1
|
Geldmaker LE, Zganjar AJ, Gonzalez Albo GA, Haehn DA, Qosja N, Wieczorek MA, Ball CT, Thiel DD. Impact of Inner Layer Renorrhaphy Suture on Renal Artery Pseudoaneurysm Formation Following Robotic-assisted Partial Nephrectomy. Urology 2023; 182:125-132. [PMID: 37673406 DOI: 10.1016/j.urology.2023.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To report the impact of resection base inner layer renorrhaphy suture type on renal artery pseudoaneurysm (RAP) rate following robotic-assisted partial nephrectomy (RAPN). METHODS Five hundred and sixty-three consecutive RAPNs performed by a single surgeon were retrospectively reviewed. Patients were classified into 3 categories: (1) No base suture, (2) monofilament barbed suture (2-0 V-Loc 180 absorbable suture, Medtronic, Minneapolis, MN), (3) polyglactin 910 (2-0 Vicryl coated suture, Ethicon Inc, Cincinnati, OH). In a secondary analysis, we evaluated suturing (Vicryl and V-Loc) vs no base suture. All patients had outer cortical renorrhaphy performed with 0-Vicryl suture utilizing the standard sliding clip technique. RESULTS One hundred ten patients (19.5%) had V-Loc suturing, 255 patients (45.3%) had Vicryl suturing, and 198 patients (35.2%) had no base suture. Patients had a median age of 62.8years (interquartile range: 53.5-69.7) and median RENAL score was 8 (6-9). Median mass size from preoperative imaging was 3.0 cm (2.5-4.0) for V-Loc, 3.3 cm (2.5-4.2) for Vicryl, and 2.0 cm (1.8-3.0) for no base suture (P < .001). Overall, 21 patients (3.7%) developed a symptomatic postoperative RAP. The rate of RAP was 3.6% (4/110) for V-Loc, 3.9% (10/255) for 2-0 Vicryl, and 3.5% (7/198) for no base suture (P = 1.00). Similarly, the rate of RAP was 3.5% (7/198) for no base suture and 3.8% (14/365) for base suture (P = 1.00). CONCLUSION Utilization of base suture and type of base suture used during RAPN was not predictive of postoperative RAP development.
Collapse
Affiliation(s)
| | | | | | | | - Neda Qosja
- Department of Urology, Mayo Clinic, Jacksonville, FL
| | - Mikolaj A Wieczorek
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Colleen T Ball
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL.
| |
Collapse
|
2
|
Deininger S, Törzsök P, Lusuardi L, Deininger SHM, Freude T, Wichlas F, Deininger C. Renal Arteriovenous (AV) Fistula after High-Grade Blunt Renal Trauma Caused by Traffic Accidents. J Clin Med 2023; 12:6362. [PMID: 37835006 PMCID: PMC10573478 DOI: 10.3390/jcm12196362] [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: 09/07/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE To report a series of three patients with traumatic renal AV fistulas after blunt renal laceration. METHODS We retrospectively analyzed the renal trauma cases treated in the Department of Urology of Salzburg University Clinic during a time period of 10 years concerning traumatic AV fistula formation and other clinical parameters. RESULTS In total, 3 cases of traumatic AV fistula formation were identified in 106 blunt renal trauma patients (2.8%), with a mean age of 39 (17-56) years. All renal traumas were classified as American Association for the Surgery of Trauma (AAST) grade IV. Two patients were primarily treated with ureteral stent; one was managed conservatively. All AV fistulas were diagnosed after a mean time of 7 (1-13) days. Two patients were symptomatic with gross hematuria, and the mean time between trauma and onset of symptoms was 11 (9-13) days. All cases were managed via coil embolization after a mean of 10 (8-13) days. Two patients received a second intervention after a mean of 18 (11-25) days. The mean AV fistula size was 18.7 (12-24) mm. Mean hemoglobin loss was 3.6 g/dL. One patient received one erythrocyte concentrate. Discharge was after a mean time of 13.3 (7-12) days, with the mean time of intensive care treatment being 2.3 (1-3) days. CONCLUSIONS Traumatic renal AV fistula is a rare but severe complication associated with higher-grade renal trauma. It can become evident through hematuria or blood loss several days after the initial trauma. The availability of coil embolization in a trauma center can help kidney preservation management.
Collapse
Affiliation(s)
- Susanne Deininger
- Department of Urology and Andrology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (L.L.)
- No Limit Surgery e.V. (NLS), 5020 Salzburg, Austria; (S.H.M.D.); (F.W.)
| | - Peter Törzsök
- Department of Urology and Andrology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (L.L.)
| | - Lukas Lusuardi
- Department of Urology and Andrology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (P.T.); (L.L.)
| | | | - Thomas Freude
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Florian Wichlas
- No Limit Surgery e.V. (NLS), 5020 Salzburg, Austria; (S.H.M.D.); (F.W.)
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Christian Deininger
- No Limit Surgery e.V. (NLS), 5020 Salzburg, Austria; (S.H.M.D.); (F.W.)
- Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria;
| |
Collapse
|
3
|
Tufano A, Asero V, Proietti F, Flammia RS, Franco G, Leonardo C. Arteriovenous fistula after robotic partial nephrectomy: Case report and narrative review. Radiol Case Rep 2022; 17:2550-2553. [PMID: 35601380 PMCID: PMC9121071 DOI: 10.1016/j.radcr.2022.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 10/26/2022] Open
Abstract
Arteriovenous fistulas (AVF) of the kidney are uncommon. They may be acquired, idiopathic or arise of congenital arteriovenous malformation. Acquired renal AVF are mostly iatrogenic due to the increasing number of mini-invasive nephron surgery. We report a case of renal AVF in a 65-year-old woman previously treated with left robotic partial nephrectomy (PN), which was successfully treated by endovascular coiling.
Collapse
Affiliation(s)
- Antonio Tufano
- Department of Urology, Sapienza University, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| | - Vincenzo Asero
- Department of Urology, Sapienza University, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| | - Flavia Proietti
- Department of Urology, Sapienza University, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| | - Rocco Simone Flammia
- Department of Urology, Sapienza University, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giorgio Franco
- Department of Urology, Sapienza University, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| | - Costantino Leonardo
- Department of Urology, Sapienza University, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161, Rome, Italy
| |
Collapse
|
4
|
Takayama T, Fujita A, Sugihara T, Fujisaki A, Yamazaki M, Kameda T, Kamei J, Ando S, Kurokawa S, Fujimura T. Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy. Transl Androl Urol 2021; 10:3555-3565. [PMID: 34733652 PMCID: PMC8511543 DOI: 10.21037/tau-21-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/15/2021] [Indexed: 11/06/2022] Open
Abstract
Background We assessed the natural history of renal artery pseudoaneurysm (RAP) after robot-assisted partial nephrectomy (RAPN). Methods From May 2016 to September 2020, 106 patients underwent RAPN for renal tumors at our institution. Among 100 patients, excluding 6 who were ineligible for contrast-enhanced computed tomography (CE-CT), 4 underwent renal artery selective embolization (RAE), of which 2 cases were emergency RAE within 7 days after RAPN and the other 2 were prophylactic RAE 8 or more days after RAPN. In 98 patients examined for the clinical course of asymptomatic RAP managed by surveillance, excluding the 2 who underwent emergency RAE, routine CE-CT was performed at 7 days, 1 month and 3 months after RAPN. Factors influencing the occurrence of RAP among these 98 patients, including the 2 who underwent emergency RAE and excluding the 2 who underwent prophylactic RAE, were analyzed by logistic regression analysis. Results Median [interquartile range (IOR), range] observation period, age, radiographic tumor size, and maximum diameter of RAP were 20.8 (23.9, 3.0–57.6) months, 63 (18, 22–84) years, 23 (11, 9–48) mm, and 6.6 (5.2, 3.0–16.0) mm, respectively. CE-CT detected 28 RAPs in 23 (23.0%) of 100 patients by 7 days after RAPN and routine CE-CT detected 25 RAPs in 21 (21.4%) of 98 patients excluding 2 who underwent emergency RAE at 7 days after RAPN. RAP was diagnosed by routine CE-CT in 21 (21.4%), 1 (1.0%), and 0 (0%) patients at 7 days, 1 month, and 3 months after RAPN, respectively. In univariate analysis, age [odds ratio (OR) 0.144: 69–84 vs. 22–56 years old, P=0.0179], R.E.N.A.L [radius (tumor size as maximal diameter), exophytic/endophytic properties of tumor, nearness of tumor deepest portion to collecting system or sinus, anterior/posterior descriptor and location relative to polar line] nephrometry score (OR 1.374, P=0.0382), warm ischemic time (OR 1.085, P=0.0393), and renorrhaphy time (OR 1.055, P=0.0408) were significantly associated with the occurrence of RAP. In multivariate analysis, only age (OR 0.124, P=0.0148) was a significant factor. Conclusions Asymptomatic RAP up to 15 mm in diameter resolved spontaneously 3 months after RAPN. Young age (under 56 years) may be a factor in the development of RAP.
Collapse
Affiliation(s)
- Tatsuya Takayama
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akifumi Fujita
- Department of Radiology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akira Fujisaki
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Masahiro Yamazaki
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomohiro Kameda
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoshi Ando
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shinsuke Kurokawa
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| |
Collapse
|
5
|
Raghavan D, Thangarasu M, J SP, Paul R, Selvaraj N. A Hemostatic Technique in Robot-Assisted Laparoscopic Partial Nephrectomy and Its Impact on Renal Function. Cureus 2021; 13:e15122. [PMID: 34159024 PMCID: PMC8213237 DOI: 10.7759/cureus.15122] [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: 12/02/2022] Open
Abstract
Purpose Robot-assisted partial nephrectomy (RAPN) has become popular in recent years for small renal masses. We describe a technique of suturing renal defects during RAPN that is reliable and quick, does not necessitate the need for hemostatic agents, and reduces perioperative complications. Materials and methods A total of 24 patients who underwent RAPN were included in the study period between 2013 and 2018 and data were analyzed. Perioperative and postoperative outcomes were measured and compared. Results The median tumor size was 4 cm. Median warm ischemia time was 41 minutes (IQR: 38-45 minutes) and estimated blood loss was 150 mL (IQR: 120-200 mL). There were no major intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed. Conclusion Our technique is safe and effective. It negates the use of hemostatic agents, decreases perioperative complications, and negates that determination of long-term renal function is not associated with prolonged warm ischemia time alone. Hence, we propose that our technique is safe in partial nephrectomy when the pelvic calyceal system and renal vessels are opened in multiple locations.
Collapse
|
6
|
Yamashita S, Kawabata H, Deguchi R, Ueda Y, Higuchi M, Muraoka S, Koike H, Kikkawa K, Kohjimoto Y, Hara I. Natural History of Asymptomatic Pseudoaneurysm Soon After Robot-assisted Partial Nephrectomy: Single-center Prospective Study. Urology 2020; 148:145-150. [PMID: 33248140 DOI: 10.1016/j.urology.2020.09.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To prospectively investigate the natural history of asymptomatic pseudoaneurysm after robotic-assisted partial nephrectomy. METHODS Robotic-assisted partial nephrectomy was undertaken for 67 patients between July 2014 and July 2018. Patients who could not undergo enhanced CT were excluded, so 60 patients were finally included in the present study. We prospectively investigated the presence of pseudoaneurysm based on early enhanced CT scan on postoperative day 7. According to our treatment policy, patients with symptomatic pseudoaneurysm underwent selective transarterial embolization. Meanwhile, patients with asymptomatic pseudoaneurysm were observed with follow-up CT imaging, regardless of the size of the aneurysm. RESULTS Overall incidence of pseudoaneurysm on postoperative day 7 was 18% (11/60 cases). The median size of the pseudoaneurysm was 9 mm (quartile: 6-12 mm). Two patients with symptomatic pseudoaneurysm underwent selective transarterial embolization. Nine patients had asymptomatic pseudoaneurysm; in 8 of these it disappeared without therapeutic intervention. The median period from surgery to confirmed disappearance of the aneurysm was 19 days (quartile 14-32 days). In the remaining 1 patient, small asymptomatic pseudoaneurysm (2 mm) could still be observed even 1 year after surgery. CONCLUSION Our study showed high incidence of pseudoaneurysm 1 week after robotic-assisted partial nephrectomy that mostly disappeared without therapeutic intervention. Routine enhanced CT screening and pre-emptive embolization may not be necessary for asymptomatic renal artery pseudoaneurysm.
Collapse
Affiliation(s)
- Shimpei Yamashita
- Department of Urology, Wakayama Medical University, Wakayama, Japan.
| | - Hiroki Kawabata
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Ryusuke Deguchi
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Yuko Ueda
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | | | - Satoshi Muraoka
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Koike
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
7
|
Bukavina L, Mishra K, Calaway A, Ponsky L. Robotic Partial Nephrectomy: Update on Techniques. Urol Clin North Am 2020; 48:81-90. [PMID: 33218596 DOI: 10.1016/j.ucl.2020.09.013] [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: 01/15/2023]
Abstract
Surgical techniques for robot-assisted partial nephrectomy are driven by the aims of simplifying the most challenging surgical steps, maximizing functional and oncologic outcomes, and consistently pushing the envelope on possibilities. Over the past several years, we have seen an emergence in not only innovation in surgical technique, and robotic platforms, but integration of a variety of imaging techniques. We believe with developing robotic expertise, practicing urologists will continue to push the envelope in nephron preservation and complication-free recovery.
Collapse
Affiliation(s)
- Laura Bukavina
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kirtishri Mishra
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam Calaway
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lee Ponsky
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Suite 411, Cleveland, OH 44106, USA.
| |
Collapse
|
8
|
Lee CH, Ha HK, Ku JY, Seo WI, Choi SH. Clinical factors that influence the occurrence of symptomatic pseudoaneurysms and arteriovenous fistulas after partial nephrectomy: multi-institutional study of renal function outcomes after one year of selective arterial embolization. Int Braz J Urol 2020; 47:149-158. [PMID: 33047920 PMCID: PMC7712700 DOI: 10.1590/s1677-5538.ibju.2019.0789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/22/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Renal artery pseudoaneurysms (RAPs) and arteriovenous fistulas (AVFs) are rare but potentially life-threatening complications after partial nephrectomy (PN). Selective arterial embolization (SAE) is an effective method for controlling RAPs/AVFs. We assessed the clinical factors affecting the occurrence of RAPs/AVFs after PN and the effects of SAE on postsurgical renal function. MATERIALS AND METHODS Four hundred ninety-three patients who underwent PN were retrospectively reviewed. They were placed in either the SAE or the non-SAE group. The effects of clinical factors, including R.E.N.A.L. scores, on the occurrence of RAPs/AVFs were analyzed. The influence of SAE on the estimated glomerular filtration rate (eGFR) during the first postoperative year was evaluated. RESULTS Thirty-three (6.7%) patients experienced RAPs/AVFs within 8 days of the median interval between PN and SAE. The SAE group had significantly higher R.E.N.A.L. scores, higher N component scores, and higher L component scores (all, p <0.05). In the multivariate analysis, higher N component scores were associated with the occurrence of RAPs/AVFs (Odds ratio: 1.96, p=0.039). In the SAE group, the mean 3-day postembolization eGFR was significantly lower than the mean 3-day postoperative eGFR (p <0.01). This difference in the eGFRs was still present 1 year later. CONCLUSIONS Renal tumors located near the renal sinus and collecting system were associated with a higher risk for RAPs/AVFs after PN. Although SAE was an effective method for controlling symptomatic RAPs/AVFs after PN, a procedure-related impairment of renal function after SAE could occur and still be present at the end of the first postoperative year.
Collapse
Affiliation(s)
- Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Ja Yoon Ku
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Won Ik Seo
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seock Hwan Choi
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
9
|
Morita S, Matsuzaki Y, Yamamoto T, Kamoshida K, Yamazaki H, Tajima T, Kondo T, Takagi T, Yoshida K, Tanabe K, Sakai S. Mid-term outcome of transarterial embolization of renal artery pseudoaneurysm and arteriovenous fistula after partial nephrectomy screened by early postoperative contrast-enhanced CT. CVIR Endovasc 2020; 3:68. [PMID: 32936351 PMCID: PMC7494709 DOI: 10.1186/s42155-020-00160-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose To retrospectively evaluate the mid-term outcome of transarterial embolization (TAE) of renal artery pseudoaneurysm (RAP) including arteriovenous fistula (AVF) after partial nephrectomy screened by early postoperative contrast-enhanced CT (CE-CT). Materials and methods Eighty-two patients (7.0%) who underwent TAE after partial nephrectomy were reviewed, from 1166 partial nephrectomies performed over 6 years. In 18 patients (22.0%), TAE was performed emergently on the median postoperative day (POD) seven. In the remaining patients, elective TAE was performed on the median POD six for RAP detected by early postoperative CE-CT or that emerged on follow-up CE-CT. Results In one patient (1.2%), TAE was performed twice because one of two RAPs could not be embolized during the first TAE, being successfully embolized at the second TAE after readmission with hematuria. Otherwise, no bleeding recurrence or RAPs were observed during the median 1354 follow-up days. Thus, the primary and secondary success rates of TAE were 98.8% (81 of 82 patients) and 100% (82 of 82 patients), respectively. On angiography, the average number of lesions was 1.7 ± 0.9 and the average RAP size was 12.8 ± 6.0 mm. The shapes of the lesions varied: oval-round 60, oval-round + AVF 36, irregular + AVF 14, AVF 12, irregular 10, disruption 4, and extravasation 3. No major complications were observed. The median inpatient days after TAE were two. No estimated glomerular filtration rate deterioration was observed (64.6 ± 18.6 vs. 64.2 ± 18.4 mL/min/1.73 m2, p = 0.902). Conclusion TAE is largely effective and safe for treating bleedings or RAPs, including AVFs, after partial nephrectomy, as screened by early postoperative CE-CT.
Collapse
Affiliation(s)
- Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Yuka Matsuzaki
- School of Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takahiro Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kumi Kamoshida
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroshi Yamazaki
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Tsuyoshi Tajima
- Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
10
|
Tachibana H, Kondo T, Yoshida K, Takagi T, Tanabe K. Lower Incidence of Postoperative Acute Kidney Injury in Robot-Assisted Partial Nephrectomy Than in Open Partial Nephrectomy: A Propensity Score-Matched Study. J Endourol 2020; 34:754-762. [PMID: 32368924 DOI: 10.1089/end.2019.0622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Acute kidney injury (AKI) after partial nephrectomy is attributed to parenchymal reduction and ischemia, but the extent of its effect remains unclear. This study aimed to compare the incidence of postoperative AKI among surgical modalities, robot-assisted partial nephrectomy (RAPN), laparoscopic partial nephrectomy (LPN), and open partial nephrectomy (OPN), and to evaluate the validity of RAPN by comparing it with LPN and OPN in terms of postoperative AKI, perioperative complications, and long-term renal function. Patients and Methods: Patients who underwent RAPN, LPN, and OPN for renal tumors at our institutions between 2004 and 2018 were retrospectively analyzed. RAPN and LPN were performed under warm ischemia and OPN under cold ischemia. En bloc hilar clamping was employed for LPN and OPN and arterial clamping for RAPN. AKI was defined as % decrease in estimated glomerular filtration rate (eGFR) >25% from preoperative eGFR to postoperative nadir eGFR. Multivariate regression analysis was used to test associations of AKI with perioperative factors. Then, we compared the incidence of AKI with two propensity score-matched cohorts: RAPN vs OPN and RAPN vs LPN. Results: This study included 1762 cases (RAPN: 959, LPN: 215, and OPN: 588). After matching, 147 cases each from RAPN and LPN groups and 368 cases each from RAPN and OPN groups were selected. RAPN had shorter warm ischemia time than LPN, lower incidence of AKI, and lower % decrease in eGFR after 6 months. RAPN had a shorter ischemia time and a lower incidence of AKI than OPN, although the % decrease in eGFR after 6 months did not differ significantly. Conclusions: AKI incidence was lower in RAPN than in LPN or OPN, which may be due to the shorter ischemia time or clamping of only arteries in RAPN. Although long-term renal outcomes did not differ between RAPN and OPN, RAPN can help prevent AKI. This supports the validity of RAPN for patients with chronic kidney disease.
Collapse
Affiliation(s)
- Hidekazu Tachibana
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
11
|
Baboudjian M, Gondran-Tellier B, Abdallah R, Lannes F, Sichez PC, Akiki A, Gaillet S, Toledano H, Delaporte V, Andre M, Karsenty G, Lechevallier E, Rossi D, Vidal V, Boissier R, Bastide C. Selective Trans-arterial Embolization of Iatrogenic Vascular Lesions Did Not Influence the Global Renal Function After Partial Nephrectomy. Urology 2020; 141:108-113. [PMID: 32283170 DOI: 10.1016/j.urology.2020.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the renal function outcomes after selective trans-arterial embolization (SAE) of iatrogenic vascular lesions (IVL), including pseudoaneurysm and arteriovenous fistula, following partial nephrectomy (PN). MATERIALS AND METHODS A multi-institutional study was conducted including consecutive patients who underwent PN between January 2009 and March 2019. Two surgical approaches were used: open and robot-assisted PN. Patients with SAE were identified and matched (1:2) with patients without IVL. The matching criteria were age, gender, Charlson score, creatinine clearance, RENAL score, and tumor size. The primary outcome was the evolution of global renal function at 6-months postoperatively. RESULTS A total of 493 consecutive PN (360 open PN and 133 robot-assisted PN) were included. IVL occurred in 17 cases (3.4%) without statistical difference according to the surgical approach (P = .78). Patients from embolization group were matched to 34 cases without postoperative IVL. Groups were comparable concerning clinical, tumor and surgical characteristics. The clinical success of SAE, defined as the absence of recourse to a second embolization or a total nephrectomy, was obtained in 16 (94.1%) cases. No minor or major complications were reported after SAE. The preoperative estimated glomerular filtration rate (eGFR) was similar between control group (93 [85-102] ml/min) and embolization group (95 [83-102] ml/min) (P = .99). Median (IQR) eGFR between control group (87 [72-95] ml/min) and embolization group (83 [76-93] ml/min) at a follow-up of 6 months showed no significant difference (P = .73). CONCLUSION IVL are rare complications of PN. SAE is an effective and minimally invasive management tool, with no deleterious effect on global renal function.
Collapse
Affiliation(s)
- Michael Baboudjian
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France.
| | - Bastien Gondran-Tellier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Rony Abdallah
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Francois Lannes
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Pierre Clement Sichez
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Akram Akiki
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Sarah Gaillet
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Harry Toledano
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Veronique Delaporte
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Marc Andre
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Radiology and Medical imaging, Marseille, France
| | - Gilles Karsenty
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Eric Lechevallier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Dominique Rossi
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| | - Vincent Vidal
- Aix-Marseille University, APHM, La Timone Academic Hospital, Dept. of Radiology and Medical imaging, Marseille, France; European Center for Medical Imaging Research CERIMED/LIIE, Marseille, France
| | - Romain Boissier
- Aix-Marseille University, APHM, Conception Academic Hospital, Dept. of Urology and Kidney Transplantation, Marseille, France
| | - Cyrille Bastide
- Aix-Marseille University, APHM, Nord Academic Hospital, Dept. of Urology, Marseille, France
| |
Collapse
|
12
|
Shigeta K, Matsumoto K, Abe T, Komatsuda A, Takeda T, Mizuno R, Kikuchi E, Asanuma H, Arita Y, Akita H, Jinzaki M, Miyajima A, Oya M. The efficacy of the TachoSil binding suturing technique in laparoscopic partial nephrectomy to prevent the development of pseudoaneurysm. Asian J Surg 2019; 43:668-675. [PMID: 31629637 DOI: 10.1016/j.asjsur.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Our specific aim was to introduce the TachoSil binding suturing technique for renal cell carcinoma (RCC) patients when closing the parenchymal defect after tumor excision during laparoscopic partial nephrectomy (LPN), which is a novel technique for reducing the risk of developing subsequent pseudoaneurysm (PA). METHODS We identified 113 pT1aN0M0 RCC patients who underwent LPN at our institution. Eighty-one (72%) patients underwent the suturing procedure without binding TachoSil, whereas 32 (28%) patients underwent renorraphy with the renal defect closed together with TachoSil. The vascular complications were evaluated by computed tomography or magnetic resonance imaging with enhanced contrast material at the first visit after LPN. We conducted Fischer's exact test to determine risk factors for transcatheter arterial embolization (TAE). RESULTS The median age was 55 (36-86) years old and the median follow-up time was 65 (12-147) months. In the overall population, there were 11 (11%) patients who underwent TAE because they developed PA. All 11 patients exhibited the imaging findings of PA, and were all from the conventional suturing group. In contrast, no patients for whom the TachoSil binding method was used had any significant findings on imaging (14% vs. 0%). Based on the analysis to determine risk factors for TAE due to PA development, the TachoSil binding suturing technique was one of the significant indicators for reducing the risk of developing PA. CONCLUSIONS Our study demonstrated that the TachoSil binding suturing technique might reduce the development of PA after LPN. Prospective randomized study and comparison to the standard 2 or 3-layer renorrhaphy is needed to prove its actual value.
Collapse
Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Takayuki Abe
- Department of Preventive Medicine and Public Health, Biostatistics Unit at the Clinical Translational Research Center, Keio University School of Medicine, Tokyo, Japan
| | - Akari Komatsuda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Arita
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, Kanagawa, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
13
|
Tohi Y, Murata S, Makita N, Suzuki I, Kubota M, Sugino Y, Inoue K, Ueda H, Kawakita M. Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy. Asian J Urol 2019; 7:24-28. [PMID: 31970068 PMCID: PMC6962716 DOI: 10.1016/j.ajur.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
Objective To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm (RAP) on contrast-enhanced computed tomography (CE-CT) after robot-assisted partial nephrectomy (RAPN) without parenchymal renorrhaphy. Methods From May 2016 to December 2017, 78 patients underwent RAPN for renal tumors. Inner suture was performed in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft coagulation system was used, and absorbable hemostats were placed on the resection bed. CE-CT was carried out within 7 days after surgery. Data on these patients were prospectively collected. A single radiologist determined the diagnosis of RAP. Results Median (range) data were as follows: Patient age, 65 (19–82) years; radiographic tumor size, 30 (12–95) mm; operating time, 166 (102–294) min; warm ischemic time, 16 (7–67) min; and blood loss, 15 (0–4450) mL. One patient (1.6%) required a perioperative blood transfusion. No patient required conversion to open surgery or nephrectomy. CE-CT was carried out at median 6 (3–7) days after surgery. CE-CT showed no RAP development in all 61 patients. Urinary leakage was not observed. One patient had acute cholecystitis, a postoperative complication classified as Clavien-Dindo grade higher than 3, which was treated with cholecystectomy. Positive surgical margin was identified in four patients (6.6%). Conclusion RAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe. Our technique could eliminate the risk of RAP.
Collapse
Affiliation(s)
- Yoichiro Tohi
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Shiori Murata
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Noriyuki Makita
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Issei Suzuki
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Masashi Kubota
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Yoshio Sugino
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Koji Inoue
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Hiroyuki Ueda
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| | - Mutsushi Kawakita
- Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan
| |
Collapse
|
14
|
Dominique I, Dariane C, Fourniol C, Le Guilchet T, Hurel S, Fontaine E, Mandron E, Audenet F, Mejean A, Timsit MO. Performing an early systematic Doppler-ultrasound fails to prevent hemorrhagic complications after complex partial nephrectomy. Ther Adv Urol 2019; 11:1756287219828966. [PMID: 30800173 PMCID: PMC6378436 DOI: 10.1177/1756287219828966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background: The aim of this work was to assess the clinical relevance of a systematic postoperative Doppler-ultrasound (DU) after complex partial nephrectomy (PN). Materials and methods: All patients who underwent open, laparoscopic or robotic PN from 2014 to 2017 at our institution were included. Postoperative hemorrhagic complications (HCs) were defined as the occurrence of blood transfusion, hemorrhagic shock, arterial embolization, or re-hospitalization for hematoma. DU was systematically performed between post-op day 4 and 7 for every complex tumor (RENAL score ⩾ 7). DU was considered positive in the presence of pseudoaneurysm (PA) or arteriovenous fistula (AVF). Results: Among 194 patients, 117 underwent DU (60.3%). We reported 22 HCs (11.3%) requiring 8 selective embolization procedures (4.1%). HCs occurred during the hospital stay in 17 patients (77.3%), thus directly diagnosed on a computed tomography scan. Among the five patients (22.7%) with HC occurring after hospital discharge, between day 7 to 15, four had a previously negative systematic DU. Overall, systematic DU was positive in only five patients (4.3%) with only one patient of 194 (0.5%) undergoing preventive embolization of a PA-AVF. The negative predictive values (NPVs) and positive predictive values of DU were respectively 96.5% and 5%, with 20% sensitivity and 96.5% specificity. Conclusions: Our results may suggest offering systematic DU in patients under antiplatelet therapies, with high tumor size (>T1b), or early postoperative hemoglobin variations. A high NPV of DU might be counterbalanced by its low sensibility. Since all secondary HCs occurred between postoperative day 7 to 15, our results may suggest differing DU in selected cases.
Collapse
Affiliation(s)
- Inès Dominique
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP, 20-40 rue Leblanc, Paris, 75015, France
| | - Charles Dariane
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Cyril Fourniol
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Thomas Le Guilchet
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Sophie Hurel
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Eric Fontaine
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Eric Mandron
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Francois Audenet
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Arnaud Mejean
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| | - Marc Olivier Timsit
- Department of Urology, Hôpital Européen Georges-Pompidou (HEGP), Assistance Publique Hôpitaux de Paris (APHP), Paris, France Paris-Descartes University, Paris, France
| |
Collapse
|
15
|
Nouhaud FX, Williams M, Arnfield E, Perera ML, Cho J, Esler R, Coughlin G. Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy? BJU Int 2018; 122 Suppl 5:15-21. [DOI: 10.1111/bju.14485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Michael Williams
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Evyn Arnfield
- Department of Radiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Marlon Lakmal Perera
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Jonathan Cho
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
| | - Rachel Esler
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Wesley Urology Clinic; Wesley Hospital; Brisbane Qld Australia
| | - Geoff Coughlin
- Department of Radiology; Royal Brisbane and Women's Hospital; Brisbane Qld Australia
- Wesley Urology Clinic; Wesley Hospital; Brisbane Qld Australia
| |
Collapse
|
16
|
Tachibana H, Takagi T, Kondo T, Ishida H, Tanabe K. Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis. Int Braz J Urol 2018; 44:467-474. [PMID: 29244272 PMCID: PMC5996815 DOI: 10.1590/s1677-5538.ibju.2016.0581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 07/08/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose: Renorrhaphy in partial nephrectomy may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to the formation of renal artery pseudoaneurysms or vascularized parenchymal volume reduction. Using propensity score matching, we compared surgical outcomes following non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy (OPN) for T1a renal tumors. Materials and Methods: We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent OPN for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables were adjusted using 1:1 propensity score matching between the two Groups: renorrhaphy (inner and outer layer sutures) and non-renorrhaphy (inner layer sutures only). Postoperative complications and renal function were compared between the two groups. Results: We matched 43 patients per Group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the two Groups. Urine leakage (Clavien-Dindo grade ≥3) occurred in 0 renorrhaphy cases and 2 non-renorrhaphy cases (0% versus 4.6%, P=0.49). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases and in 0 non-renorrhaphy cases (13% versus 0%, P=0.02). Conclusions: The non-renorrhaphy technique may result in a lower risk of RAP but a greater risk of urine leakage. This technique needs further refinement to become a standard procedure for OPN.
Collapse
Affiliation(s)
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
17
|
Tachibana H, Takagi T, Kondo T, Ishida H, Tanabe K. Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy: A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume. Int J Urol 2018; 25:359-364. [DOI: 10.1111/iju.13529] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/27/2017] [Indexed: 01/12/2023]
Affiliation(s)
| | - Toshio Takagi
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Tsunenori Kondo
- Department of Urology; Tokyo Women's Medical University; Medical Center East; Tokyo Japan
| | - Hideki Ishida
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| |
Collapse
|
18
|
Kaygisiz O, Çelen S, Vuruşkan BA, Vuruşkan H. Comparison of two different suture techniques in laparoscopic partial nephrectomy. Int Braz J Urol 2017; 43:863-870. [PMID: 28727369 PMCID: PMC5678517 DOI: 10.1590/s1677-5538.ibju.2016.0550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/24/2017] [Indexed: 01/20/2023] Open
Abstract
Objective: To comparatively evaluate the traditional interrupted knot-tying and running suture renorrhaphy with Monocryl® in laparoscopic partial nephrectomy (LPN). Materials and Methods: A retrospective analysis of 62 consecutive patients undergoing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n=31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl®, Ethicon) (Group 2; n=31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic surgeon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated. Results: The running suture renorrhaphy with Monocryl® reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture. Conclusion: The renorrhaphy using the running suture with Monocryl® is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.
Collapse
Affiliation(s)
- Onur Kaygisiz
- Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Sinan Çelen
- Afyon Sandikli Government Hospital, Afyon, Turkey
| | - Berna Aytac Vuruşkan
- Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Hakan Vuruşkan
- Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey
| |
Collapse
|
19
|
Takagi T, Kondo T, Tachibana H, Iizuka J, Omae K, Yoshida K, Kobayashi H, Okumi M, Ishida H, Tanabe K. Comparison of Surgical Outcomes Between Resection and Enucleation in Robot-Assisted Laparoscopic Partial Nephrectomy for Renal Tumors According to the Surface-Intermediate-Base Margin Score: A Propensity Score-Matched Study. J Endourol 2017; 31:756-761. [DOI: 10.1089/end.2017.0260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Omae
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
20
|
Chiancone F, Fedelini M, Pucci L, Di Lorenzo D, Meccariello C, Fedelini P. Emergent Embolization of a Very Late Detected Pseudoaneurysm at a Lower Pole Subsegmental Artery of the Kidney after Clampless Laparoscopic Partial Nephrectomy. Curr Urol 2017; 10:105-107. [PMID: 28785196 DOI: 10.1159/000447160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/11/2016] [Indexed: 12/20/2022] Open
Abstract
Renal artery pseudoaneurysm is a rare but life-threatening condition. Its incidence is higher after minimally invasive partial nephrectomy (PN) than after the open approach. We reported a case of a renal artery pseudoaneurysm occurred about four months after a clampless laparoscopic PN. A 49-year-old female underwent a clampless laparoscopic PN for a right renal tumor with high surgical complexity. The patient experienced an intraoperative blood loss from renal bed and the surgeons performed a deep medullary absorbable suture. Three months after surgery the patient underwent a renal ultrasonography with good results. The patient came to our emergency department 115 days after surgery with a hypovolemic shock stage 3. Her CT scan showed a pseudoaneurysm of a lower pole vessel of the right kidney. She underwent a superselective embolization of the segmental renal artery. The surgical complexity of the tumor, the anatomical relationships with the renal sinus and the deep medullary suture could be responsible for the development of the pseudoaneurysm. The authors presented an unusual case of a very late detected pseudoaneurysm of a renal vessel, suggesting that all very complex renal tumors removed with a minimally invasive technique should be followed up closely at least during the first six-months in order to early detect this major complication.
Collapse
Affiliation(s)
| | | | - Luigi Pucci
- Urology Unit, AORN Cardarelli Hospital, Naples, Italy
| | | | | | | |
Collapse
|
21
|
Takagi T, Kondo T, Tachibana H, Iizuka J, Omae K, Kobayashi H, Yoshida K, Tanabe K. Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes. Int J Urol 2017; 24:505-510. [DOI: 10.1111/iju.13363] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Toshio Takagi
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Tsunenori Kondo
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | | | - Junpei Iizuka
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kenji Omae
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | | | - Kazuhiko Yoshida
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| | - Kazunari Tanabe
- Department of Urology; Tokyo Women's Medical University; Tokyo Japan
| |
Collapse
|
22
|
Williams RD, Snowden C, Frank R, Thiel DD. Has Sliding-Clip Renorrhaphy Eliminated the Need for Collecting System Repair During Robot-Assisted Partial Nephrectomy? J Endourol 2017; 31:289-294. [DOI: 10.1089/end.2016.0562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Ryan Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida
| | - David D. Thiel
- Department of Urology, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
23
|
Delayed renal artery pseudoaneurysm after robotic partial nephrectomy. J Robot Surg 2017; 11:275-277. [DOI: 10.1007/s11701-017-0676-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
|
24
|
Gupta N, Patel A, Ensor J, Ahrar K, Ahrar J, Tam A, Odisio B, Huang S, Murthy R, Mahvash A, Avritscher R, McRae S, Sabir S, Wallace M, Matin S, Gupta S. Multiple Renal Artery Pseudoaneurysms in Patients Undergoing Renal Artery Embolization Following Partial Nephrectomy: Correlation with RENAL Nephrometry Scores. Cardiovasc Intervent Radiol 2016; 40:202-209. [PMID: 27681271 DOI: 10.1007/s00270-016-1473-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the incidence of multiple renal artery pseudoaneurysms (PSA) in patients referred for renal artery embolization following partial nephrectomy and to study its relationship to RENAL nephrometry scores. MATERIALS AND METHODS The medical records of 25 patients referred for renal artery embolization after partial nephrectomy were retrospectively reviewed for the following parameters: size and number of tumors, RENAL nephrometry scores, angiographic abnormalities, technical and clinical outcomes, and estimated glomerular filtration rates (eGFRs) after embolization. RESULTS Twenty-four patients had primary renal tumors, while 1 patient had a pancreatic tumor invading the kidney. Multiple tumors were resected in 4 patients. Most patients (92 %) were symptomatic, presenting with gross hematuria, flank pain, or both. Angiography revealed PSA with (n = 5) or without (n = 20) AV fistulae. Sixteen patients (64 %) had multiple PSA involving multiple renal vessels. Higher RENAL nephrometry scores were associated with an increasing likelihood of multiple PSA. Multiple vessels were embolized in 14 patients (56 %). Clinical success was achieved after one (n = 22) or two (n = 3) embolization sessions in all patients. Post-embolization eGFR values at different time points after embolization were not significantly different from the post-operative eGFR. CONCLUSION A majority of patients requiring renal artery embolization following partial nephrectomy have multiple pseudoaneurysms, often requiring selective embolization of multiple vessels. Higher RENAL nephrometry score is associated with an increasing likelihood of multiple pseudoaneurysms. We found transarterial embolization to be a safe and effective treatment option with no long-term adverse effect on renal function in all but one patient with a solitary kidney.
Collapse
Affiliation(s)
- Nakul Gupta
- Houston Methodist Hospital, Houston, TX, USA
| | - Anish Patel
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joe Ensor
- The Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Judy Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Alda Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Stephen Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Ravi Murthy
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Armeen Mahvash
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Rony Avritscher
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Stephen McRae
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Sharjeel Sabir
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Michael Wallace
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA
| | - Surena Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Unit 1471, PO Box 301402, Houston, TX, 77230-1402, USA.
| |
Collapse
|
25
|
A propensity score-matched comparison of surgical precision obtained by using volumetric analysis between robot-assisted laparoscopic and open partial nephrectomy for T1 renal cell carcinoma: a retrospective non-randomized observational study of initial outcomes. Int Urol Nephrol 2016; 48:1585-91. [DOI: 10.1007/s11255-016-1323-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 05/14/2016] [Indexed: 12/22/2022]
|
26
|
Özkan B, Coşkuner ER, Yalçın V. Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience. Turk J Urol 2016; 42:1-6. [PMID: 27011873 DOI: 10.5152/tud.2016.36786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. MATERIAL AND METHODS Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. RESULTS Patients undergoing RAPN had a mean tumor size of 4.42 cm (2-8) and a mean renal nephrometry score of 5.82 (4-11). The mean estimated blood loss was 250 mL (150-450 ml) and the mean operative time was 195 minutes (150-300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2-10). In only 1 patient disease recurrence was detected at the 21(st) month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3-36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). CONCLUSION With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors.
Collapse
Affiliation(s)
- Burak Özkan
- Department of Urology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Enis Rauf Coşkuner
- Department of Urology, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Veli Yalçın
- Department of Urology, Bakırköy Acıbadem Hospital, İstanbul, Turkey
| |
Collapse
|
27
|
Shiroki R, Fukami N, Fukaya K, Kusaka M, Natsume T, Ichihara T, Toyama H. Robot-assisted partial nephrectomy: Superiority over laparoscopic partial nephrectomy. Int J Urol 2015; 23:122-31. [DOI: 10.1111/iju.13001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/23/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Ryoichi Shiroki
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Naohiko Fukami
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Kosuke Fukaya
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Mamoru Kusaka
- Department of Urology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| | - Takahiro Natsume
- Faculty of Radiological Technology; Fujita Health University School of Health Sciences; Toyoake Aichi Japan
| | - Takashi Ichihara
- Faculty of Radiological Technology; Fujita Health University School of Health Sciences; Toyoake Aichi Japan
| | - Hiroshi Toyama
- Department of Radiology; Fujita Health University School of Medicine; Toyoake Aichi Japan
| |
Collapse
|
28
|
Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication. BIOMED RESEARCH INTERNATIONAL 2015; 2015:981251. [PMID: 26539549 PMCID: PMC4619914 DOI: 10.1155/2015/981251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/15/2015] [Accepted: 08/27/2015] [Indexed: 11/21/2022]
Abstract
Objectives. A symptomatic renal pseudoaneurysm (RPA) is a severe complication after open partial nephrectomy (OPN). The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6%) patients, on average 14 (4–42) days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p = 0.004). There was a significant correlation between RPAs and transfusion and the duration of stay (p < 0.001 and p = 0.021). Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment.
Collapse
|
29
|
Fujii Y. Editorial Comment from Dr. Fujii to Early unclamping might reduce the risk of renal artery pseudoaneurysm after robot-assisted laparoscopic partial nephrectomy. Int J Urol 2015; 22:1103. [PMID: 26344052 DOI: 10.1111/iju.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| |
Collapse
|
30
|
Kondo T, Takagi T, Morita S, Omae K, Hashimoto Y, Kobayashi H, Iizuka J, Yoshida K, Fukuda N, Tanabe K. Early unclamping might reduce the risk of renal artery pseudoaneurysm after robot-assisted laparoscopic partial nephrectomy. Int J Urol 2015; 22:1096-102. [PMID: 26307333 DOI: 10.1111/iju.12902] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/23/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine the influence of the early unclamping technique on the risk of renal artery pseudoaneurysm during robot-assisted laparoscopic partial nephrectomy. METHODS From January 2013 to October 2014, 96 patients underwent robot-assisted laparoscopic partial nephrectomy for renal masses at Tokyo Women's Medical University Hospital, Tokyo, Japan. Computed tomography angiography was carried out 3-4 days after surgery. Early in the series, renal hilum was left unclamped and renorrhaphy was subsequently carried out (conventional unclamping technique). An early unclamping technique has been used since November 2013. RESULTS A total of 61 patients underwent robot-assisted laparoscopic partial nephrectomy with early unclamping, and 35 patients underwent robot-assisted laparoscopic partial nephrectomy with conventional unclamping. Ischemia time was significantly shorter in the early unclamping group (16.5 vs. 23.1 min; P < 0.01). The early unclamping group showed a significantly lower incidence of asymptomatic renal artery pseudoaneurysm relative to the conventional unclamping group (11.4% vs. 28.6%; P = 0.03). Multivariate analysis showed that the early unclamping technique was a significant independent factor in reducing the risk of renal artery pseudoaneurysm (hazard ratio 0.27; P = 0.01). CONCLUSIONS The present findings suggest that an early unclamping technique might reduce ischemic time and risk of renal artery pseudoaneurysm. The absence of arterial bleeding before renorrhaphy is likely to be a key step in preventing renal artery pseudoaneurysm during robot-assisted laparoscopic partial nephrectomy.
Collapse
Affiliation(s)
- Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Omae
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | | | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Norihiro Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
31
|
Morita S, Tajima T, Yamazaki H, Sonoyama Y, Nishina Y, Kenji O, Takagi T, Kondo T, Tanabe K, Sakai S. Early postoperative screening by contrast-enhanced CT and prophylactic embolization of detected pseudoaneurysms prevents delayed hemorrhage after partial nephrectomy. J Vasc Interv Radiol 2015; 26:950-7. [PMID: 25881511 DOI: 10.1016/j.jvir.2015.02.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/23/2015] [Accepted: 02/23/2015] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To evaluate retrospectively whether prophylactic embolization of pseudoaneurysms detected on early postoperative screening with computed tomography (CT) after partial nephrectomy can prevent delayed hemorrhage. MATERIALS AND METHODS Between January 2012 and May 2014, early postoperative contrast-enhanced CT was performed 3-5 days after partial nephrectomy in 312 patients (group A); CT was not performed in 65 patients (group B) because of renal insufficiency or contrast medium allergy. If pseudoaneurysms were detected on CT in group A, prophylactic embolization was performed. The frequency of delayed hemorrhage occurring more than 3 days after surgery in group A was compared with group B and with 212 patients (group C) who underwent partial nephrectomy between January 2010 and December 2011 without early postoperative CT. Changes in estimated glomerular filtration rate at discharge were compared among the groups. RESULTS Prophylactic embolization of pseudoaneurysms was performed in 26 patients (8%) in group A. Frequency of delayed hemorrhage in group A (0.6%) was significantly lower than in groups B (4.6%; P = .038) and C (4.7%; P = .005). No major complications attributable to prophylactic embolization were observed. The decrease in estimated glomerular filtration rate in group A (-2% ± 13%) was smaller than that in group B (-8% ± 13%; P < .001) and not worse than that in group C (-4% ± 14%; P = .108). CONCLUSIONS Prophylactic embolization of pseudoaneurysms detected on early postoperative CT can prevent delayed hemorrhage after partial nephrectomy, without major complications.
Collapse
Affiliation(s)
- Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan.
| | - Tsuyoshi Tajima
- Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Hiroshi Yamazaki
- Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Yasuyuki Sonoyama
- Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Yu Nishina
- Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Omae Kenji
- Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine (Radiology), Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Tokyo162-8666, Japan
| |
Collapse
|
32
|
Jain S. Editorial comment to Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy. Int J Urol 2015; 22:361. [PMID: 25600009 DOI: 10.1111/iju.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Samay Jain
- Department of Urology, University of Toledo Medical Center, Toledo, OH, USA.
| |
Collapse
|