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Rawal S, Ganpule A, Singh G, Shrivastava N, Kishore TA, Dubey D, Mavuduru RS, Kumar A, Gautam G, Pooleri GK, Keshavamurthy M, Ragavan N, Baxi H, Addla SK, Raghunath SK, Dahiya A, Gupta D, Sharma G. Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database. Indian J Urol 2024; 40:121-126. [PMID: 38725898 PMCID: PMC11078450 DOI: 10.4103/iju.iju_443_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44-62]), median operative time was 180 min (IQR 133-240), median estimated blood loss was 100 mL (IQR 50-200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.
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Affiliation(s)
- Sudhir Rawal
- Department of Genito Uro-Oncology Services, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Gurpremjit Singh
- Department of Uro-Oncology and Robotic Surgery, Medanta, Gurugram, Haryana, India
| | - Nikita Shrivastava
- Department of Urology, DKS Super Speciality Hospital and Postgraduate Institute, Raipur, Chhattisgarh, India
| | - T. A. Kishore
- Department of Urology, Aster Medicity, Kochi, Kerala, India
| | - Deepak Dubey
- Department of Urology, Manipal Hospital, Bengaluru, India
| | - Ravimohan S. Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anant Kumar
- Department of Urology and Renal Transplantation, Max Hospitals, Delhi, India
| | - Gagan Gautam
- Department of Uro-Oncology and Robotic Surgery, Max Institute of Cancer Care, New Delhi, India
| | - Ginil Kumar Pooleri
- Department of Urology and Renal Transplantation, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | - Hemang Baxi
- Department of Urology, HCG Cancer Center, Ahmedabad, Gujarat, India
| | - Sanjai Kumar Addla
- Department of Uro Oncology, Apollo Hospital, Hyderabad, Telangana, India
| | | | - Akhil Dahiya
- Department of Clinical and Medical Affairs, Intuitive Surgical, California, USA
| | | | - Gopal Sharma
- Department of Urology, Medanta, Gurugram, Haryana, India
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Garg H, Tiwari D, Nayak B, Singh P, Yadav S, Kumar R, Seth A, Nayyar R, Dogra P. A comparative analysis of various surgical approaches of nephron-sparing surgery and correlation of histopathological grade with RENAL nephrometry score in renal cell carcinoma. J Minim Access Surg 2019; 16:144-151. [PMID: 30777990 PMCID: PMC7176007 DOI: 10.4103/jmas.jmas_208_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Nephron-sparing surgery (NSS) is the standard of care for small renal masses whenever feasible. This study aims to evaluate the perioperative outcomes of NSS performed by open (open partial nephrectomy [OPN]) or laparoscopic (laparoscopic PN [LPN]) or robotic (robotic PN [RPN]) approach over the past 6 years and to study the correlation of histopathological grade of renal cell carcinoma with the RENAL score. Materials and Methods: A retrospective analysis of prospectively collected data of all patients who underwent NSS was done. Results: A total of 135 patients underwent NSS. The mean tumour size was 4.4 cm. About 61 patients underwent OPN, 24 had LPN and 50 had RPN. Although tumour size was larger in OPN group (P = 0.01), tumour complexity based on the RENAL score was similar in OPN and RPN groups (P = 0.15). The OPN group had shorter operative time (P = 0.008) but more blood loss (P = 0.001) and length of hospital stay (P = 0.049) as compared to LPN or RPN group. Maximum radiological diameter of tumour (P = 0.017) appeared to be a significant predictor of operative time, while the open surgical approach (P = 0.003) and tumour stage (P = 0.044) were found to be significant predictors of blood loss. Hilar clamping time was similar in OPN and RPN groups (P = 0.054) but higher in LPN group (P = 0.01). However, post-operative decline in renal function (estimated glomerular filtration rate) (P = 0.08) and margin status were comparable among the three groups. The most common histopathology was clear cell carcinoma (70%), and RENAL score was identified as a significant predictor of histopathological grade of tumour (P = 0.008). Conclusion: Open, laparoscopic and robotic approaches to PN provide similar patient outcomes. OPN was usually preferred for larger tumours. The post-operative decline in renal functions and complications were comparable among the three approaches. RENAL score correlated significantly with histopathological grade and hence could help in predicting tumour behaviour pre-operatively.
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Deviprasad Tiwari
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharth Yadav
- Department of Urology, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Premnath Dogra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Leow JJ, Heah NH, Chang SL, Chong YL, Png KS. Outcomes of Robotic versus Laparoscopic Partial Nephrectomy: an Updated Meta-Analysis of 4,919 Patients. J Urol 2016; 196:1371-1377. [PMID: 27291654 DOI: 10.1016/j.juro.2016.06.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE We evaluated the current literature comparing outcomes of robotic vs laparoscopic partial nephrectomy. MATERIALS AND METHODS We performed a literature search according to Cochrane guidelines up to December 2015 including studies comparing robotic and laparoscopic partial nephrectomy, and we compared baseline patient and tumor characteristics. We performed a meta-analysis to evaluate safety, effectiveness and functional outcomes of robotic vs laparoscopic partial nephrectomy using weighted mean difference and inverse variance pooled risk ratios, respectively. RESULTS A total of 4,919 patients were included from 25 studies (robotic partial nephrectomy 2,681, laparoscopic partial nephrectomy 2,238). There were no significant differences between the 2 groups in terms of age, gender, laterality and final malignant pathology. Patients treated with robotic partial nephrectomy had larger tumors (WMD 0.17 cm, p=0.001) and higher mean R.E.N.A.L. nephrometry scores (WMD 0.59, p=0.002), and were associated with a decreased likelihood of conversion to laparoscopic/open surgery compared to laparoscopic partial nephrectomy (RR 0.36, p <0.001), any (Clavien 1 or greater) (RR 0.84, p=0.007) and major (Clavien 3 or greater) (RR 0.71, p=0.023) complications, positive margins (RR 0.53, p <0.001) and shorter warm ischemia time by 4.3 minutes (p <0.001). Both approaches had similar operative times (WMD -12.2 minutes, p=0.34), estimated blood loss (WMD -24.6 ml, p=0.15) and postoperative change in estimated glomerular filtration rate. CONCLUSIONS This updated meta-analysis of retrospective cohort studies demonstrated that robotic partial nephrectomy confers a superior morbidity profile compared to laparoscopic partial nephrectomy in most of the examined perioperative outcomes. Despite being the strongest available evidence (Level 2b) for outcomes of robotic vs laparoscopic partial nephrectomy thus far, there have been no completed or ongoing randomized trials to lend Level 1 support for either approach.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | | | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yew Lam Chong
- Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Keng Siang Png
- Department of Urology, Tan Tock Seng Hospital, Singapore
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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.
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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
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