outcomes. Prior to the advent of robotic surgery, massive tumors, contiguous organ invasion, need for lymphadenectomy, and IVC tumor thrombus were thought by many to require open surgery. Since 2011, several studies have reported robotic nephrectomy for complex tumors with recent comparisons of robotic and open approaches finding similar oncologic and survival outcomes but with shorter length of stay (LOS) and less blood loss with robotic surgery. SUMMARY Robotic surgery is a feasible and well tolerated alternative to open surgery for the management of complex renal tumors and IVC thrombi. The potential benefits of shorter LOS, less blood loss, and earlier convalescence suggest this approach should continue to be evaluated. Patient selection and surgeon experience are of paramount importance.
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Tapiero S, Karani R, Limfueco L, Xie L, Jefferson FA, Reinwart C, Okhunov Z, Clayman RV, Landman J. Evaluation of Interactive Virtual Reality as a Preoperative Aid in Localizing Renal Tumors. J Endourol 2020; 34:1180-1187. [PMID: 32597217 DOI: 10.1089/end.2020.0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Introduction: A detailed understanding of renal tumor anatomy is required to perform partial nephrectomy. We evaluated the utility of a CT-based interactive virtual reality (iVR) display to assist surgeons' understanding of the precise location of the renal tumor. Methods: CT scans and iVR models of 11 patients with a mean R.E.N.A.L. nephrometry score of 6.9 were evaluated. Seven faculty urologists and six urology residents reviewed CT scans and positioned each tumor onto a digital three-dimensional model of the same kidney, although without the tumor present. A week later, participants repeated the session using both iVR models and CT scans. For both time points, the overlap between the surgeon-inserted tumor and the actual tumor location was calculated. Participants answered a 1 to 10 Likert scale survey to gauge their understanding of renal and tumor anatomy based on CT alone vs CT+iVR. Results: Median tumor overlap for the entire cohort was 28% after CT review and 42% after CT+iVR (p = 0.05); among faculty urologists, for CT+iVR vs CT alone, percentage overlap improved (47% vs 33%, p = 0.033) and the incidence of 0% overlap decreased (19%-4%, p = 0.024), respectively. Among residents, there was no significant difference for either percentage overlap or 0% overlap for CT vs CT+iVR. The percentage overlap for the two tumors with high R.E.N.A.L. nephrometry scores (i.e., 10) increased from 51% to 67% after using CT+iVR (p = 0.039). The combination of CT+iVR was an independent predictor of improved overlap vs CT alone (odds ratio 2.22, 95% confidence interval 1.04-4.78, p = 0.039). Faculty surgeons' survey responses showed an improved understanding of the tumor location and shape with the addition of iVR (p < 0.05). Conclusions: The addition of patient-specific iVR models to standard CT imaging improved the ability of faculty urologists to accurately configure the location of a renal tumor, and improved their understanding of tumor anatomy.
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Affiliation(s)
- Shlomi Tapiero
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Rajiv Karani
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Luke Limfueco
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Lillian Xie
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Francis A Jefferson
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Clare Reinwart
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California, USA
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11
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Hajiha M, Baldwin DD. EDITORIAL COMMENT. Urology 2019; 132:127-128. [PMID: 31581990 DOI: 10.1016/j.urology.2019.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/06/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Mohammad Hajiha
- Department of Urology, Loma Linda University Health, Loma Linda, CA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Loma Linda, CA
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Vigneswaran HT, Dobbs RW, Huang J, Sofer LA, Halgrimson WR, Crivellaro S. Use of a Novel Articulating Laparoscopic Needle Driver for Partial nephrectomy: An Initial Experience. Urology 2019; 132:123-129. [PMID: 31310768 DOI: 10.1016/j.urology.2019.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To demonstrate the clinical feasibility of an articulated laparoscopic needle driver to assist in the performance of laparoscopic partial nephrectomy (LPN). Previous studies have demonstrated under-utilization of minimally invasive techniques for patients undergoing partial nephrectomy (PN). METHODS Consecutive patients with renal masses amenable to PN underwent LPN with an articulating laparoscopic needle driver. A consecutive cohort of patients who previously underwent robot assisted laparoscopic PN (RALPN) was selected as a comparison cohort. Preoperative, perioperative, and postoperative variables were retrospectively collected. RESULTS A total of 20 patients underwent PN with 10 patients assigned to each of the LPN and RALPN cohorts. Median R.E.N.A.L. nephrometry scores assigned to the LPN and RALPN cohorts were 7 and 6 respectively (P= .31). Median warm ischemia time for patients in the LPN and RALPN groups was 25.5 and 18.5 minutes respectively (P= .36). Median estimated blood loss for LPN and RALPN was 200 and 50 mL (P= .03). Median operative time for LPN and RALPN was 203 and 194 minutes respectively (P= .76). Median Length of stay after LPN and RALPN was similar (3.0 vs 2.5 nights, P= .26). Following LPN, 3 patients required blood transfusion as compared to 2 patients in the RALPN cohort (P= .61). CONCLUSION Our initial results demonstrated the clinical safety and feasibility of a new surgical device for performing LPN. Patients who underwent LPN with a novel articulating needle driver demonstrated equivalent results to RALPN across several key outcomes.
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Affiliation(s)
| | - Ryan W Dobbs
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Jason Huang
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Laurel A Sofer
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | | | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL
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13
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Identifying Current Trends in the Urologic Oncology Workforce—Does Completion of Fellowship Significantly Change Future Practice? UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Grivas N, Kalampokis N, Larcher A, Tyritzis S, Rha KH, Ficarra V, Buffi N, Ploumidis A, Autorino R, Porpiglia F, van der Poel H, Mottrie A, de Naeyer G. Robot-assisted versus open partial nephrectomy: comparison of outcomes. A systematic review. MINERVA UROL NEFROL 2019; 71:113-120. [DOI: 10.23736/s0393-2249.19.03391-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Xia L, Talwar R, Taylor BL, Shin MH, Berger IB, Sperling CD, Chelluri RR, Zambrano IA, Raman JD, Guzzo TJ. National trends and disparities of minimally invasive surgery for localized renal cancer, 2010 to 2015. Urol Oncol 2019; 37:182.e17-182.e27. [DOI: 10.1016/j.urolonc.2018.10.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 01/06/2023]
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Chen FM, Hu RJ, Jiang XN, Zhong SW, Tang S. The correlation between affected renal function and affected renal residual volume: A retrospective outcome of laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking-up for localized renal tumors. Medicine (Baltimore) 2019; 98:e13927. [PMID: 30633167 PMCID: PMC6336637 DOI: 10.1097/md.0000000000013927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.Trial registration: ChiCTR-RRC-17011418.
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Affiliation(s)
- Fang-Min Chen
- Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin
| | - Rui-Jie Hu
- The First People's Hospital of Jiujiang City, Jiujiang, Jiangxi
| | - Xi-Nan Jiang
- Department of Urology, Affliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Si-Wen Zhong
- Department of Urology, Affliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shuai Tang
- Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin
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17
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Phung MC, Lee BR. Recent advancements of robotic surgery for kidney cancer. Asian J Endosc Surg 2018; 11:300-307. [PMID: 30168283 DOI: 10.1111/ases.12635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 01/20/2023]
Abstract
Surgical management of renal cell carcinoma has undergone a transformation in recent decades, especially with the dissemination of the robotic platform. Increasingly, larger and more complex renal lesions are now being treated in a minimally invasive fashion. The purpose of this article is to review advances in the use of the robotic approach for treatment of renal cell carcinoma, including nephron-sparing surgery, radical nephrectomy, and cytoreductive nephrectomy.
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Affiliation(s)
- Michael C Phung
- Division of Urology, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Benjamin R Lee
- Division of Urology, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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18
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Inflammation-Related Mechanisms in Chronic Kidney Disease Prediction, Progression, and Outcome. J Immunol Res 2018; 2018:2180373. [PMID: 30271792 PMCID: PMC6146775 DOI: 10.1155/2018/2180373] [Citation(s) in RCA: 307] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 12/13/2022] Open
Abstract
Persistent, low-grade inflammation is now considered a hallmark feature of chronic kidney disease (CKD), being involved in the development of all-cause mortality of these patients. Although substantial improvements have been made in clinical care, CKD remains a major public health burden, affecting 10–15% of the population, and its prevalence is constantly growing. Due to its insidious nature, CKD is rarely diagnosed in early stages, and once developed, its progression is unfortunately irreversible. There are many factors that contribute to the setting of the inflammatory status in CKD, including increased production of proinflammatory cytokines, oxidative stress and acidosis, chronic and recurrent infections, altered metabolism of adipose tissue, and last but not least, gut microbiota dysbiosis, an underestimated source of microinflammation. In this scenario, a huge step forward was made by the increasing progression of omics approaches, specially designed for identification of biomarkers useful for early diagnostic and follow-up. Recent omics advances could provide novel insights in deciphering the disease pathophysiology; thus, identification of circulating biomarker panels using state-of-the-art proteomic technologies could improve CKD early diagnosis, monitoring, and prognostics. This review aims to summarize the recent knowledge regarding the relationship between inflammation and CKD, highlighting the current proteomic approaches, as well as the inflammasomes and gut microbiota dysbiosis involvement in the setting of CKD, culminating with the troubling bidirectional connection between CKD and renal malignancy, raised on the background of an inflammatory condition.
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Chang YH, Chang SW, Liu CY, Lin PH, Yu KJ, Pang ST, Chuang CK, Kan HC, Shao IH. Demographic characteristics and complications of open and minimally invasive surgeries for renal cell carcinoma: a population-based case-control study in Taiwan. Ther Clin Risk Manag 2018; 14:1235-1241. [PMID: 30038497 PMCID: PMC6049605 DOI: 10.2147/tcrm.s164592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Renal cell carcinoma (RCC) is one of the most lethal urological malignancies, and surgeries remain the mainstay for localized RCC. This study aimed to compare the selection of open surgery and minimally invasive kidney surgery for RCCs for the aspects of complication, medical costs, and patient preference. Materials and methods We conducted a population-based case-control study by using the National Health Insurance Research Database of Taiwan, which included data from 23 million Taiwanese residents. Patients newly diagnosed with RCC during 2006-2012 were included. We compared the general characteristics, underlying disease, complications, hospital stay, postoperative analgesic dosage, and medical costs between open group and minimally invasive group. Results A total of 3,172 patients who received radical nephrectomy (RN) or partial nephrectomy (PN) for RCC were included. The mean age was 61.1 years, with a male to female ratio of 1.88. In the minimally invasive groups, the mean hospital stay was significantly shorter than in open groups (12.4 days in open RN versus 10.3 days in minimally invasive RN, and 9.7 days in open PN versus 8.2 days in minimally invasive PN). There was no significant difference between the medical costs and the incidence of major bleeding complication between the open group and the minimally invasive group. Female patients and patients with higher monthly income were more likely to receive minimally invasive surgery. Conclusion During past decades, open RN has gradually been replaced by minimally invasive surgeries and PN. Compared to open surgeries, minimally invasive surgeries could lead to less postoperative pain and faster recovery. Economic status of the patients potentially hinders them from receiving minimally invasive surgeries, which may cost more.
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Affiliation(s)
- Ying-Hsu Chang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - See-Tong Pang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
| | - I-Hung Shao
- Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan, .,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan,
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Pradere B, Peyronnet B, Khene ZE, Mathieu R, Verhoest G, Bensalah K. Simplified robot-assisted partial nephrectomy: step-by-step technique and perioperative outcomes. J Robot Surg 2018; 13:245-251. [PMID: 29982905 DOI: 10.1007/s11701-018-0845-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/04/2018] [Indexed: 11/29/2022]
Abstract
Controversies have been raised and still exist regarding several technical aspects of robot-assisted partial nephrectomy (RAPN). While the "perfect RAPN" has still to be determined, we aimed to report a simplified technique of RAPN in a step-by-step fashion and the perioperative outcomes of a single-center series. A simplified technique of RAPN was developed, refined and standardized over the past 7 years in an academic department of urology to make it as safe and as reproducible as possible, the main goal being to make it an "easy to learn" technique for fellows. This technique is presented in 12 key steps. The patients' characteristics and perioperative outcomes were prospectively collected and are reported herein. Since the first case performed in our department in 2010, 406 patients have undergone RAPN with a standardized and stable simplified technique after the first 30 cases, involving several key steps including systematic use of the transperitoneal approach, minimal visceral mobilization of the colon, systematic psoas exposure and ureter identification, minimal dissection of the perinephric fat, arterial clamping with early unclamping, no use of hemostatic agents or drain. The majority of RAPN were performed by surgeons with either low experience (i.e., < 20 procedures; 46.3%) or intermediate experience (i.e., 20-50 procedures; 17.2%). The mean warm ischemia time was 15.3 min. Conversions to an open approach and to radical nephrectomy were required in 14 (3.5%) and 21 (5.2%) cases, respectively. From 132 patients who experienced post-operative complications (32.5%), 47 experienced a major complication (11.6%). The positive surgical margin rate was 5.6%. The simplified technique of RAPN was feasible and reproducible with satisfactory perioperative outcomes. Most of the key steps have been assessed through single-center and multicenter clinical studies.
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Affiliation(s)
- Benjamin Pradere
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
| | - Benoit Peyronnet
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Zine-Eddine Khene
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Romain Mathieu
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Gregory Verhoest
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
| | - Karim Bensalah
- Department of Urology, CHU Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France
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21
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Rotker K, Iosifescu S, Baird G, Thavaseelan S, Hwang K. What's Gender Got to Do With It: Difference in the Proportion of Traditionally Female Cases Performed by General Urologists of Each Gender. Urology 2018; 116:35-40. [DOI: 10.1016/j.urology.2017.12.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
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22
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Simone G, Misuraca L, Tuderti G, Minisola F, Ferriero M, Romeo G, Costantini M, Al-Rawashdah SF, Guaglianone S, Gallucci M. Purely off-clamp robotic partial nephrectomy: Preliminary 3-year oncological and functional outcomes. Int J Urol 2018; 25:606-614. [DOI: 10.1111/iju.13580] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/12/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Giuseppe Simone
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
| | - Leonardo Misuraca
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
| | - Gabriele Tuderti
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
| | - Francesco Minisola
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
| | | | - Giuseppe Romeo
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
| | - Manuela Costantini
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
| | | | | | - Michele Gallucci
- Department of Urology; “Regina Elena” National Cancer Institute; Rome Italy
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Edgcumbe P, Singla R, Pratt P, Schneider C, Nguan C, Rohling R. Follow the light: projector-based augmented reality intracorporeal system for laparoscopic surgery. J Med Imaging (Bellingham) 2018; 5:021216. [PMID: 29487888 DOI: 10.1117/1.jmi.5.2.021216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/22/2018] [Indexed: 01/20/2023] Open
Abstract
A projector-based augmented reality intracorporeal system (PARIS) is presented that includes a miniature tracked projector, tracked marker, and laparoscopic ultrasound (LUS) transducer. PARIS was developed to improve the efficacy and safety of laparoscopic partial nephrectomy (LPN). In particular, it has been demonstrated to effectively assist in the identification of tumor boundaries during surgery and to improve the surgeon's understanding of the underlying anatomy. PARIS achieves this by displaying the orthographic projection of the cancerous tumor on the kidney's surface. The performance of PARIS was evaluated in a user study with two surgeons who performed 32 simulated robot-assisted partial nephrectomies. They performed 16 simulated partial nephrectomies with PARIS for guidance and 16 simulated partial nephrectomies with only an LUS transducer for guidance. With PARIS, there was a significant reduction [30% ([Formula: see text])] in the amount of healthy tissue excised and a trend toward a more accurate dissection around the tumor and more negative margins. The combined point tracking and reprojection root-mean-square error of PARIS was 0.8 mm. PARIS' proven ability to improve key metrics of LPN surgery and qualitative feedback from surgeons about PARIS supports the hypothesis that it is an effective surgical navigation tool.
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Affiliation(s)
- Philip Edgcumbe
- University of British Columbia, MD/PhD Program, Vancouver, Canada
| | - Rohit Singla
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada
| | - Philip Pratt
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Caitlin Schneider
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada
| | - Christopher Nguan
- University of British Columbia, Department of Urological Sciences, Vancouver, Canada
| | - Robert Rohling
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada.,University of British Columbia, Department of Mechanical Engineering, Vancouver, Canada
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24
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Ameri C, Lopez F, Vitagliano G, Rios Pita H, Guglielmi J, Blas L. New technique for nephron-sparing surgery in polar tumours. A modification of the Kim technique. Actas Urol Esp 2017; 41:535-539. [PMID: 28363423 DOI: 10.1016/j.acuro.2017.01.010] [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: 12/06/2016] [Revised: 12/26/2016] [Accepted: 01/02/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Nephron-sparing surgery (NSS) is the indication, provided it is feasible and meets the international treatment guidelines. One of the objectives of performing NSS is to reduce the ischemia time as much as possible. We propose a surgical technique for treating polar renal tumours and those larger than 4cm based on the principle of the technique described by Kim in 1964. METHOD The technique performs a continuous circular suture on the base of the tumour, achieving compression of the renal pole without vascular clamping, facilitating haemostasis and avoiding the blind transfixion performed in Kim's original technique. We selected 28 patients for the implementation of the technique. RESULTS The patients' mean age was 56 years (30-69). The R.E.N.A.L. scores were as follows: 12 of low complexity, 12 of moderate complexity and 4 of high complexity. The mean surgical time was 109minutes (75-140), and the mean estimated blood loss was 120mL (50-300mL). No positive margins were identified, and no patients required blood transfusions. The mean stay was 3.7 days (2-6). There were no Clavien grade 2 or higher complications. There were 3 Clavien 1 complications (fever). The difference in glomerular filtration rate was -0.71mL/min/m2. The pathology was malignant in 26 cases, 19 of them clear-cell carcinomas. Two cases were reported as oncocytomas. CONCLUSION The proposed technique showed acceptable results, with a low rate of complications in the patient group.
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25
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Wake N, Rude T, Kang SK, Stifelman MD, Borin JF, Sodickson DK, Huang WC, Chandarana H. 3D printed renal cancer models derived from MRI data: application in pre-surgical planning. Abdom Radiol (NY) 2017; 42:1501-1509. [PMID: 28062895 DOI: 10.1007/s00261-016-1022-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether patient-specific 3D printed renal tumor models change pre-operative planning decisions made by urological surgeons in preparation for complex renal mass surgical procedures. MATERIALS AND METHODS From our ongoing IRB approved study on renal neoplasms, ten renal mass cases were retrospectively selected based on Nephrometry Score greater than 5 (range 6-10). A 3D post-contrast fat-suppressed gradient-echo T1-weighted sequence was used to generate 3D printed models. The cases were evaluated by three experienced urologic oncology surgeons in a randomized fashion using (1) imaging data on PACS alone and (2) 3D printed model in addition to the imaging data. A questionnaire regarding surgical approach and planning was administered. The presumed pre-operative approaches with and without the model were compared. Any change between the presumed approaches and the actual surgical intervention was recorded. RESULTS There was a change in planned approach with the 3D printed model for all ten cases with the largest impact seen regarding decisions on transperitoneal or retroperitoneal approach and clamping, with changes seen in 30%-50% of cases. Mean parenchymal volume loss for the operated kidney was 21.4%. Volume losses >20% were associated with increased ischemia times and surgeons tended to report a different approach with the use of the 3D model compared to that with imaging alone in these cases. The 3D printed models helped increase confidence regarding the chosen operative procedure in all cases. CONCLUSIONS Pre-operative physical 3D models created from MRI data may influence surgical planning for complex kidney cancer.
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Affiliation(s)
- Nicole Wake
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA.
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY, USA.
| | - Temitope Rude
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Stella K Kang
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Michael D Stifelman
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - James F Borin
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Daniel K Sodickson
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY, USA
| | - William C Huang
- Division of Urologic Oncology, Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Hersh Chandarana
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, New York, NY, USA
- Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY, USA
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Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Simone G, Tuderti G, Anceschi U, Papalia R, Ferriero M, Misuraca L, Minisola F, Mastroianni R, Costantini M, Guaglianone S, Sentinelli S, Gallucci M. Oncological outcomes of minimally invasive partial versus minimally invasive radical nephrectomy for cT1-2/N0/M0 clear cell renal cell carcinoma: a propensity score-matched analysis. World J Urol 2016; 35:789-794. [DOI: 10.1007/s00345-016-1923-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/11/2016] [Indexed: 02/04/2023] Open
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28
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Peyronnet B, Seisen T, Oger E, Vaessen C, Grassano Y, Benoit T, Carrouget J, Pradère B, Khene Z, Giwerc A, Mathieu R, Beauval JB, Nouhaud FX, Bigot P, Doumerc N, Bernhard JC, Mejean A, Patard JJ, Shariat S, Roupret M, Bensalah K. Comparison of 1800 Robotic and Open Partial Nephrectomies for Renal Tumors. Ann Surg Oncol 2016; 23:4277-4283. [DOI: 10.1245/s10434-016-5411-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Indexed: 01/20/2023]
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Lam W, Chakravorty M, Challacombe B. If the robot is there, why not use it? Why we should use the robot for laparoscopic nephrectomy. BJU Int 2016; 118:852-854. [DOI: 10.1111/bju.13509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Wayne Lam
- Urology Centre; Guy's and St Thomas' NHS Foundation Trust; London UK
| | | | - Ben Challacombe
- Urology Centre; Guy's and St Thomas' NHS Foundation Trust; London UK
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Olbert PJ, Maier M, Heers H, Hegele A, Hofmann R. [Indications for nephron-sparing surgery. Analysis over a 13-year period in the context of changing guidelines]. Urologe A 2016; 54:804-10. [PMID: 25503720 DOI: 10.1007/s00120-014-3710-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The indications for nephron-sparing surgery have been considerably extended by guideline recommendations in recent years. It remains unclear whether clinical practice still reflects these new guidelines. OBJECTIVE In this retrospective, monocentric analysis at a tertiary referral center the indications for partial nephrectomy over a 13-year period were evaluated. METHODS In a retrospective database analysis all cases of surgically treated renal masses from 2001 to 2013 were evaluated. Besides demographic, tumor-specific and perioperative variables the development of the surgical technique depending on the tumor stage was evaluated. RESULTS AND DISCUSSION The proportion of nephron-sparing surgery cases increased from below 20 % in 2001 to 35 % in 2013 in the entire cohort. For stage T1a tumors, partial nephrectomy increased from approximately 50 % to over 90 % and for T1b tumors it rose from 10 % to 50 %. Logistic regression revealed stage 1 tumors to be predictive of partial nephrectomy over the complete evaluation period. Extending the indications for partial nephrectomy even to higher stages is under discussion but not yet supported by data from prospective, controlled studies.
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Affiliation(s)
- P J Olbert
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland,
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Kiechle JE, Abouassaly R, Gross CP, Dong S, Cherullo EE, Zhu H, Trinh QD, Sun M, Meropol NJ, Hoimes CJ, Ialacci S, Kim SP. Racial Disparities in Partial Nephrectomy Persist Across Hospital Types: Results From a Population-based Cohort. Urology 2015; 90:69-74. [PMID: 26724412 DOI: 10.1016/j.urology.2015.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/11/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the national utilization of partial nephrectomy (PN) for T1a renal masses across different racial groups by hospital type. Although clinical guidelines recommend PN for small renal masses (SRMs), racial disparities persist in the use of PN. High-volume and academic hospitals have been associated with greater use of PN for SRMs. However, it is unknown whether racial disparities persist in the use of PN across different types of hospitals. METHODS Using the National Cancer Database, we identified patients with localized T1a renal cancer (≤4 cm) from 1998 to 2011. The primary outcome was receipt of PN among patients surgically treated for SRMs. Multivariable logistic regression analyses were used to assess for racial differences in treatment with PN stratified by hospital characteristics. RESULTS Among 118,207 patients diagnosed with clinical T1a renal masses, 36.5% underwent PN (n = 43,134). Overall, a greater proportion of white patients underwent PN (37.3%) compared with African-American (32.4%) and Hispanic (33.7%) patients with SRMs (P <.001). When stratified by hospital type, disparities persisted in the use of PN; African-American patients had lower adjusted odds ratios for being treated with PN when treated at comprehensive community cancer (odds ratio: 0.90; P = .003) and academic (odds ratio: 0.65; P <.001) hospitals compared with white patients. CONCLUSIONS In this population-based cohort, we found that racial disparities persist across all types of hospitals in the use of PN for SRMs. Further research is needed to identify, and target for intervention, the factors contributing to racial disparities in the surgical management of SRMs.
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Affiliation(s)
- Jonathan E Kiechle
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Robert Abouassaly
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Cary P Gross
- Department of Internal Medicine, Yale University, New Haven, CT; Cancer Outcomes and Public Policy Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
| | - Shan Dong
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Edward E Cherullo
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Harvard Medical School, Boston, MA
| | | | - Neal J Meropol
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Christopher J Hoimes
- University Hospitals Case Medical Center Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sarah Ialacci
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH
| | - Simon P Kim
- University Hospitals Case Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Urology Institute, Cleveland, OH; Department of Internal Medicine, Yale University, New Haven, CT.
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Shin SJ, Ko KJ, Kim TS, Ryoo HS, Sung HH, Jeon HG, Jeong BC, Seo SI, Lee HM, Choi HY, Jeon SS. Trends in the Use of Nephron-Sparing Surgery over 7 Years: An Analysis Using the R.E.N.A.L. Nephrometry Scoring System. PLoS One 2015; 10:e0141709. [PMID: 26599436 PMCID: PMC4657937 DOI: 10.1371/journal.pone.0141709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/12/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To analyze trends in the use of partial nephrectomy, we evaluated which individual factors of renal nephrometry score (RNS) influenced the operative approach bi-annually from 2008 to 2014. MATERIALS AND METHODS We performed a retrospective review of renal cell carcinoma treated by surgery in 2008, 2010, 2012, and 2014. The complexity of renal masses was measured using the R.E.N.A.L. nephrometry scoring system with CT or MRI. Group comparison in terms of operation year and surgical type (partial nephrectomy versus radical nephrectomy) was performed. We developed a nomogram to quantitate the likelihood of selecting partial nephrectomy over radical nephrectomy. RESULTS A total of 1106 cases (237 in 2008, 225 in 2010, 292 in 2012, and 352 in 2014) were available for the study. Over the study period, the proportion of partial nephrectomies performed increased steadily from 21.5% in 2008 to 66.5% in 2014 (p < 0.05). Furthermore, use of partial nephrectomy increased steadily in all RNS complexity groups (low, moderate, and high) (p < 0.05). In the analysis of individual components of RNS, values of the R and N components increased statistically by year in the partial nephrectomy group (p < 0.05). Average AUC was 0.920. CONCLUSIONS The proportion of partial nephrectomies performed sharply increased over the study period. Additionally, over the study period, more partial nephrectomies were performed for renal masses of larger size and closer to the collecting system and main renal vessels. A nomogram developed based on this recent data set provides significant predictive value for surgical decision making.
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Affiliation(s)
- Seung Jea Shin
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sun Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Soo Ryoo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Postoperative drainage does not prevent complications after robotic partial nephrectomy. World J Urol 2015; 34:933-8. [PMID: 26511751 DOI: 10.1007/s00345-015-1721-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/20/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES We aimed to assess the impact of a postoperative drainage after RPN. METHODS A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)]. RESULTS Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (>50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64-1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay. CONCLUSION The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
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Oberlin DT, Matulewicz RS, Bachrach L, Hofer MD, Brannigan RE, Flury SC. National Practice Patterns of Treatment of Erectile Dysfunction with Penile Prosthesis Implantation. J Urol 2015; 193:2040-4. [DOI: 10.1016/j.juro.2014.11.095] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Daniel T. Oberlin
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Richard S. Matulewicz
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Laurie Bachrach
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthias D. Hofer
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert E. Brannigan
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sarah C. Flury
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Suson KD, Wolfe-Christensen C, Elder JS, Lakshmanan Y. National Practice Patterns and Outcomes of Pediatric Nephrectomy: Comparison between Urology and General Surgery. J Urol 2015; 193:1737-41. [DOI: 10.1016/j.juro.2014.10.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Kristina D. Suson
- College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
| | | | - Jack S. Elder
- Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, Michigan
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Yegappan Lakshmanan
- College of Osteopathic Medicine, Michigan State University, Detroit, Michigan
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Stewart GD, Laird A, McNeill SA, Leibovich BC. Observations on transatlantic renal cell cancer surgery outcomes. BJU Int 2015; 117:212-4. [PMID: 25754679 DOI: 10.1111/bju.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Grant D Stewart
- Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, UK.,Department of Urology, NHS Lothian, Edinburgh, UK
| | - Alexander Laird
- Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, UK.,Department of Urology, NHS Lothian, Edinburgh, UK
| | - Stuart A McNeill
- Edinburgh Urological Cancer Group, University of Edinburgh, Edinburgh, UK.,Department of Urology, NHS Lothian, Edinburgh, UK
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Khene ZE, Peyronnet B, Mathieu R, Fardoun T, Verhoest G, Bensalah K. Analysis of the impact of adherent perirenal fat on peri-operative outcomes of robotic partial nephrectomy. World J Urol 2015; 33:1801-6. [PMID: 25669610 DOI: 10.1007/s00345-015-1500-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/27/2015] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Adherent perirenal fat (APF) can be defined as inflammatory fat sticking to renal parenchyma, whose dissection is difficult and makes it troublesome to expose the tumour. Our objective was to evaluate the impact of APF on the technical difficulty of robot-assisted partial nephrectomy (RPN). PATIENTS AND METHODS We analysed data of 202 patients who underwent RPN for a small renal tumour. Patients were divided into two groups according to the presence of APF. Peri-operative data were compared between the two groups. Predictors of APF were evaluated by univariate and multivariate analysis. The validity of the MAP score (radiological scoring system) was also assessed. RESULTS APF was observed in 80 patients (39.6 %). Tumour complexity and surgeon's experience were similar between both groups. Operative time was 40 min longer in the APF group (188.5 vs. 147.9 min, p < 0.0001). Blood loss was twice higher, and transfusions were more common in the APF group (694 vs. 330 ml, p < 0.0001 and 19 vs. 5.8 %, p = 0.003, respectively). APF was associated with an increased risk of conversion to open surgery (11.2 vs. 0 %, p = 0.0002) or radical nephrectomy (6.2 vs. 0.8 %, p = 0.03). In multivariate analysis, male gender (OR 13.2, p < 0.0001), obesity (OR 1.2, p = 0.007), hypertension (OR 3.7, p = 0.02), and MAP score (OR 3.3; p < 0.0001) were significant predictors of APF. CONCLUSION During RPN, APF is associated with increased bleeding and a higher risk of conversion to open surgery and to radical nephrectomy. Male gender, hypertension, obesity, and MAP score are predictors of APF.
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Affiliation(s)
- Zine-Eddine Khene
- Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France.
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Tarek Fardoun
- Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Grégory Verhoest
- Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, 2, rue Henri Le Guilloux, 35033, Rennes Cedex, France
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Taylor AS, Lee B, Rawal B, Thiel DD. Impact of fellowship training on robotic-assisted laparoscopic partial nephrectomy: benchmarking perioperative safety and outcomes. J Robot Surg 2015; 9:125-30. [PMID: 26531112 DOI: 10.1007/s11701-015-0498-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/16/2015] [Indexed: 11/25/2022]
Abstract
To provide perioperative benchmark data for surgeons entering practice from formal robotic training and performing robotic-assisted laparoscopic partial nephrectomy (RAPN). Perioperative outcomes of the first 100 RAPN from a surgeon entering into practice directly from robotic fellowship training were analyzed. Postoperative complications were categorized by Clavien-Dindo grade. Surgical "trifecta scores" and Margin, Ischemia, and Complication (MIC) scoring were utilized to assess surgical outcomes. Statistical analyses were performed using SAS (version 9.2; SAS Institute, Inc., Cary, North Carolina). Median age of the cohort was 63 years (22-81 years), and 34 (34.3%) patients were over age 65. Forty-one (41.4%) patients had a BMI > 30. Thirteen (13.1%) had RENAL 10-12 tumors, 22 of which (22.2%) were >4 cm in size. Median warm ischemia time was 17 min, and 13 patients had resection without warm ischemia. Five patients were converted to open partial nephrectomy, and 1 patient was converted to laparoscopic nephrectomy. Twenty-one patients (21.2%) experienced a complication, 6 of whom had a major (Clavien grade 3 or higher) complication with one grade 5 complication. Operating room time decreased with experience, but surgical complications and hospital stay did not change with experience. MIC score of renal cell carcinoma (RCC) patients was 74.7%, while the surgical trifecta was reached in 71.3 % of RCC patients. Surgeons may enter practice directly from formal robotic training and perform RAPN with perioperative outcomes, surgical complications, surgical trifecta scores, and MIC scoring in line with those the most experienced robotic partial nephrectomists.
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Affiliation(s)
- Abby S Taylor
- Department of Urology, Section of Biostatistics at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bruce Lee
- Mayo School of Health Sciences, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Bhupendra Rawal
- Department of Health Sciences Research, Section of Biostatistics at Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Section of Biostatistics at Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Do Statin Medications Impact Renal Functional or Oncologic Outcomes for Robot-Assisted Partial Nephrectomy? J Endourol 2014; 28:1308-12. [DOI: 10.1089/end.2014.0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Abstract
Historically, open radical nephrectomy (ORN) represented the standard of care for localized renal cell carcinoma (RCC). While the incidence of T1 RCC is rising, treatment options are developing fast and the standard of care according to European and American guidelines has changed to partial nephrectomy (PN), or laparoscopic radical nephrectomy in patients not suitable for PN. To assess the implementation of guideline recommendations and to profile recent surgical and technical innovations, we reviewed the current literature. We observed that ORN still represents the most commonly used treatment in T1 RCC patients. Utilization of PN increased over time but implementation is still in progress. Whereas PN is frequently used in tertiary care centers, population-based studies suggest discrepancies in the diffusion of standard of care treatments. Alternative minimally invasive approaches for PN are available but their superiority is not yet proven. Further efforts in improving the training of urologic surgeons are required to continue the implementation of guideline recommendations.
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Affiliation(s)
- Jonas Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sammon JD, Zhu G, Sood A, Sukumar S, Kim SP, Sun M, Karakiewicz PI, Menon M, Trinh QD, Elder JS. Pediatric Nephrectomy: Incidence, Indications and Use of Minimally Invasive Techniques. J Urol 2014; 191:764-70. [DOI: 10.1016/j.juro.2013.09.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Jesse D. Sammon
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Grace Zhu
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Akshay Sood
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Shyam Sukumar
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Simon P. Kim
- Department of Urology, Yale University, New Haven, Connecticut
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Public Health, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Mani Menon
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Quoc-Dien Trinh
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
- Department of Surgery, Division of Urology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Jack S. Elder
- Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
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