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Lu X, Guo Z, Yang G, Yang F, Sun Y, Zhang S, Huang J, He M, Wu J, Cheng J, Guo J, Wang H. A novel mini-retractor for retroperitoneal laparoscopic partial nephrectomy. J Surg Oncol 2024. [PMID: 38606525 DOI: 10.1002/jso.27642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/19/2024] [Accepted: 02/11/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Retroperitoneal partial nephrectomy (RLPN) is the premier treatment for localized renal tumors despite narrow operation space. Many efforts have been taken to facilitate the operation of RLPN, but the optimal resolution remains debatable. OBJECTIVE To explore the feasibility of using Mini-lap to improve workspace and surgical vision in RLPN. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective review of 51 patients who underwent RLPN with Mini-lap from January 2018 to December 2020 was conducted. SURGICAL PROCEDURE Standard RLPN under three poles was performed in all cases. We highlighted the usage of Mini-lap (Teleflex Minilap percutaneous Surgical System) as a novel retractor in RLPN. OUTCOME AND MEASUREMENTS AND STATICAL ANALYSIS Demographics, preoperative, intraoperative, and postoperative outcomes were assessed. RESULTS AND LIMITATIONS All 51 cases completed RLPN with three ports successfully and no conversion to open surgery. The mean diameter of tumors was (3.53 ± 1.05) cm, in which 62.7% (32/51) were located anteriorly. The operation time and warm ischemic time (WIT) were (86.7 ± 15.9) min and (25.6 ± 5) min respectively. Minor complications (Clavien grade 1-2) occurred in 6 cases. The limitations were small sample size, retrospective design, and absence of control. CONCLUSIONS Mini-lap could be used as a mini-retractor in RLPN, sparing extra assistant ports, expanding workspace, and optimizing vision. PATIENT SUMMARY With highlights of larger workspace and less instrument interference, mini-lap could be applied in retroperitoneal laparoscopic partial nephrectomy.
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Affiliation(s)
- Xuwei Lu
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Zhuifeng Guo
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Guanwen Yang
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
| | - Fan Yang
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Yang Sun
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Sihong Zhang
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
| | - Jiaqi Huang
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Minke He
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Jiawen Wu
- Department of Urology, Minhang Hospital, FUDAN University, Shanghai, China
| | - Jie Cheng
- Department of Urology, Xuhui Hospital, FUDAN University, Shanghai, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
| | - Hang Wang
- Department of Urology, Zhongshan Hospital, FUDAN University, Shanghai, China
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Noguchi H, Shingaki K, Sato Y, Kubo S, Kaku K, Okabe Y, Nakamura M. Outcomes and Cost Comparison of 3 Different Laparoscopic Approach for Living Donor Nephrectomy: A Retrospective, Single-Center, Inverse Probability of Treatment Weighting Analysis of 551 Cases. Transplant Proc 2024; 56:482-487. [PMID: 38331594 DOI: 10.1016/j.transproceed.2024.01.009] [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: 08/22/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND At our institution, we switched from hand-assisted retroperitoneal laparoscopic donor nephrectomy (HRN) to hand-assisted transperitoneal laparoscopic donor nephrectomy (HTN); we later switched to standard retroperitoneal laparoscopic donor nephrectomy (SRN). This study was performed to evaluate outcomes and hospital costs among the 3 techniques. METHODS This retrospective, observational, single-center, inverse probability of treatment weighting analysis study compared the outcomes among 551 cases of living donor kidney transplantation between 2014 and 2022. RESULTS After the inverse probability of treatment weighting analysis, there were 114 cases in the HRN group, 204 cases in the HTN group, and 213 cases in the SRN group. Donor complication rates were lowest in the SRN group but did not differ between the HRN and HTN groups (1.1 vs 4.4 and 5.9%, P = .021). Donors in the SRN group had the lowest serum C-reactive protein concentrations on postoperative day 1 (4.3 vs 10.5 and 7.8 mg/dL, P < .001) and the shortest postoperative stay (4.3 vs 7.4 and 8.4 days, P < .001). Donors in the SRN group had the lowest total cost among the 3 groups (8868 vs 9709 and 10,592 USD, P < .0001). Donors in the SRN group also had the lowest costs in terms of "basic medical fees," "medication and injection fees," "Intraoperative drug and material costs," and "testing fees." Furthermore, the presence of complications was significantly correlated with higher total hospital costs (P < .001). CONCLUSION SRN appeared to have the least invasive and complication, and a potential cost savings compared with the HRN and HTN.
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Affiliation(s)
- Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kodai Shingaki
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Shrivastava N, Bhargava P, Sharma G, Choudhary GR. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systematic review and meta-analysis. World J Urol 2024; 42:83. [PMID: 38358565 DOI: 10.1007/s00345-024-04796-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) can be performed either by a transperitoneal (TP) or a retroperitoneal (RP) approach. However, the superiority of one approach over the other is not established. Hence, the primary aim of this review was to compare perioperative outcomes between these two surgical approaches. METHODS Literature was systematically searched to identify studies reporting perioperative outcomes following TP RAPN and RP RAPN. The study protocol was registered with PROSPERO (CRD42023399496). The primary outcome was comparing complication rates between the two approaches. RESULTS This review included 22 studies, 5675 patients, 2524 in the RP group, and 3151 in the TP group. The overall complications were significantly lower in the RP group [Odds ratio (OR) 0.80 (0.67, 0.95), p = 0.01]. However, the rate of major complications was similar between the two groups. The operative time was significantly shorter with the RP group [Mean Difference (MD)-16.7 (- 22.3, - 11.0), p = < 0.0001]. Estimated blood loss (EBL) and need for blood transfusion (BT) were significantly lower in the RP group. There was no difference between the two groups for conversion to radical nephrectomy [OR 0.66 (0.33, 1.33), p = 0.25] or open surgery [OR 0.68 (0.24, 1.92, p = 0.47] and positive surgical margins [OR 0.93 (0.66, 1.31, p = 0.69]. Length of stay (LOS) was shorter in the RP group [MD - 0.27 (- 0.45, - 0.08), p = < 0.00001]. CONCLUSIONS RP approach, compared to TP, has significantly lower complication rates, EBL, need for BT and LOS. However, due to the lack of randomized studies on the topic, further data is required.
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Affiliation(s)
- Nikita Shrivastava
- Department of Urology, DKS Super Specialty Hospital and Postgraduate Institute, Raipur, India
| | - Priyank Bhargava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Gopal Sharma
- Department of Urologic Oncology and Robotic Surgery, Medanta-The Medicity, Gurugram, Haryana, 122001, India.
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Kovač R, Juginović I, Delić N, Velat I, Vučemilović H, Vuković I, Kozomara V, Lekić A, Duplančić B. The Effect of Epidural Analgesia on Quality of Recovery (QoR) after Open Radical Nephrectomy: Randomized, Prospective, and Controlled Trial. J Pers Med 2024; 14:190. [PMID: 38392623 PMCID: PMC10890626 DOI: 10.3390/jpm14020190] [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: 01/11/2024] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
No studies are currently evaluating the quality of recovery (QoR) after open radical nephrectomy (ORN) and epidural morphine analgesia. This was a randomized, prospective, and controlled study that explored the QoR on the first postoperative day after ORN. Eighty subjects were randomized into two groups. The first group received general anesthesia combined with epidural anesthesia and postoperative epidural analgesia with morphine and ropivacaine. The second group received general anesthesia and continuous postoperative intravenous analgesia with tramadol. Both groups received multimodal analgesia with metamizole. The primary outcome measure was the total QoR-40 score. The secondary outcome measures were QoR-15, QoR-VAS, and the visual analog scale (VAS) for pain, anxiety, and nausea. The median difference in the QoR-40 score after 24 postoperative hours between the two groups of patients was 10 (95% CI: 15 to 5), p < 0.0001. The median score and IQR of QoR-40 during the first 24 postoperative hours in the epidural group was 180 (9.5), and in the control group, it was 170 (13). The general independence test for secondary outcomes between groups was significant (p < 0.01). QoR-VAS was correlated with QoR-40 (r = 0.63, p ≤ 0.001) and with QoR-15 (r = 0.54, p ≤ 0.001). The total QoR-40 and QoR-15 alpha coefficients with a 95% CI were 0.88 (0.85-0.92) and 0.73 (0.64-0.81), respectively. There was a significant difference in the QoR between the epidural and the control groups after ORN. The QoR-40 and QoR-15 showed good convergent validity and reliability.
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Affiliation(s)
- Ruben Kovač
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivo Juginović
- Department of Urology, University Hospital Split, 21000 Split, Croatia
| | - Nikola Delić
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivan Velat
- Department of Urology, University Hospital Split, 21000 Split, Croatia
| | - Hrvoje Vučemilović
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Ivan Vuković
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Verica Kozomara
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
| | - Angela Lekić
- Surgery Department, University Hospital Split, 21000 Split, Croatia
| | - Božidar Duplančić
- Department of Anesthesiology and Intensive Care, University Hospital Split, 21000 Split, Croatia
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Chen Y, Liu S, Li B, Lin R, Lai W, Liu D, Wang Z, Liu J, Qin X, Wu X, Li J, Jia K, Chen J. Application of the quality of recovery-40 questionnaire to evaluate the effectiveness of enhanced recovery after surgery protocols in gastric cancer. Updates Surg 2024:10.1007/s13304-023-01719-w. [PMID: 38245892 DOI: 10.1007/s13304-023-01719-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/29/2023] [Indexed: 01/23/2024]
Abstract
Patient reported outcomes is currently considered to be an important supplement to evaluate the effectiveness of enhanced recovery after surgery (ERAS) clinical practice. The Quality of Recovery-40 Questionnaire (QoR-40) is one of the most frequently used and validation tool to assess the subjective feelings of quality of life after surgery. The present study aimed to use the QoR-40 to evaluate the effectiveness of ERAS protocols in gastric cancer from the perspective of patient-reported quality of recovery. The study was designed as a prospective, non-randomized clinical trial, conducted in a single center. Patients in our hospital who were scheduled to undergo radical surgery for gastric cancer were divided into ERAS group and control group (Contr group). The QoR-40 were administered one day before surgery (Baseline) and on postoperative day 1, 3, 6, and 30. The difference in QoR-40 scores between the ERAS and Contr groups was compared by repeated-measures ANOVA. A total of 200 patients completed the study, including 100 patients in the ERAS group and 100 patients in the Contr group. The Baseline time point QoR-40 scores of the ERAS and Contr groups were 179.68 ± 14.46 and 180.12 ± 17.12, respectively, and no significant difference was noted between the two groups (p = 0.845). The postoperative QoR-40 score of the ERAS group was significantly higher than that of the Contr group, and the difference was statistically significant (p = 0.006). This study demonstrated that, in terms of patient-reported quality of recovery, the postoperative recovery effect of ERAS protocols in gastric cancer is significantly better than that of the traditional treatment model.
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Affiliation(s)
- Yeyang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
- Department of Thyroid and Breast surgery, The First People's Hospital of Yulin, Yulin, China
| | - Siyu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Bopei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Rujing Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Weikun Lai
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Dejun Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Zhen Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Jinlu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Xingan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Xianghua Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Jiehua Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Kui Jia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China
| | - Junqiang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Guangxi, China.
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Mjaess G, Bernhard JC, Khene ZE, Doumerc N, Vaessen C, Henon F, Bruyere F, Brenier M, Parier B, Albisinni S, Ingels A. Retroperitoneal vs. transperitoneal robotic partial nephrectomy: a multicenter propensity-score matching analysis (PADORA Study - UroCCR n° 68). Minerva Urol Nephrol 2023; 75:434-442. [PMID: 37530660 DOI: 10.23736/s2724-6051.23.05346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
BACKGROUND Robot-assisted partial nephrectomy can be performed through either a transperitoneal or retroperitoneal approach. This study aimed to compare the rate of trifecta achievement between retroperitoneal (RRPN) and transperitoneal (TRPN) robot-assisted partial nephrectomy using a large multicenter prospectively-maintained database and propensity-score matching analysis. METHODS This study was launched by the French Kidney Cancer Research Network, under the UroCCR Project (NCT03293563). Patients who underwent TRPN or RRPN by experienced surgeons in 15 participating centers were included. Data on demographic and clinical parameters, tumor characteristics, renal function, and surgical parameters were collected. The primary outcome was the rate of trifecta achievement, which was defined as a warm ischemia time of less than 25 minutes, negative surgical margins, and no major complications. Secondary outcomes included operative time, hospital length-of-stay, blood loss, postoperative complications, postoperative renal function, and each trifecta item taken alone. Subgroup analysis was done according to tumor location. RESULTS A total of 2879 patients (2581 TRPN vs. 298 RRPN) were included in the study. Before matching, trifecta was achieved in 73.0% of the patients in the TRPN group compared to 77.5% in the RRPN group (P=0.094). After matching 157 patients who underwent TRPN to 157 patients who underwent RRPN, the trifecta rate was 82.8% in the TRPN group vs. 84.0% in the RRPN group (P=0.065). The RRPN group showed shorter operative time (123 vs. 171 min; P<0.001) and less blood loss (161 vs. 293 mL; P<0.001). RRPN showed a higher trifecta achievement for posterior tumors than TRPN (71% vs. 81%; P=0.017). CONCLUSIONS RRPN is a viable alternative to the transperitoneal approach, particularly for posterior renal tumors, and is a safe and effective option for partial nephrectomy.
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Affiliation(s)
- Georges Mjaess
- Department of Urology, Brussels University Hospital, Brussels, Belgium -
| | | | | | | | | | | | | | - Martin Brenier
- Department of Urology, Hôpital Saint Joseph, Paris, France
| | - Bastien Parier
- Department of Urology, Hôpital Kremlin Bicêtre, Paris, France
| | - Simone Albisinni
- Department of Urology, Brussels University Hospital, Brussels, Belgium
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Alexandre Ingels
- Department of Urology, CHU Henri Mondor, Créteil, France
- Inserm, Clinical Investigation Center 1430, Henri Mondor University Hospital, AP-HP, Creteil, France
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Harrison R, Ahmed M, Billah M, Sheckley F, Lulla T, Caviasco C, Sanders A, Lovallo G, Stifelman M. Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes. J Robot Surg 2023; 17:223-231. [PMID: 35648289 DOI: 10.1007/s11701-022-01415-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [- 0.13 (95% CI; - 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.
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Affiliation(s)
- Robert Harrison
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.
| | - Mutahar Ahmed
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.,Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Mubashir Billah
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Fahad Sheckley
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Tina Lulla
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Christina Caviasco
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Angeline Sanders
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA
| | - Gregory Lovallo
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.,Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Michael Stifelman
- Department of Urology, Hackensack University Medical Center, 360 Essex St. Suite 403, Hackensack, NJ, 07601, USA.,Hackensack Meridian School of Medicine, Hackensack, NJ, USA
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Ishiyama Y, Kondo T, Yoshida K, Iizuka J, Tanabe K, Takagi T. Efficacy and feasibility of robot-assisted partial nephrectomy for octogenarians: comparison with younger counterparts. J Robot Surg 2022; 16:1165-1173. [DOI: 10.1007/s11701-021-01350-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 01/31/2023]
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Tachibana H, Omae K, Ishihara H, Fukuda H, Yoshida K, Iizuka J, Tanabe K, Kondo T, Takagi T. Validation of predictive model for new baseline renal function after robot-assisted partial nephrectomy or radical nephrectomy in Japanese patients. J Endourol 2021; 36:745-751. [PMID: 34806410 DOI: 10.1089/end.2021.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The study aim was to externally validate a new predictive model for new baseline glomerular filtration rate post-nephrectomy among Japanese patients. MATERIALS AND METHODS Patients with renal tumors who underwent radical nephrectomy or robot-assisted partial nephrectomy at a single Japanese institution in 2000-2020 were retrospectively analyzed. New baseline glomerular filtration rate is defined as the final estimated glomerular filtration rate within postoperative 3-12 months. The correlation/bias/accuracy/precision of the equation was examined by comparing the calculated new baseline glomerular filtration rate with the observed rate. RESULTS The study included 485 cases of radical nephrectomy, and 1030 cases of robot-assisted partial nephrectomy. The correlation/bias/accuracy/precision of the new equation predicting new baseline glomerular filtration rate were 0.86/-0.92/95.9/-5.65-3.62 in robot-assisted partial nephrectomy and 0.79/-1.02/87.8/-6.26-3.91 in radical nephrectomy, respectively. The fractional polynomial regression line approximated zero and its pointwise 95% confidence interval was considerably tight for the majority of both cohorts. The 95% confidence interval to discriminate new baseline glomerular filtration rates of ≥45 ml/min/1.73 m2 from receiver operating curves was 0.96 (0.95-0.97) and 0.89 (0.87-0.92) in robot-assisted partial nephrectomy and radical nephrectomy, respectively. Various preoperative factors including age, tumor size, complexity, body mass index, hypertension, and diabetes did not affect the predictive ability (correlation > 0.7) from the subgroup analysis. CONCLUSION The novel simple equation can accurately predict new baseline glomerular filtration rates after radical and robot-assisted partial nephrectomies in Japanese patients. This model will help physicians choose surgical treatments for renal tumors in daily clinical practice.
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Affiliation(s)
| | - Kenji Omae
- Fukushima Medical University, 12775, Department of Innovative Research and Education for Clinicians and Trainees, Fukushima, Fukushima, Japan;
| | - Hiroki Ishihara
- Tokyo Women's Medical University Medical Center East, 163613, Arakawa-ku, Tokyo, Japan;
| | | | | | - Junpei Iizuka
- Tokyo Women's Medical University, Urology, Tokyo, Japan;
| | - Kazunari Tanabe
- Tokyo Women's Medical University, 13131, Urology, Shinjuku-ku, Tokyo, Japan;
| | - Tsunenori Kondo
- Tokyo Women's Medical University Medical Center East, 163613, Department of Urology, Arakawa-ku, Tokyo, Japan;
| | - Toshio Takagi
- Tokyo Women's Medical University, Urology, 8-1, Kawacacho, Shinjyuku-ku, Tokyo, Japan, 162-8666;
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Gong Y, Li S. Diagnostic Value of Color Doppler Ultrasound Combined with Superb Microvascular Imaging in the Detection of Small Renal Tumors Less than 3 cm Treated with Jinkui Shenqi Pills. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5327331. [PMID: 34512778 PMCID: PMC8433002 DOI: 10.1155/2021/5327331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate the diagnostic value of color Doppler ultrasound combined with superb microvascular imaging (SMI) in the detection of small renal tumors less than 3 cm treated with Jinkui Shenqi pills. 50 cases were randomly selected from the patients with angioleiomyoma (a kind of small renal tumor) less than 3 cm confirmed by pathological examination and treated in our hospital from January 2018 to January 2020. All patients were treated with Jinkui Shenqi pills. All patients were first detected by color Doppler ultrasound and then by SMI. The results of color Doppler ultrasound were used as the control group, while those of color Doppler ultrasound combined with SMI were used as the experimental group. After that, the specificity, sensitivity, positive and negative detection results, and detection accuracy were compared between the two groups. The specificity and sensitivity in the experimental group were significantly higher than those in the control group, with statistical significance (P < 0.05). The cases of positive and negative detection results in the experimental group were significantly higher than those in the control group, with statistical significance (P < 0.05). The detection accuracy in the experimental group was significantly higher than that in the control group, with statistical significance (P < 0.05). The specificity, sensitivity, positive and negative detection results, and detection accuracy of color Doppler ultrasound combined with SMI in the detection of small renal tumors less than 3 cm treated with Jinkui Shenqi pills were all significantly higher than those of color Doppler ultrasound; therefore, the application of color Doppler ultrasound combined with SMI for the diagnosis of small renal tumors is of high value.
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Affiliation(s)
- Yuping Gong
- Department of Ultrasonic Imaging, Traditional Chinese Medicine Hospital of China Three Gorges University, Yichang Traditional Chinese Medicine Hospital, Yichang 443000, Hubei Province, China
| | - Shuhui Li
- Department of Nephropathy, The People's Hospital Attached to Sanxia (Three Gorges) University, The First Hospital of Yichang, Yichang 443000, Hubei Province, China
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Zhou J, Liu ZH, Cao DH, Peng ZF, Song P, Yang L, Liu LR, Wei Q, Dong Q. Retroperitoneal or transperitoneal approach in robot-assisted partial nephrectomy, which one is better? Cancer Med 2021; 10:3299-3308. [PMID: 33932108 PMCID: PMC8124103 DOI: 10.1002/cam4.3888] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose To systematically assess the perioperative outcomes of retroperitoneal (RP) and transperitoneal (TP) approaches in robot‐assisted partial nephrectomy (RAPN), we conducted an updated meta‐analysis. Methods A literature retrieval of multi‐database including PubMed, Web of Science, Embase, Cochrane Library, and CNKI was performed to identify eligible comparative studies from the inception dates to January 2021. Perioperative outcomes included operative time (OT), estimated blood loss (EBL), warm ischemia time (WIT), postoperative length of stay (PLOS), positive surgical margin (PSM), and complications (major complications and overall complications). Outcomes of data were pooled and analyzed with Review Manager 5.4.1. Results Twenty‐one studies involving a total of 2482 RP and 3423 TP approach RAPN patients met the inclusion criteria. Operating time (OT) (weighted mean difference [WMD] −16.60; 95% confidence interval [CI] −23.08, −10.12; p < 0.01) and PLOS (WMD −0.46 days; 95% CI −0.69, −0.23; p < 0.01) were shorter in RP‐RAPN. Besides, lower EBL (WMD −21.67; 95% CI −29.74, −13.60; p < 0.05) was also found in RP‐RAPN. Meanwhile, no significant differences were found in other outcomes. Conclusions RP‐RARN was superior to TP‐RAPN in patients undergoing RAPN in terms of OT, PLOS, and estimated blood loss. Besides these two approaches have no significant differences in PSMs or perioperative complications.
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Affiliation(s)
- Jing Zhou
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - Zheng-Huan Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - De-Hong Cao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhu-Feng Peng
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Pan Song
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - Luchen Yang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Sichuan University, Chengdu, China
| | - Liang-Ren Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
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