Correlation Between the Mayo Adhesive Probability Score and the Operative Time in Laparoscopic Donor Nephrectomy

Is the Mayo adhesive probability score predictive of post-operative Clavien-Dindo complication grade in laparoscopic adrenalectomy?

INTRODUCTION

Laparoscopic adrenalectomy (LA) continues to be considered the optimum approach to the surgical treatment of small benign adrenal tumours. The present study explores the correlation between the Mayo adhesive probability (MAP) score, derived from computed tomography images and delineating such perinephric fat characteristics as thickness and adhesiveness, and post-operative complications in patients undergoing LA.

PATIENTS AND METHODS

Data of patients who underwent LA between 2013 and 2023 were subjected to a retrospective analysis, and MAP scores were calculated for all patients. Intraoperative and post-operative surgical outcomes, as well as any complications, were categorised using Modified Clavien-Dindo grading, and the relationship between their MAP scores and outcomes was analysed.

RESULTS

The mean body mass index, rate of overweight patients, Clavien-Dindo scores of II, III or IV, surgical time, hospitalisation duration, transfusion requirement and post-operative blood loss of the group of patients with MAP scores of 2-3 were significantly higher than those in the group with MAP scores in the 0-1 range (P < 0.05). Each one-point increase in MAP score led to a 2.559-times greater probability of a Clavien-Dindo Grade > I (95% confidence interval: 1.391-4.708, P < 0.05).

CONCLUSION

A high MAP score is associated with Grade II and higher Clavien-Dindo complications in LA.

Impact of prior endoscopic management of upper tract urothelial carcinoma on nephroureterectomy complexity

PURPOSE

Kidney-sparing endoscopic surgery is considered the preferred approach for the treatment of low-risk upper tract urothelial cancer (UTUC), yet its impact on subsequent radical nephroureterectomy's (RNU) surgical complexity remains uncertain. This study aims to evaluate the effect of prior endoscopic procedures on peri-operative outcomes of UTUC patients undergoing RNU.

METHODS

A retrospective analysis of 176 consecutive UTUC patients who underwent RNU from July 2008 to July 2023 at a single tertiary center. Demographic, clinical, and pathological data were recorded. The cohort was stratified based on the intention of endoscopic intervention: patients who did not undergo ureteroscopy and those who underwent a single diagnostic ureteroscopy only (non-mURS group) were compared to those who underwent multiple endoscopic treatments with laser ablation as part of a kidney-sparing strategy before RNU referral (mURS group). Statistical analyses addressed the correlations between ureteroscopy frequency and surgical complexity. Multivariate regression analysis was conducted to assess surgical complexity.

RESULTS

Among 176 patients who underwent RNU, 63 (35.7%) were included in the mURS group, and 113 (64.3%) in the non-mURS group. The mURS patients had longer RNU duration (306 ± 114 vs. 269 ± 114 min, p = 0.005), greater blood loss (hemoglobin decrease of 3.5 ± 1.1 vs. 1.02 ± 0.49 g/dL, p < 0.001), increased peri-ureteral adhesions (88.9% vs. 25.7%, p < 0.001), higher postoperative opioid use (87% vs. 53%, p < 0.001), and higher prevalence of fibrosis in pathology reports (88.9% vs. 30.9%, p < 0.001). No significant differences were found in post-operative complications.

CONCLUSION

Pre-RNU endoscopic treatment for UTUC is associated with increased surgical complexity of RNU without adversely affecting postoperative complication rates.

Clinical predictors associated with prolonged pneumoperitoneum time in laparoscopic living donor nephrectomy

BACKGROUND

Kidney transplantation (KT) is a useful treatment option for patients with end-stage chronic kidney disease to avoid dialysis and achieve a good quality of life. In Japan, approximately 90% of kidneys for KT are obtained from living kidney donors. Laparoscopic renal nephrectomy (LDN) is the most commonly performed KT procedure in Japan. We aimed to determine the clinical variables that influence the prolongation of pneumoperitoneum time (PT) in LDN.

METHOD

This retrospective study was carried out on 218 consecutive patients who underwent LDN at Gifu University Hospital. T The enrolled patients were divided into two groups according to the third quartile of PT in the LDN, with those in the lower third quartile (Q3) as Group 1 and those in the upper Q3 as Group 2. The primary endpoint was identification of predictive factors for prolonged PT.

RESULT

In total, 178 patients were included in the analysis. For all patients, the median PT, estimated blood loss, and warm ischemic time were 170 min, 20 mL, and 4 min, respectively. Significantly longer PT was observed in Group 2 than in Group 1. Multiple regression analysis results showed that male donors, body mass index ≥ 25 kg/m2, and donors with more than two renal arteries were independent predictive factors for PT prolongation.

CONCLUSION

Male sex, BMI ≥ 25 kg/m2, and two or more renal arteries are predictive factors for prolonged PT for donors in LDN.

Foundation Model and Radiomics-Based Quantitative Characterization of Perirenal Fat in Renal Cell Carcinoma Surgery

RATIONALE AND OBJECTIVES

To quantitatively characterize the degree of perirenal fat adhesion using artificial intelligence in renal cell carcinoma.

MATERIALS AND METHODS

This retrospective study analyzed a total of 596 patients from three cohorts, utilizing corticomedullary phase computed tomography urography (CTU) images. The nnUNet v2 network combined with numerical computation was employed to segment the perirenal fat region. Pyradiomics algorithms and a computed tomography foundation model were used to extract features from CTU images separately, creating single-modality predictive models for identifying perirenal fat adhesion. By concatenating the Pyradiomics and foundation model features, an early fusion multimodal predictive signature was developed. The prognostic performance of the single-modality and multimodality models was further validated in two independent cohorts.

RESULTS

The nnUNet v2 segmentation model accurately segmented both kidneys. The neural network and thresholding approach effectively delineated the perirenal fat region. Single-modality models based on radiomic and computed tomography foundation features demonstrated a certain degree of accuracy in diagnosing and identifying perirenal fat adhesion, while the early feature fusion diagnostic model outperformed the single-modality models. Also, the perirenal fat adhesion score showed a positive correlation with surgical time and intraoperative blood loss.

CONCLUSION

AI-based radiomics and foundation models can accurately identify the degree of perirenal fat adhesion and have the potential to be used for surgical risk assessment.

Bacterial information in serum extracellular vesicles reflects the inflammation of adherent perinephric fat

Adipose tissue and bacterial flora are involved in metabolism in the human body. However, the relationship between the two remains unclear. Recently, the presence of circulating bacterial DNAs has been reported. We previously reported the utility of bacterial DNA in serum extracellular vesicles (EVs) for diagnosing patients with renal cell carcinoma (RCC). In this study, we aimed to assess whether there is a correlation between bacterial DNA in serum EVs and inflammation in adipose tissue. We undertook 16S rRNA metagenomic analysis of bacterial DNA in serum EVs from 77 patients with RCC (the derivation cohort). We discovered that DNAs from Enterobacteriaceae, Polaromonas, and Coxiellaceae were highly expressed in patients with low Mayo adhesive probability (MAP) scores. A lower MAP score reflects a reduced risk of dense adipose tissue and adhesions. Additionally, we combined these bacterial DNAs to create the EPC (Enterobacteriaceae, Polaromonas, Coxiellaceae) index that predicts a MAP score of 0. Subsequently, we undertook 16S rRNA metagenomic analysis of bacterial DNA in serum EVs from 32 patients with RCC (the validation cohort). The EPC index could distinguish patients with low MAP scores from those with high MAP scores in the derivation (area under the curve [AUC], 0.76; sensitivity, 56%; specificity, 85%) and validation (AUC, 0.81; sensitivity, 100%; specificity, 62%) cohorts. These results suggest that bacterial DNA in serum EVs could reflect the inflammation of adherent perinephric fat around the kidney.

Association of the Mayo-Adhesive Probability Score With the Total Operative Time of Hand-Assisted Laparoscopic Donor Nephrectomy

INTRODUCTION

Living-donor kidney transplantation (LDKT) is often performed using hand-assisted laparoscopic donor nephrectomy (HALDN). Adherent perinephric fat (APF) can complicate HALDN, increasing operative time. The Mayo Adhesive Probability (MAP) score predicts APF preoperatively. This study investigates the association between MAP score and operative time in patients undergoing HALDN.

METHODOLOGY

This cross-sectional study included 133 patients undergoing HALDN at Shifa International Hospital, Islamabad, Pakistan, from December 2021 to July 2023. The primary outcome was total operative time, defined as incision-to-closure duration. The predictor of interest was the MAP score, calculated from preoperative CT scans assessing posterior renal fat thickness and perinephric fat stranding. Data collection included demographic and clinical characteristics of the patients. Data analysis was done using IBM SPSS Statistics software, version 25 (IBM Corp., Armonk, NY), to determine a significant association between the mean operative time across different MAP scores and other parameters, taking a p-value <0.05 as significant.

RESULTS

The mean donor age was 35.1 ± 10.1 years, and females were predominant (85, 63.9%). Most patients had a MAP score of 0 (76.7%) and an American Society of Anesthesiologists (ASA) score of one (81.2%). The mean operative time was 196.86 + 53.81 minutes. The MAP score was not significantly associated with operative time (p = 0.244). Mean operative time did not significantly differ across MAP score groups (p = 0.148). There was a significant association between gender and MAP score, with females having lower scores (p = 0.001). No significant correlations were found between operative time and MAP score, gender, or ASA score (p > 0.05).

CONCLUSIONS

The MAP score does not significantly correlate with operative time in HALDN among the studied population. Interestingly, a significant association was noted between lower MAP scores and female gender, adding to the understanding of gender-specific characteristics in laparoscopic donor nephrectomy and highlighting the need for further research to validate the utility of this score in diverse clinical settings and populations. These results underline the need for larger, multicentered studies to validate the utility of the MAP score in predicting operative complexity across diverse clinical settings and populations. Our study contributes to the ongoing efforts to optimize preoperative planning and enhance outcomes in LDKT cases.

Relationship between surgical difficulty and postoperative complications of hand-assisted laparoscopic living donor nephrectomy and establishment of prediction model

BACKGROUND

Few studies have systematically explored the factors influencing the difficulty of hand-assisted laparoscopic living donor nephrectomy. To investigate the relationship between the difficulty of hand-assisted laparoscopic living donor nephrectomy and postoperative complications of the donor as well as the recipient, and then build a model for predicting the difficulty of surgery.

METHODS

In this study, 60 patients who underwent hand-assisted laparoscopic living donor nephrectomy by the same surgeon from September 2022 to March 2024 were included as the modeling group. 20 patients operated on by another surgeon served as the external validation group. The subjective score (1-3 points) of surgical difficulty was used as the quantitative index of surgical difficulty. Pearson and Spearman correlation tests were used to explore the correlation between preoperative data and surgical difficulty scores of kidney donors, and finally built a prediction model through multiple linear regression analysis.

RESULTS

With the increase in the difficulty of operation, both donors and recipients' complications were increased. Linear regression analysis showed that only the number of renal arteries, visceral fat thickness and MAP score were independent risk factors for the difficulty of hand-assisted laparoscopic living donor nephrectomy. The prediction equation is as follows: Difficulty score = 0.584*Number of renal arteries + 0.731*MAP score + 0.110*visceral fat thickness.

CONCLUSIONS

Donors with higher surgical difficulty are more likely to have serious complications after surgery as well as the recipient. We also established a reliable prediction model for the difficulty of hand-assisted laparoscopic donor nephrectomy.

Effective and safe implementation of robot-assisted donor nephrectomy by experienced laparoscopic surgeons

BACKGROUND

In June 2021, the first robot-assisted donor nephrectomy (RADN) was performed at the Leiden University Medical Center (LUMC), the Netherlands. The goal of this study was to investigate whether this procedure has been implemented safely and efficiently.

METHODS

RADN was retrospectively compared to laparoscopic donor nephrectomy (LDN) performed during the same time period (June 2021 until November 2022). Patients were assigned to RADN depending on the availability of the da Vinci robot and surgical team. The studied endpoints were postoperative complications, operative time, estimated blood loss, warm ischemic time (WIT), and postoperative pain experience. For analysis, the Student's t-test and Chi-squared test were used for, respectively, continuous and categorical data.

RESULTS

Forty RADN were compared to 63 LDN. Total insufflation time was significantly longer in RADN compared to LDN (188 min (169-214) versus 172 min (144-194); p = 0.02). Additionally, WIT was also found to be significantly higher in the robot-assisted group (04:54 min vs. 04:07 min; p < 0.01). No statistical differences were found in postoperative outcomes (eGFR of the recipient at 3-month follow-up, RADN 54.08 mL/min ±18.79 vs. LDN 56.41 mL/min ±16.82; p = 0.52), pain experience, and complication rate.

CONCLUSION

RADN was safely and efficiently implemented at the LUMC. It's results were not inferior to laparoscopic donor nephrectomy. Operative time and warm ischemic times were longer in RADN. This may relate to a learning curve effect. No clinically relevant effect on postoperative outcomes was observed.

Study of the predictive factors affecting outcomes of patients undergoing transperitoneal laparoscopic donor nephrectomy

PURPOSE

We aim to study the preoperative and intraoperative factors and compare against specific outcomes in patients undergoing transperitoneal laparoscopic donor nephrectomy and see if we could find what were the predictive factors for these outcomes.

METHODS

This is a prospective cohort study done in a single high-volume transplant center. 153 kidney donors were evaluated over a period of 1 year. The preoperative factors such as age, gender, smoking status, obesity, visceral obesity, perinephric fat thickness, number of vessels, anatomic abnormalities, comorbidities, and side of kidney and intraoperative factors such as lay of colon on the kidney, height of splenic or hepatic flexure of colon, loaded or unloaded colon, and sticky mesenteric fat were compared against specific outcomes such as duration of surgery, duration of hospital stay, postoperative paralytic ileus, and postoperative wound complications.

RESULTS

Multivariate logistic regression models were used to study the variables of interest against the various outcomes. There were three positive risk factors for increased hospital stay, which were perinephric fat thickness and height of splenic or hepatic flexure of colon and smoking history. There was one positive risk factor for postoperative paralytic ileus which is lay of colon with relation to kidney and there was one positive risk factor for postoperative wound complication which was visceral fat area.

CONCLUSION

The predictive factors for adverse postoperative outcomes after transperitoneal laparoscopic donor nephrectomy were perinephric fat thickness, height of splenic or hepatic flexure, smoking status, lay or redundancy of colon with relation to kidney and visceral fat area.

Mayo adhesive probability score is associated with perioperative outcomes in retroperitoneal laparoscopic adrenalectomy

BACKGROUNDS

This study aimed to determine whether the Mayo adhesive probability score (MAP), which evaluated adherent perinephric fat (APF), is useful in evaluating the difficulty of retroperitoneal laparoscopic adrenalectomy (RLA), and to analyse the correlation between MAP and perioperative parameters.

METHODS

Clinical data of 104 patients with adrenal adenoma who underwent RLA were collected for retrospective analysis. According to the CT images obtained before surgery, patients were divided into two groups: High MAP group (2-5 points) and Low MAP group (0-1 points). Comparison of the general clinical characteristics and the perioperative data between the two groups was made.

RESULTS

There were more male patients (73.7% versus 34.3%), more patients with a smoking history (24.3% versus 7.5%), higher BMI (25.7 versus 23.2, kg/m² ), and bigger (23.8 versus 18.5, mm) neoplasm in the high MAP group (P < 0.05). Significant difference was observed in operative time (128.8 versus 102.3, min), estimated blood loss (47.2 versus 25.2, ml) and drainage tube removal time (4.0 versus 3.2, d) between the two groups (P < 0.05). A high MAP score (P < 0.001) and the size of tumour (P = 0.024) were independent risk factors for extended operative time. A higher BMI (OR = 1.525, P < 0.001) and larger tumour size (OR = 2.862, P = 0.004) were independent risk factors for a high MAP score.

CONCLUSIONS

MAP score was associated with the perioperative outcomes of RLA. BMI and tumour size were better indicators of MAP score, which can influence the difficulty of RLA.