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Ordon M, Sowerby RJ, Ghiculete D, Djuimo M, Kroczak T, Lee JY, Honey RJD, Pace KT. Clips Can be Safely Used for Vascular Control of the Renal Vessels During Laparoscopic Donor Nephrectomy. Urology 2020; 147:150-154. [PMID: 33166541 DOI: 10.1016/j.urology.2020.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/25/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review our experience using clips to control the renal vessels during laparoscopic donor nephrectomy (LDN) and determine the safety of this practice. METHODS We performed a retrospective review of patients who underwent LDN at our centre January 1, 2007-September 17, 2019. The primary outcome was the rate of complication associated with vascular control of the renal vessels, which included (1) conversion to open to manage bleeding, (2) additional procedures for bleeding, and (3) major bleeding requiring blood transfusion. Secondary outcomes included the rate of renal artery/vein clip dislodgement or crossing, change in hemoglobin, warm ischemia time and the incidence of intra-operative complications and postoperative in-hospital complications. RESULTS We included 503 patients who underwent LDN, of which 497 were left sided. The main renal artery was controlled with 3 titanium clips in 489 (97%) cases. The main renal vein was controlled with 2 polymer-locking clips in 478 (95%) cases. For our primary outcome, there were no conversions to open to manage bleeding, no secondary procedures due to bleeding and no major bleeding requiring blood transfusion. Additionally, there were no donor deaths. Regarding our secondary outcomes, there were 5 intraoperative events related to the titanium clips being placed on the renal artery and 1 intraoperative event related to the polymer-locking clips on the renal vein, none of which resulted in any morbidity. CONCLUSION Using 3 titanium clips on the renal artery and 2 polymer-locking clips on the renal vein during left LDN is safe and provides excellent vascular control.
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Affiliation(s)
- Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Robert J Sowerby
- Division of Urology, Department of Surgery, Mackenzie Health, University of Toronto, Vaughan, Canada
| | - Daniela Ghiculete
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Melody Djuimo
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Tadeusz Kroczak
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - R John D'A Honey
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Shirk JD, Thiel DD, Wallen EM, Linehan JM, White WM, Badani KK, Porter JR. Effect of 3-Dimensional Virtual Reality Models for Surgical Planning of Robotic-Assisted Partial Nephrectomy on Surgical Outcomes: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1911598. [PMID: 31532520 PMCID: PMC6751754 DOI: 10.1001/jamanetworkopen.2019.11598] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Planning complex operations such as robotic-assisted partial nephrectomy requires surgeons to review 2-dimensional computed tomography or magnetic resonance images to understand 3-dimensional (3-D), patient-specific anatomy. OBJECTIVE To determine surgical outcomes for robotic-assisted partial nephrectomy when surgeons reviewed 3-D virtual reality (VR) models during operative planning. DESIGN, SETTING, AND PARTICIPANTS A single-blind randomized clinical trial was performed. Ninety-two patients undergoing robotic-assisted partial nephrectomy performed by 1 of 11 surgeons at 6 large teaching hospitals were prospectively enrolled and randomized. Enrollment and data collection occurred from October 2017 through December 2018, and data analysis was performed from December 2018 through March 2019. INTERVENTIONS Patients were assigned to either a control group undergoing usual preoperative planning with computed tomography and/or magnetic resonance imaging only or an intervention group where imaging was supplemented with a 3-D VR model. This model was viewed on the surgeon's smartphone in regular 3-D format and in VR using a VR headset. MAIN OUTCOMES AND MEASURES The primary outcome measure was operative time. It was hypothesized that the operations performed using the 3-D VR models would have shorter operative time than those performed without the models. Secondary outcomes included clamp time, estimated blood loss, and length of hospital stay. RESULTS Ninety-two patients (58 men [63%]) with a mean (SD) age of 60.9 (11.6) years were analyzed. The analysis included 48 patients randomized to the control group and 44 randomized to the intervention group. When controlling for case complexity and other covariates, patients whose surgical planning involved 3-D VR models showed differences in operative time (odds ratio [OR], 1.00; 95% CI, 0.37-2.70; estimated OR, 2.47), estimated blood loss (OR, 1.98; 95% CI, 1.04-3.78; estimated OR, 4.56), clamp time (OR, 1.60; 95% CI, 0.79-3.23; estimated OR, 11.22), and length of hospital stay (OR, 2.86; 95% CI, 1.59-5.14; estimated OR, 5.43). Estimated ORs were calculated using the parameter estimates from the generalized estimating equation model. Referent group values for each covariate and the corresponding nephrometry score were summed across the covariates and nephrometry score, and the sum was exponentiated to obtain the OR. A mean of the estimated OR weighted by sample size for each nephrometry score strata was then calculated. CONCLUSIONS AND RELEVANCE This large, randomized clinical trial demonstrated that patients whose surgical planning involved 3-D VR models had reduced operative time, estimated blood loss, clamp time, and length of hospital stay. TRIAL REGISTRATION ClinicalTrials.gov identifiers (1 registration per site): NCT03334344, NCT03421418, NCT03534206, NCT03542565, NCT03556943, and NCT03666104.
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Affiliation(s)
- Joseph D. Shirk
- David Geffen School of Medicine, Department of Urology, University of California, Los Angeles
| | - David D. Thiel
- Department of Urology, Mayo Clinic Florida, Jacksonville
| | - Eric M. Wallen
- Chapel Hill School of Medicine, Department of Urology, University of North Carolina, Chapel Hill
| | - Jennifer M. Linehan
- John Wayne Cancer Institute, Providence St John’s Health Center, Santa Monica, California
| | - Wesley M. White
- Department of Urology, The University of Tennessee Medical Center, Knoxville
| | - Ketan K. Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York
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Saki Z, Kallidonis P, Noureldin Y, Kotsiris D, Ntasiotis P, Adamou C, Vagionis A, Liatsikos E. Experimental Studies of Nonabsorbable Polymeric Surgical Clips for Use in Urologic Laparoscopy. J Endourol 2019; 33:730-735. [PMID: 31266362 DOI: 10.1089/end.2019.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: This study aimed to compare the stability of the Click'aV® (Grena®), Click'aV plus (Grena), and Hem-o-lok® (Weck®, Teleflex®) polymer clips and the evaluation of the clips stability on a complete porcine artery. Materials and Methods: A dynamometer with a custom support and clamp unit was used. The crank gradually increased the tension force being applied on the clip via the suture. Different directions for the application of the force were tested. The highest force before the start of slipping the suture was noted. The procedure was repeated three times for each ligating clip. Results: For transverse stability, the "XL-size" Grena Click'aV Plus required preventing slippage at a greater force compared to the Hem-o-lok (p = 0.0071). No significant differences found statistically between the Grena Click'aV and Hem-o-lok clips (p = 0.1). For longitudinal stability, the Hem-o-lok required a significantly higher force to be opened compared to the Click'aV (p = 0.0036), but no statistically significant difference was found compared to the Click'aV Plus (p = 0.1). Concerning porcine artery stability, the artery slipped through the Click'aV clip in both measurements at a force of 10.2 and 9.4 N. In contrast, the arteries were cut in all measurements using the Click'aV Plus and the Hem-o-lok clips at forces of 11.8 and 12.8 N and 12.9 and 14.2 N, respectively. None of the clips leaked with up to 300 mm Hg of intra-arterial pressure applied to porcine renal arteries. Conclusions: The Grena Click'aV Plus clip has similar performance to the Hem-o-lok clip, and this clip can be equally useful for ligating vessels in laparoscopic urologic surgeries. We believe, from our findings in this study as well as those from other reports, that vascular clips applied properly by experienced surgeons provide a safe, reliable, and considerable cost-saving option for vascular control in urologic laparoscopic surgery.
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Affiliation(s)
- Zakaria Saki
- Department of Urology, University of Patras Medical School, Patras, Greece
| | | | - Yasser Noureldin
- Department of Urology, University of Patras Medical School, Patras, Greece
- Department of Urology, Benha University Faculty of Medicine, Benha, Egypt
| | - Dimitrios Kotsiris
- Department of Urology, University of Patras Medical School, Patras, Greece
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Liu Y, Huang Z, Chen Y, Liao B, Luo D, Gao X, Wang K, Li H. Staplers or clips?: A systematic review and meta-analysis of vessel controlling devices for renal pedicle ligation in laparoscopic live donor nephrectomy. Medicine (Baltimore) 2018; 97:e13116. [PMID: 30407327 PMCID: PMC6250510 DOI: 10.1097/md.0000000000013116] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Controlling of the renal vessels is a critical step in live donor nephrectomy (LDN). Currently, mainly 2 devices, Hem-o-Lok clips and staplers, are utilized to control vessels during LDN. Both of them have advantages and disadvantages. METHODS This systematic review and meta-analysis was aimed to compare the safety and the efficacy of the 2 devices and to identify the better one in LDN. A systematic search for related publications in the databases of PubMed, Medline, Embase, the Cochrane Library, and Web of Science through February 2018 was performed. Eight studies were selected and evaluated with the Newcastle-Ottawa Scale (NOS). RESULTS The meta-analysis result showed that utilization of Hem-o-Lok clips resulted in greater amount of estimated blood loss (mean differences [MD]: 40.10; 95% confidence interval [CI] 4.37-75.84) and longer time of warm ischemia (WIT) (MD: 55.61; 95% CI 36.79-74.43) than using staplers. Residual vascular length of grafts in clip group was longer than that in stapler group (MD: 2.51; 95% CI 0.78-4.24). However, the differences in primary outcomes such as device failure rate, death rate, and severe hemorrhage rate, were not significant between these 2 groups. In addition, utilization of Hem-o-Lok clips costed approximate $400 lower than staplers per patient. CONCLUSION This study revealed that Hem-o-Lok clips and staplers have the similar function in LDN renal ligation, regarding the device failure rate, death rate, and severe hemorrhage rate. However, the surgeons would benefit from the clips in terms of the residue length of vessels, these outstanding features provide operation convenience and flexibility, such as right-sided donor nephrectomies, early vascular bifurcation, and rare vascular variation. In addition, the clips have potential economic advantages. In some developing countries, it would reduce the healthcare expenditure.
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Abstract
A lost needle during minimally invasive surgery is a cause of undue anxiety to the entire surgical team and also causes prolongation of surgical time. There is no literature reporting follow-up of any patient with needle left behind as they are considered as a 'never event' during a surgical procedure. Preventing such events needs vigilance on part of the surgeon and assistant. Here, we report a case of lost needle during performance of a robot-assisted nephron sparing surgery. The robot needed to be de-docked and converted to laparoscopy. After a thorough search, the needle was found to be lodged at an unusual place. A brief review of available literature is also provided alongside.
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Affiliation(s)
- Aditya Prakash Sharma
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Uttam Kumar Mete
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Durgaprasad Bendapuddi
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar Singh Bora
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan S Mavuduru
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zaporozhchenko BS, Kolodiy VV, Gorbunov AA, Zaporozhchenko MB, Muravyev PT, Kholodov IG. [LIFTING LAPAROSCOPY IN SIMULTANT SURGERY]. Klin Khir 2017:5-8. [PMID: 30273466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Results of treatment of 84 patients, to whom simultant operative interventions on abdominal, the small pelvis and retroperitoneal organs were performed for concomitant somatic diseases, were analyzed. The author’s technology of laparolifting was applied in 36 patients, and classical technology with carboxyperitoneum adjustment - in 48. Variants of optimal operative accesses were determined, structure and rate of postoperative complications, peculiarities of the early postoperative period course studied. Indisputable advantages of the lifting laparoscopic operations were established, including reduction of the postoperative complications rate and severity, the postoperative pain syndrome intensity, the concurrent chronic diseases exacerbation rate, and postoperative stationary stay.
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Abstract
PURPOSE Saving warm ischemia time (WIT) in laparoscopic partial nephrectomy (LPN) is important. We have designed a new device, a remotely activated bulldog clamp, to facilitate LPN. In present study, the effectiveness, convenience, and safety of the new design device were compared with that of standard bulldog vascular clamp in a pig model. MATERIALS AND METHODS Fifteen cases of LPN were bilaterally operated on upper or lower pole of kidneys in five pigs. As the test group, eight cases involved the remotely activated bulldog clamp, whereas the remaining seven cases, as the control group, involved the common standard vascular bulldog clamp. The mean operative time, blood lost, and mean WIT were compared between the two groups. RESULTS The mean operative time and blood lost were not significantly different between the groups (p < 0.05). Continuous artery clamping was used in the two groups. With on-demand clamping, the mean WIT in the test group was 19.0 ± 3.42 minutes, which was significantly less compared with the control group (31.54 ± 5.23 minutes, p < 0.05). CONCLUSIONS The newly designed device can remotely control the renal artery, which made clamping and unclamping much easier. It is effective and safe in LPN.
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Affiliation(s)
- Wei Chen
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Jian-Ming Guo
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Jun Hou
- 2 Pathology Department, Zhongshan Hospital, Fudan University , Shanghai, China
| | - Guo-Min Wang
- 1 Urology Department, Zhongshan Hospital, Fudan University , Shanghai, China
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Al’-Shukri SK, Mosoyan MS, Semenov DY, Il’in DM. EXPERIENCE OF 424 ROBOT-ASSISTED OPERATIONS IN ST-PETERSBURG: RADICAL PROSTATECTOMY, PARTIAL AND RADICAL NEPHRECTOMY. Vestn Khir Im I I Grek 2016; 175:74-77. [PMID: 30427137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The article presents the results of 257 robot-assisted radical prostatectomies, 135 partial nephrectomies and 32 radical nephrectomies at the period from 2010 to 2016. The operations were performed on robotic complex da Vinci S. The mean operative time was 170±50 min, 158,4±72,2 min and 143,3±67,3 min, the mean blood loss was 130±35 ml, 213,0±102,2 ml and 141,4±49,0 ml for robotic radical prostatectomy, partial and radical nephrectomy, respectively. The mean time of warm ischemia consisted of 13,1±2,7 min. Five-year cancer-specific survival rate was 100%, 100% and 98%. The overall survival rate was 97,5%, 87% and 92% for robotic radical prostatectomy, partial and radical nephrectomy, respectively.
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Kim DK, Yoon YE, Han WK, Rha KH. Roles of NOTES and LESS in management of small renal masses. Int J Surg 2015; 36:574-582. [PMID: 26607854 DOI: 10.1016/j.ijsu.2015.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/27/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Over the last 2 decades, open surgery has been largely displaced by laparoscopic surgery for the treatment of renal masses. Recently, minimally invasive surgical techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), have been developed for such purpose. METHODS In the present literature review, the current status of treatment for small renal masses was investigated. The advantages and disadvantages of LESS and NOTES are presented to confirm the feasibility and reproducibility of these techniques. RESULTS LESS significantly reduces pain and offers excellent cosmetic outcomes with comparable oncological and perioperative results, and NOTES offers the potential for surgery by various approach without any transcutaneous abdominal incision in management of small renal masses. CONCLUSION When the technical limitations are overcome, clinical application of LESS and NOTES is expected to increase. Further prospective and comparative studies are needed to clarify the application of these new techniques.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, CHA Gangnam Hospital, CHA University, CHA Medical School, Seoul, Republic of Korea; Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul, Republic of Korea.
| | - Young Eun Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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Affiliation(s)
- Jacques Hubert
- Department of Urology, University Hospital Nancy Brabois, Vandœuvre Les Nancy, France
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Biktimirov RG, Martov AG, Sokolov AA. [DELAYED PORT DEPLOYMENT FOR HAND-ASSISTED LAPAROSCOPIC DONOR NEPHRECTOMY. CASE REPORT AND LITERATURE REVIEW]. Urologiia 2015:77-80. [PMID: 26859944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The standard method of surgical treatment of end-stage renal failure is kidney transplantation. A laparoscopic method of organ retrieval from a living donor is currently preferred. The techniques of laparoscopic surgery include hand-assisted nephrectomy and "pure" laparoscopic nephrectomy. We present analysis of the literature data and our own data on the use of the advantages of each of the techniques. A case of complication associated with the use of hand-port from our own practice is described.
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Xu W, Li H, Zhang Y, Zhang X, Ji Z. Comparison of standard absorbable sutures with self-retaining sutures in retroperitoneoscopic partial nephrectomy: a retrospective study of 68 patients. Urol J 2014; 11:1878-1883. [PMID: 25361708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 05/28/2014] [Accepted: 08/11/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE Although laparoscopic partial nephrectomy (LPN) has been increasingly adopted in the treatment of small localized renal tumor, technical changes remain nowadays. The current study aimed to evaluate the safety and efficacy of the novel QUILLTM Self-Retaining System (SRS) for renorrhaphy during LPN. MATERIALS AND METHODS Sixty-eight patients with kidney neoplasm that accepted LPN at the Peking Union Medical College Hospital from July 2010 to March 2013 were retrospectively analyzed. Thirty-five patients who received renal sutures with QUILLTM SRS constituted group 1. The control group (group 2) was composed of 33 patients who received standard absorbable Vicryl sutures by the same surgeon. Renorrhaphy was performed in both groups using two layers, with a closure of the deep vessels and collecting system, followed by a running closure of the renal capsule. The demographic and perioperative parameters (gender, laterality of the tumor, body mass index (BMI), tumor size, standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score), estimated blood loss and warm ischemic time (WIT)) were compared between the groups. Risk factors of WIT and blood loss were analyzed using logistic regression analysis. RESULTS Renorrhaphy was successfully completed in both groups. The baseline data of two groups did not differ significantly. Logistic regression analysis showed WIT decreased when the QUILLTM SRS was used (21.8 ± 3.5 min vs. 25.6 ± 4.0 min; ? = -4.109, P < .001). Suture methods were an independent predictor of WIT rather than blood loss (115.7 ± 57.9 mL vs. 137.9 ± 68.5 mL; P = .329). CONCLUSION QUILLTM SRS can be effectively and safely used for renorrhaphy during LPN with the potential advantage of shortening WIT.
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Affiliation(s)
| | - Hanzhong Li
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730,China.
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Breda A, Schwartzmann I, Emiliani E, Rodriguez-Faba O, Gausa L, Caffaratti J, de León XP, Villavicencio H. Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope. World J Urol 2014; 33:707-12. [PMID: 25182807 DOI: 10.1007/s00345-014-1360-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). METHODS Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. CONCLUSIONS Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.
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Affiliation(s)
- Alberto Breda
- Urology Department, Fundació Puigvert, Barcelona, Spain,
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Kaouk JH, Haber GP, Autorino R, Crouzet S, Ouzzane A, Flamand V, Villers A. A novel robotic system for single-port urologic surgery: first clinical investigation. Eur Urol 2014; 66:1033-43. [PMID: 25041850 DOI: 10.1016/j.eururo.2014.06.039] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The idea of performing a laparoscopic procedure through a single abdominal incision was conceived with the aim of expediting postoperative recovery. OBJECTIVE To determine the clinical feasibility and safety of single-port urologic procedures by using a novel robotic surgical system. DESIGN, SETTING, AND PARTICIPANTS This was a prospective institutional review board-approved, Innovation, Development, Exploration, Assessment, Long-term Study (IDEAL) phase 1 study. After enrollment, patients underwent a major urologic robotic single-port procedure over a 3-wk period in July 2010. The patients were followed for 3 yr postoperatively. INTERVENTION Different types of urologic surgeries were performed using the da Vinci SP Surgical System. This system is intended to provide the same core clinical capabilities as the existing multiport da Vinci system, except that three articulating endoscopic instruments and an articulating endoscopic camera are inserted into the patient through a single robotic port. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The main outcomes were the technical feasibility of the procedures (as measured by the rate of conversions) and the safety of the procedures (as measured by the incidence of perioperative complications). Secondary end points consisted of evaluating other key surgical perioperative outcomes as well as midterm functional and oncologic outcomes. RESULTS AND LIMITATIONS A total of 19 patients were enrolled in the study. Eleven of them underwent radical prostatectomy; eight subjects underwent nephrectomy procedures (partial nephrectomy, four; radical nephrectomy, two; and simple nephrectomy, two). There were no conversions to alternative surgical approaches. Overall, two major (Clavien grade 3b) postoperative complications were observed in the radical prostatectomy group and none in the nephrectomy group. At 1-yr follow-up, one radical prostatectomy patient experienced biochemical recurrence, which was successfully treated with salvage radiation therapy. The median warm ischemia time for three of the partial nephrectomies was 38 min. At 3-yr follow-up all patients presented a preserved renal function; none had tumor recurrence. Study limitations include the small sample and the lack of a control group. CONCLUSIONS We describe the first clinical application of a novel robotic platform specifically designed for single-port urologic surgery. Major urologic procedures were successfully completed without conversions. Further assessment is warranted to corroborate these promising findings. PATIENT SUMMARY A novel purpose-built robotic system enables surgeons to perform safely and effectively a variety of major urologic procedures through a single small abdominal incision. TRIAL REGISTRATION The study was registered on www.ClinicalTrials.gov (NCT02136121).
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Affiliation(s)
- Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | | | - Riccardo Autorino
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Adil Ouzzane
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| | - Vincent Flamand
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
| | - Arnauld Villers
- Department of Urology, CHU Lille, University Lille Nord de France, Lille, France
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Jung JH, Kim HW, Oh CK, Song JM, Chung BH, Hong SJ, Rha KH. Simultaneous robot-assisted laparoendoscopic single-site partial nephrectomy and standard radical prostatectomy. Yonsei Med J 2014; 55:535-8. [PMID: 24532529 PMCID: PMC3936649 DOI: 10.3349/ymj.2014.55.2.535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/16/2013] [Accepted: 04/23/2013] [Indexed: 11/27/2022] Open
Abstract
Recently, patients with urologic malignancies are treated with robot-assisted surgery and the expanded role of robot-assisted surgery includes even those patients with two concomitant primary urologic malignancies. In an effort to further reduce port site-related morbidity, robot-assisted laparoendoscopic single-site surgery (RLESS) has been developed. Therefore, we present herein our early experience and feasibility of simultaneous RLESS partial nephrectomy and standard robotrobot- assisted laparoendoscopic radical prostatectomy (RALP) on 3 patients with synchronous renal masses and prostate cancer.
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Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
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Binsaleh S. Specimen processing during laparoscopic renal surgery: a review of techniques and technologies. Clinics (Sao Paulo) 2014; 69:862-6. [PMID: 25628000 PMCID: PMC4286670 DOI: 10.6061/clinics/2014(12)12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/01/2014] [Indexed: 12/03/2022] Open
Abstract
Laparoscopic surgery has well-defined benefits for patients and has become accepted over time as a standard access strategy for the management of benign and malignant urologic diseases. Unlike in open surgery, the surgeon is often faced with the additional challenges of specimen retrieval and extraction at the end of laparoscopic extirpative procedures. This final step often requires significant laparoscopic skill to entrap and safely extract the laparoscopic specimens. Failure to apply safe exit steps at the end of a laparoscopic procedure may lead to significant morbidity. The aim of this review is to explore the different techniques and technologies available for laparoscopic kidney retrieval, entrapment and safe extraction.
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Affiliation(s)
- Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Castillo OA, Rodriguez-Carlin A, Lopez-Fontana G, Aleman E. Robotic partial nephrectomy with selective parenchymal compression (Simon clamp). Actas Urol Esp 2013; 37:425-8. [PMID: 23433637 DOI: 10.1016/j.acuro.2012.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/17/2012] [Accepted: 11/27/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. MATERIAL AND METHODS In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. RESULTS The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. CONCLUSION Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.
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Affiliation(s)
- O A Castillo
- Unidad de Urología y Centro de Cirugía Robótica, Clínica INDISA, Santiago, Chile; Facultad de Medicina, Universidad Andrés Bello, Santiago, Chile.
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Abaza R. No ischemia robotic partial nephrectomy: why and why not? Urol Oncol 2013; 31:5-8. [PMID: 23544192 DOI: 10.1016/j.urolonc.2012.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ronney Abaza
- Department of Urology, The Ohio State University Comprehensive Cancer Center, Arthur G James Cancer Hospital & Richard J Solove Research Institute, Columbus, OH 43210, USA.
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Vitagliano G, Villasante N. Laparoscopic partial nephrectomy with selective polar clamping using the simon clamp: initial experience. ARCH ESP UROL 2013; 66:308-312. [PMID: 23648752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To report our initial experience in 3 cases of laparoscopic partial nephrectomy with selective parenchymal clamping using a novel laparoscopic clamp. METHODS A total of 3 laparoscopic partial nephrectomies were performed using the Simon clamp (Aesculap). Mean patient age was 67 years (range 60 to 74 years), two patients were males. All patients had an ASA score of 2. Mean tumor size was 2.2 cm (range 2 to 2.4 cm) and all tumors were of the lower pole. Two tumors were on the right kidney and one on the left kidney. RESULTS Mean operative time was 100 minutes (range 70 to 120 min). Mean operative bleeding was 16 ml (range 0 to 50 ml). Mean warm ischemia time of the renal pole was 33 minutes (range 30 to 40 min). All patients were discharged on postoperative day 2. There was no intra or postoperative complications. Surgical margins were negative in all cases. CONCLUSION The Simon clamp allows for tumor resection without bleeding and for renal defect repair without collateral renal injury. We hope that in the future the development of other instruments will allow for selective clamping in any tumor location.
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Affiliation(s)
- Gonzalo Vitagliano
- CDU Centro de Urología and Department of Urology, Hospital Alemán, Buenos Aires, Argentina.
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Ogata M, Makiyama K, Yamada T, Nagasaka M, Yamanaka H, Kubota Y. Dynamic measuring of physical properties for developing a sophisticated preoperative surgical simulator: how much reaction force should a surgical simulator represent to the surgeon? Stud Health Technol Inform 2013; 184:312-318. [PMID: 23400177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The acquisition of physical quantities for a living body in surgery is an important and necessary step toward developing a sophisticated preoperative surgical simulator and its validation and navigation. We have developed a multimodal measuring device that minimizes interference with the movements of the surgeon. We conducted nephrectomy surgery using a laboratory animal and successfully acquired physical quantities. From this experiment, we have acquired the following preliminary result. The surgeon feels a gripping force from -3.5 to 4.4N at the handle of the forceps for dissection. We assume that this data is not far from that of a human.
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Affiliation(s)
- Masato Ogata
- Research and Development Division, Mitsubishi Precision Co., Ltd., Japan.
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21
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Abstract
What's known on the subject? and What does the study add? The use of robotic assistance for the partial nephrectomy procedure has emerged as an alternative that may help some of the technical challenges of laparoscopic partial nephrectomy. The main concerns in laparoscopic partial nephrectomy relates to a steeper 'learning curve', prolonged warm ischaemia times and the potential for postoperative haemorrhage. The article delineates the dynamics of patient preparation, the surgical team, surgical technique & post-operative care to conclude that robotic-assisted partial nephrectomy is a viable alternative to both open and laparoscopic techniques. Partial nephrectomy has shown both improved overall patient survival and more effective preservation of renal function, when compared with radical nephrectomy. Robot-assisted partial nephrectomy has several potential advantages over the laparoscopic approach. Robotic assistance allows urologists to perform this complex reconstructive procedure more quickly, with improved precision and dexterity, tremor elimination and improved visualization. The present article aims to delineate the dynamics of patient preparation and surgical team, surgical technique and postoperative care. The oncological outcomes and disease-free survival of partial nephrectomy have been found to be equivalent to open partial nephrectomy [1-4].
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Affiliation(s)
- Rishma Gohil
- MRC Centre for Transplantation, King's College London, London, UK
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22
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Cervantes TM, Summers EK, Batzer R, Simpson C, Lewis R, Dhanani NN, Slocum AH. Evaluation of a minimally invasive renal cooling device using heat transfer analysis and an in vivo porcine model. Med Eng Phys 2012; 35:736-42. [PMID: 22951039 DOI: 10.1016/j.medengphy.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 07/26/2012] [Accepted: 08/06/2012] [Indexed: 11/18/2022]
Abstract
Partial nephrectomy is the gold standard treatment for renal cell carcinoma. This procedure requires temporary occlusion of the renal artery, which can cause irreversible damage due to warm ischemia after 30 min. Open surgical procedures use crushed ice to induce a mild hypothermia of 20°C in the kidney, which can increase allowable ischemia time up to 2.5 h. The Kidney Cooler device was developed previously by the authors to achieve renal cooling using a minimally invasive approach. In the present study an analytical model of kidney cooling in situ was developed using heat transfer equations to determine the effect of kidney thickness on cooling time. In vivo porcine testing was conducted to evaluate the cooling performance of this device and to identify opportunities for improved surgical handling. Renal temperature was measured continuously at 6 points using probes placed orthogonally to each other within the kidney. Results showed that the device can cool the core of the kidney to 20°C in 10-20 min. Design enhancements were made based on surgeon feedback; it was determined that the addition of an insulating air layer below the device increased difficulty of positioning the device around the kidney and did not significantly enhance cooling performance. The Kidney Cooler has been shown to effectively induce mild renal hypothermia of 20°C in an in vivo porcine model.
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Affiliation(s)
- Thomas M Cervantes
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Kaczmarek BF, Sukumar S, Petros F, Trinh QD, Mander N, Chen R, Menon M, Rogers CG. Robotic ultrasound probe for tumor identification in robotic partial nephrectomy: Initial series and outcomes. Int J Urol 2012; 20:172-6. [PMID: 22925445 DOI: 10.1111/j.1442-2042.2012.03127.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Bartosz F Kaczmarek
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA
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Gorbatiy V, Leveillee RJ. Laparoscopic nephrectomy: looking back, moving forward. MINERVA UROL NEFROL 2012; 64:73-78. [PMID: 22617302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This manuscript reviews the history of laparoscopic nephrectomy and addresses the future trends of this minimally invasive operation.
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Affiliation(s)
- V Gorbatiy
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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25
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Khoder WY, Zilinberg K, Waidelich R, Stief CG, Becker AJ, Pangratz T, Hennig G, Sroka R. Ex vivo comparison of the tissue effects of six laser wavelengths for potential use in laser supported partial nephrectomy. J Biomed Opt 2012; 17:068005. [PMID: 22734791 DOI: 10.1117/1.jbo.17.6.068005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Laparoscopic/robotic partial nephrectomy (LPN) is increasingly considered for small renal tumors (RT). This demands new compatible surgical tools for RT-resection, such as lasers, to optimize cutting and coagulation. This work aims to characterize ex vivo handling requirements for six medically approved laser devices emitting different light wavelengths (940, 1064, 1318, 1470, 1940, and 2010 nm) amenable for LPN. Incisions were made by laser fibers driven by a computer-controlled stepping motor allowing precise linear movement with a preset velocity at a fixed fiber-tip distance to tissue. Optical parameters were measured on 200 μm tissue slices. Cutting quality depended on power output, fiber velocity and fiber-tip distance to tissue. Contact manner is suitable for cutting while a noncontact manner (5 mm distance) induces coagulation. Ablation threshold differs for each wavelength. Ablation depth is proportional to power output (within limit) while axial and superficial coagulation remains mostly constant. Increased fiber velocity compromises the coagulation quality. Optical parameters of porcine kidney tissue demonstrate that renal absorption coefficient follows water absorption in the 2 μm region while for other spectral regions (900 to 1500 and 1 μm) the tissue effects are influenced by other chromophores and scattering. Tissue color changes demonstrate dependencies on irradiance, scan velocity, and wavelength. Current results clearly demonstrate that surgeons considering laser-assisted RT excisions should be aware of the mentioned technical parameters (power output, fiber velocity and fiber-tip tissue-distance) rather than wavelength only.
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Affiliation(s)
- Wael Y Khoder
- University Hospital Munich-Grosshadern, Department of Urology, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377 Munich, Germany.
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Yuh B, Muldrew S, Menchaca A, Yip W, Lau C, Wilson T, Josephson D. Integrating robotic partial nephrectomy to an existing robotic surgery program. Can J Urol 2012; 19:6193-6200. [PMID: 22512965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors. We describe our technique, results, and analysis of program setup for RAPN. MATERIALS AND METHODS Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program. Operating rooms and supply rooms were outfitted for efficient robotic throughput. Tilepro and intraoperative ultrasound were used for all cases. Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority. An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models. RESULTS Average operative time decreased over time from 235 min to 199 min (p = .03). Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors. Median estimated blood loss was 150 mL. Average length of hospital stay was 3 days (range 1-9). Average size of lesions was 2.7 cm (range 0.7-8.6). Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions. CONCLUSIONS The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps. Outcomes from an operational, oncologic, and renal functional standpoint are acceptable. Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time. An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.
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Affiliation(s)
- Bertram Yuh
- City of Hope National Cancer Center., Duarte, California 91010, USA
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Liatsikos E, Kallidonis P, Do M, Georgiopoulos I, Dietel A, Stolzenburg JU. LESS nephrectomy: technique and outcomes. ARCH ESP UROL 2012; 65:294-302. [PMID: 22495269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Laparoendoscopic single-site surgery (LESS) represents the next step of laparoscopic surgery and a major advancement towards scarless surgery. LESS radical nephrectomy is an evolving technique based on technological advancement of laparoscopic instruments as well as the refinement of existing techniques.The current report describes LESS nephrectomy technique, presents the experience with the technique in a series of 42 patients and reviews current literature in the field of LESS nephrectomy.
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Abstract
PURPOSE Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. MATERIALS AND METHODS We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. RESULTS Mean follow-up was 47.7 ± 29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease- free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). CONCLUSION Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.
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Affiliation(s)
- Hwang Gyun Jeon
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kyung Hwa Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Aminsharifi AR, Goshtasbi B, Afsar F. Laparoendoscopic single-site nephrectomy using standard laparoscopic instruments: our initial experience. Urol J 2012; 9:657-661. [PMID: 23235969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To report our initial experience with laparoendoscopic single-site (LESS) nephrectomy using a GelPOINT single port and standard laparoscopic instruments. MATERIALS AND METHODS Laparoendoscopic single-site transperitoneal nephrectomy was done for 6 adult patients with a poorly functioning small or hydronephrotic kidney. The procedure was done with the GelPOINT system, which consisted of a wound retractor (Alexis) and GelSeal cap. Standard laparoscopic instruments were used and the renal pedicle was controlled with 10-mm Hem-o-Lok clips. RESULTS The participants were 3 men and 3 women with the median age of 29.5 years. Laparoendoscopic single-site nephrectomy was successfully done in all the patients without any major complications. Median operation time was 110 minutes (range, 90 to 130 minutes). There was no need for blood transfusion in any patient. The recovery phase was uneventful and all the patients were discharged after a median hospital stay of 2.5 days (range, 2 to 3 days). Renal function remained stable in all the patients after the operation. The incision site healed well on postoperative follow-up. CONCLUSION Our initial experience with LESS nephrectomy was successful with the use of a GelPOINT single port and standard laparoscopic instruments. This report may remove barriers to further work with the LESS technique and may offer a strategy to help surgeons gain experience with this novel technology.
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Affiliation(s)
- Ali Reza Aminsharifi
- Department of Urology, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Urbańczyk G, Litarski A, Litarski A, Panek W, Pupka A, Szydełko T. [The use of polymeric Hem-o-lock clips in laparoscopic radical nephrectomy]. Polim Med 2012; 42:29-33. [PMID: 22783730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES The aim of the study was to evaluate the usefulness and cost-effectiveness of polymeric Hem-o-lock clips during laparoscopic nephrectomy. The intra- and postoperative complications of the operation were assessed too. MATERIAL AND METHODS From April 2011 through November 2011, 19 laparoscopic radical nephrectomies were performed. A preferred method to secure the renal vein was the use of polymeric Hem-o-lock clips. The renal artery was clipped by titanium clips. In five patients an Endo-GIA stapler was used to secure the renal pedicle. All procedures were carried out using a transperitoneal access. The perioperative data were analyzed retrospectively. RESULTS No intraoperative complications associated with the use of Hem-o-lock clips were observed. The mean procedure time was 202 min. The average blood loss during the operation was 480 ml. No bleeding in the postoperative period was observed. The mean abdominal drain output was 65 ml per day. The mean time to drain removal was 3 days. The average hospital stay was 5-6 days. CONCLUSIONS Using the polymeric Hem-o-lock clips is a safe, relatively easy and cheep way to close the renal vein during laparoscopic radical nephrectomy.
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Affiliation(s)
- Grzegorz Urbańczyk
- Kliniczny Oddział Urologii 4 Wojskowego Szpitala Klinicznego z Poliklinika we Wrocławiu.
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Jung JH, Arkoncel FRP, Lee JW, Oh CK, Yusoff NAM, Kim KJ, Rha KH. Initial clinical experience of simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. Yonsei Med J 2012; 53:236-9. [PMID: 22187260 PMCID: PMC3250319 DOI: 10.3349/ymj.2012.53.1.236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 11/03/2010] [Accepted: 11/09/2010] [Indexed: 12/19/2022] Open
Abstract
A 62-year-old male patient with prostate cancer and bilateral renal cell carcinoma underwent a simultaneous robot-assisted bilateral partial nephrectomy and radical prostatectomy. We describe our initial experience of combined operation with a port strategy allowing reuse of ports and surgical considerations because of prolonged pneumoperitoneum.
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Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | | | - Jae Won Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | | | - Kwang Jin Kim
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
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Tugcu V, Bitkin A, Sonmezay E, Polat H, Ilbey YO, Taşçi AI. Transperitoneal versus retroperitoneal laparoscopic partial nephrectomy: initial experience. Arch Ital Urol Androl 2011; 83:175-180. [PMID: 22670314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE We present the transperitoneal and retroperitoneal approaches to laparoscopic partial nephrectomy and compare the outcomes of each technique. METHODS Between December 2006 and March 2010, retroperitoneal laparoscopic partial nephrectomy (RLPN) was performed in 23 patients and transperitoneal laparoscopic partial nephrectomy (TLPN) in 26 patients. They were compared regarding surgical technique, operative parameters, postoperative recovery and follow-up data. The 2 approaches used similar operative techniques to control parenchymal bleeding. RESULTS The patient demographics were similar in both groups. The mean tumour size was 3.1 cm in the retroperitoneal group and 3.4 cm in the transperitoneal group. The difference was not statistically significant (p: 0.095). The mean operative time was significantly longer in the transperitoneal group (215 vs 185 minutes, p: 0.031). The mean warm ischemia time difference was not statistically significant (25 vs 28 minutes, p: 0.102). The mean estimated blood loss (EBL) was greater in the transperitoneal group (254 vs 204 cc, p: 0.003). Moreover, the mean hospital stay was 4.1 days in the RLPN and 4.3 days in the TLPN group (p: 0.303) The difference was not statistically significant. The median follow-up was 11 months (range: 2 to 35) in the retroperitoneal group and 13 months (range 1 to 36) in the transperitoneal group. CONCLUSIONS Our experience has shown that laparoscopic partial nephrectomy is a safe, feasible technique for patients with small exophytic renal tumours. We believe that the decision regarding the approach should be based on the tumor location on the kidney surface.
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Affiliation(s)
- Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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Stolzenburg JU, Kallidonis P, Ragavan N, Dietel A, Do M, Thi PH, Till H, Liatsikos EN. Clinical outcomes of laparo-endoscopic single-site surgery radical nephrectomy. World J Urol 2011; 30:589-96. [PMID: 21960202 DOI: 10.1007/s00345-011-0765-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 09/10/2011] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The conventional laparoscopic surgery is now paving way to the new technologies including robotic and laparoscopic single-site surgery (LESS). We present our updated experience on LESS radical nephrectomy (LESS-RN). PATIENTS AND METHODS The data from patients undergoing LESS-RN in our two institutions were reviewed along with various clinical and pathological parameters. RESULTS Between 2008 and 2011, 42 LESS-RN were performed (right = 22, left = 20) with mean (range) age and BMI of 63.7 (33-86) years and 25.1 (18-38.6) kg/m(2), respectively. In addition to the instruments in the single port, one extra 3-mm needlescopic instrument was required in 19 patients (right = 17, left = 2). In three patients, two additional 5-mm trocars and instruments were required. None required open conversion. The recorded adverse events include one bowel injury (intraoperative closure without the need for stoma), one postoperative bleeding requiring blood transfusion, one prolonged ileus, and one deep venous thrombosis. The resected specimens revealed pT1a (n = 3), pT1b (n = 33), pT2a (n = 4), and pT3b (n = 2) tumors. The finding of pT3b was incidental rather than planned procedure. None of the patients had positive margins. CONCLUSION LESS-RN has proven to be feasible and safe. Beyond cosmesis, further advantages of this approach need to be addressed by randomized trials.
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Shirodkar SP, González J, Parodi J, Omaida V, Bird V, Burke GW, Ciancio G. Open or laparoscopic nephrectomy and extracoroporeal repair of complicated renal artery aneurysms: techniques for renal salvage. ARCH ESP UROL 2011; 64:227-236. [PMID: 21498888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Renal artery aneurysm is an infrequently seen disease. The most feared symptom is rupture, which is often rapidly fatal. Indications for intervention include size, intractable symptoms and pregnancy. Many cases are managed by endovascular techniques; however, very complex cases often are referred to the urologist. We report our experience with the rarely used technique of renal artery aneurysms repair comprised of nephrectomy, extracorporeal vascular reconstruction with aneurysmectomy, and autotransplant.
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Affiliation(s)
- S P Shirodkar
- Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Florida, USA
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Manzanilla-García HA, Lira-Dale A, Rosas-Nava E, Almanza-González MS. Nephron-sparing surgery for clear cell carcinoma in a solitary functional kidney. Case report and literature review. CIR CIR 2011; 79:196-201. [PMID: 21631983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Since the introduction of nephron-sparing surgery, patients with small renal masses and diseases affecting overall renal function have greatly benefited. CLINICAL CASE We present the case of a 62-year-old male with a 6-cm left renal tumor in the medial parahilar segment with right renal unit functionally excluded, secondary to chronic obstruction due to ureteral lithiasis. Right ureteroscopy was performed with pneumatic lithotripsy. Despite localization and size of the tumor, left nephron-sparing surgery was performed in order to preserve renal function. Follow-up of the patient demonstrates no tumor activity. CONCLUSIONS Open nephron-sparing surgery has been the standard treatment for small renal masses with peripheral localization; however, in specific cases with deteriorated renal function and tumors >5 cm close to the renal hilum, certain risk must be taken in order to perform this procedure that has proven to be highly effective in preserving renal function. Open nephron-sparing surgery represents a highly effective procedure in small renal masses with a nonfunctional contralateral kidney.
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Abstract
The detection of renal tumors is increasing with the widespread use of ultrasonography and CT. Laparoscopic partial nephrectomy (LPN) offers less pain, smaller scars, and shorter convalescence. Expanded indications of LPN include larger and more complex tumors, including those in hilar or central locations, multiple tumors, solitary kidneys, and patients with previous renal surgery. This procedure is in constant evolution. We describe the technical nuances of LPN over the past decade of evolution.
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Affiliation(s)
- Andre K Berger
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Gumprecht JDJ, Bauer T, Stolzenburg JU, Lueth TC. A robotics-based flat-panel ultrasound device for continuous intraoperative transcutaneous imaging. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2011:2152-2155. [PMID: 22254764 DOI: 10.1109/iembs.2011.6090403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Laparoscopic partial nephrectomy has become more and more popular in the last decade. Video laparoscopes remain the gold standard of intraoperative imaging during laparoscopic interventions. However, providing only superficial images of the target tissue. In contrast, ultrasound (US) imaging may offer crucial information of the interior of the target tissue that could improve surgical outcome. In this paper, we propose a new concept and prototype system to manipulate an US-probe during laparoscopic partial nephrectomies. Our primary goal was to provide the surgeon with US-images during the intervention in real-time. The prototype system consists of three components: a conventional US-machine, a manipulator to guide the US-probe, and a joystick console to control the manipulator. The results of our experiments show that the concept is feasible for US-imaging during laparoscopic partial nephrectomy.
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Affiliation(s)
- Jan D J Gumprecht
- Department for Micro Technolgoy and Medical Device Technology, Technische Universität München, 85748 Garching, Germany.
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Tugcu V, Ilbey YO, Mutlu B, Tasci AI. Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol 2010; 24:1315-20. [PMID: 20626273 DOI: 10.1089/end.2010.0048] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoendoscopic single-site surgery (LESS), an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions, has been developed recently. Our aim was to compare LESS simple nephrectomy (LESS-SN) and conventional transperitoneal laparoscopic simple nephrectomy (CTL-SN). PATIENTS AND METHODS In this randomized study that was conducted between December 2008 and September 2009, 27 patients who needed simple nephrectomy were randomized to either LESS-SN or CTL-SN. All procedures in both groups were performed by the first author, who is experienced in laparoscopic surgery. Patient characteristics, perioperative details, and time to return to work were recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. RESULTS There was no difference in median operative time (117.5 vs 114 min, P = 0.52), blood loss (50.71 vs 47.15 mL, P = 0.60), transfusion rates (0% for both), and hospitalization time (2.07 vs 2.11 days, P = 0.74) between the LESS-SN and CTL-SN groups. Time to return to normal activities was shorter in the LESS-SN group compared with the CTL-SN group (10.7 vs 13.5 days, P = 0.001). Both the visual analogue scale and the postoperative use of analgesics were significantly lower during postoperative days 1, 2, and 3 in patients who underwent LESS-SN, compared with patients who underwent CTL-SN. There were no intraoperative or postoperative complications in both groups. Compared with CTL-SN, LESS-SN was more expensive, but all patients undergoing LESS-SN were very pleased with the cosmetic outcome (no visible scars). CONCLUSION The early experience described in this study suggests that LESS-SN is a safe and effective alternative to CTL-SN that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus; however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain, recovery, or cosmesis.
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Affiliation(s)
- Volkan Tugcu
- Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Gidaro S, Cindolo L, Tamburro FR, Longo N, Mirone V, Forgione A, Schips L. First Italian experience in single-incision laparoscopic nephrectomy. Surg Technol Int 2010; 20:47-52. [PMID: 21082548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We describe our laparoscopic nephrectomy technique of placing trocars directly on the fascia once the skin and the subcutaneous layers are prepared. A series of 10 consecutive patients were operated on by single-incision laparoscopic nephrectomy (SILN). With a 5-cm mean skin incision, the fascia was prepared and 3/4 trocars inserted separately directly on the fascia. Surgical strategy followed the standard technique, except for the use of articulating instruments and 5-mm optic. Demographics, body mass index (BMI), operative time, blood loss, perioperative complications, transfusions, hemoglobin decrease, analgesic requirement, length of stay, and final pathology were recorded. Postoperative and prior-to-discharge visual analogue scale (VAS) pain evaluations were also collected, together with the limitations inherent in the instruments' placement and parallel driving during the procedure. The procedures were successfully completed in all but one case. The mean operative time was 169 min. (mean blood loss 113 ml). Without major perioperative complications, the patients were discharged early (mean 5.3 days). Four patients had a BMI>30. For specimen retrieval (neoplasms) two trocar holes were joined. One patient required analgesics; the mean post-operative and prior-to-discharge VAS scores were 5.7 and 1.4, respectively. Pathology examination confirmed 4 pyelonephritic kidneys, 4 renal carcinomas, and 2 upper-urinary tract carcinomas. The laparoscopic nephrectomy via a single incision is feasible and safe, with favorable perioperative and short-term outcomes. It's technically more challenging than standard laparoscopy requiring advanced surgical skills.
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Affiliation(s)
- Stefano Gidaro
- Department of Surgery University Chieti-Pescara Chieti, Italy
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Cindolo L, Scoffone C, Salzano L, Autorino R, Mirone V, Schips L. Laparoendoscopic single-site (LESS) adrenalectomy and partial nephrectomy: current Italian experience with two challenging surgical procedures. Surg Technol Int 2010; 20:240-244. [PMID: 21082573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Since its initial clinical use in urology, there has been an increasing enthusiasm and a growing interest for laparoendoscopic single-site surgery (LESS). Several clinical series have been reported with an estimated cumulative clinical experience of more than four hundred so far. Nowadays, virtually all extirpative and reconstructive urological procedures have been described and shown to be feasible and safe, including advanced reconstructive procedures and major extirpative ones. Among them, adrenalectomy and partial nephrectomy represent highly complex procedures. Initial clinical data have been recently reported to test the safety and efficacy of these interventions in selected patients. Herein, we describe our initial cases of unclamp LESS partial nephrectomy and adrenalectomy. In our opinion, LESS is an established technique within the field of minimally invasive surgery. Even if further studies are needed to demonstrate its actual benefits, early clinical outcomes are encouraging and LESS might represent the way to go in minimally invasive urological surgery.
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Affiliation(s)
- Luca Cindolo
- Department of Urology, S.Pio Da Pietrelcina Hospital, Vasto, Italy
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Laurberg JR, Nielsen J, Lund L. [Nephrectomy through a single trocar incision]. Ugeskr Laeger 2010; 172:2147-2148. [PMID: 20670591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Laparoendoscopic single-site surgery (LESS) is a laparoscopic technique in which a single small incision is made in the umbilicus with the use of a special device (single-port). We report the first nephrectomy performed in Scandinavia using this method. LESS nephrectomy is feasible, but requires a specific training programme comprising theory as well as practice. The authors believe that such training in conjunction with careful patient selection is essential.
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Devra AK, Patel S, Shah SA. Laparoscopic right donor nephrectomy: endo TA stapler is safe and effective. Saudi J Kidney Dis Transpl 2010; 21:421-425. [PMID: 20427862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Although laparoscopic donor nephrectomy is now a well-accepted alternative to traditional open donor nephrectomy at many transplantation centers, there are always concerns regarding quality of graft and vessels after laparoscopic harvest, especially with right donor nephrectomy. Several methods of graft retrieval have been explored to achieve acceptable graft outcome. We share our initial experience at the Institute of Kidney Diseases and Research Center, Amedabad, India of laparoscopic right donor nephrectomy performed by subcostal open, and pure laparoscopic approach with the use of Endo TA stapler. Nine laparoscopic right donor nephrectomies were performed by the trans-peritoneal approach at our centre from January 2006 to March 2007. In the first five cases, the grafts were retrieved through subcostal incision (Group A) and the last four cases were performed purely laparoscopically by using Endo TA stapler device (Group B). None of the patients needed open conversion. The mean operative time and hospital stay were comparable in each group. The warm ischemia time was longer in pure laparoscopic group (415 seconds) than the subcostal open approach group (176 seconds). The serum creatinine of the recipients on day seven was comparable in both the groups. The recipient surgery was effectively performed with graft retrieved using Endo TA stapler device (Group B) without any compromise to the renal vein length. Our study suggests that the Endo TA stapler device is safe and provides all the benefits of minimally invasive surgery to the donor.
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Affiliation(s)
- Amit K Devra
- Institute of Kidney Diseases and Research Centre, Ahmedabad, India.
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Simforoosh N, Ghohestani SM, Abdi H, Soltani M, Basiri A. Lack of visual endoscopic appearance of ureteropelvic urothelial cancer; is it a deterrence for nephroureterectomy? A case study and literature review. J PAK MED ASSOC 2010; 60:230-232. [PMID: 20225786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Two case reports are presented with an important question what should be done when an endoscopic appearance of the urotherial lesion is unavailable. As seen in clinical practice, many patients choose nephroureterectomy with frequent follow up procedures. The other question raised is that what should be done when the lesions are ureteroscopically inaccessible. These patients can avail the advantages of radical treatment without accepting the probable as initial form of treatment to evade the risk and detriments of unnecessary additional endoscopic procedures.
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Affiliation(s)
- Nasser Simforoosh
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University, M.C., Tehran, IR Iran
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Lasser MS, Cheuck L, Renzulli J, Pareek G. Robot-assisted laparoscopic urologic surgery. Med Health R I 2009; 92:327-330. [PMID: 19911711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Laparoscopic partial nephrectomy (LPN) is increasingly performed all over the world. However, as in its open counterpart, achieving a satisfactory haemostasis may be challenging. Our goal is to describe the different methods employed to control bleeding during LPN. We performed a non-structured review of the literature on the different haemostatic methods used during LPN. The techniques and materials used are divided into two main groups: LPN with ischemia and LPN without ischemia. The techniques to achieve warm, cold and regional ischemia are described. Energy sources and sealants are discussed in the section on LPN without ischemia. Case selection is of capital importance in the choice the appropriate haemostatic tools for LPN. Some refinements, related to the nature of the laparoscopic procedure, are still required to reach an effective cold ischemia. A broad variety of energy sources have been tested in animal models and in human setting. Major disadvantages are tissue scarring, smoke creation and low progression speed. To date none has been demonstrated to be superior to the conventional suturing. Fibrin and thrombin promoters as bio-glues are an important adjuvant method during LPN. Bipolar current devices together with fibrin sealants or coagulation promoters are used in small peripheral tumors. In bigger or central tumors, additionally suturing over Surgicel bolsters, the most popular technique is to secure the suture by means of clips. The level of the recommendations is based on comparative cohorts. We conclude that haemostasis is achieved during LPN adapting the protocols used in open nephron sparing surgery to the laparoscopic approach. Renal ischemia and bolster sutures are still mandatory in complicated LPN while in case of small exophytic tumors a satisfactory haemostasis may be achieved by using only a sealant product.
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Affiliation(s)
- Jessica H van Dijk
- Department of Urology, Academisch Medischs Centrum, University of Amsterdam, Amsterdam, the Netherlands
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Cestari A, Guazzoni G, Buffi NM, Scapaticci E, Zanoni M, Fabbri F, Gadda G, Rigatti P. Current role of robotic assisted partial nephrectomy. Arch Ital Urol Androl 2009; 81:76-79. [PMID: 19760860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
The modern urologists are nowadays greatly involved in the surgical management of small renal masses, where nephron sparing surgery showed adequate oncological results, with a saving of a great amount of healthy renal tissue. Among the various minimally invasive surgical options, laparoscopic partial nephrectomy duplicates the open technique considered the standard of referral. Robotic assisted partial nephrectomy, aims to add to laparoscopy all the well known advantages offered by the Da Vinci system, such as the 3-Dvision and 7 degree of freedom of surgical instruments. We reviewed the current English literature on robotic partial nephrectomy published in 2008-2009 with at least 20 cases, adding our experience of 26 cases. Although the retroperitoneoscopic approach showed to be feasible in selected cases, all the procedures reported were performed with a transperitoneal approach. Among the 106 robotic assisted partial nephrectomy procedures selected, the mean tumor diameter was 2.8 cm; the mean operative time was 148.7 min with a mean warm ischemia time of 23.8 min and the positive surgical margins rate was 1.8%, reflecting the learning curve of the procedure. Overall complications rate was 15%, although the majority were minor and conservatively treated. Although robotic partial nephrectomy is still in its infancy, it showed adequate overall results when compared to laparoscopic partial nephrectomy with similar results but with a reduced learning curve. Actually robotic partial nephrectomy should be considered a viable option for nephron sparing surgery both in experienced laparoscopy centers for larger lesions in robotic naive centers where it may become the standard option for the treatment of small renal masses.
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Affiliation(s)
- Andrea Cestari
- Department of Urology, Vita-Salute University, San Raffaele Turro Hospital, Milan, Italy.
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Simon J, Bartsch G, Finter F, Hautmann R, de Petriconi R. Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp. BJU Int 2009; 103:805-8. [PMID: 19007377 DOI: 10.1111/j.1464-410x.2008.08112.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jörg Simon
- Department of Urology, University of Ulm, Ulm, Germany.
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Affiliation(s)
- Jihad H Kaouk
- Section of Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Abstract
PURPOSE The da Vinci robot system has been used to perform complex reconstructive procedures in a minimally invasive fashion. Robot-assisted laparoscopic radical prostatectomy has recently established as one of the standard cares. Based on experience with the robotic prostatectomy, its use is naturally expanding into other urologic surgeries. We examine our practical pattern and application of da Vinci robot system in urologic field. PATIENTS AND METHODS Robotic urologic surgery has been performed during a period from July 2005 to August 2008 in a total of 708 cases. Surgery was performed by 7 operators. In our series, radical prostatectomy was performed in 623 cases, partial nephrectomy in 43 cases, radical cystectomy in 11 cases, nephroureterectomy in 18 cases and other surgeries in 15 cases. RESULTS In the first year, robotic urologic surgery was performed in 43 cases. However, in the second year, it was performed in 164 cases, and it was performed in 407 cases in the third year. In the first year, only prostatectomy was performed. In the second year, partial nephrectomy (2 cases), nephroureterectomy (3 cases) and cystectomy (1 case) were performed. In the third year, other urologic surgeries than prostatectomy were performed in 64 cases. The first robotic surgery was performed with long operative time. For instance, the operative time of prostatectomy, partial nephrectomy, cystectomy and nephroureterectomy was 418, 222, 340 and 320 minutes, respectively. Overall, the mean operative time of prostatectomy, partial nephrectomy, cystectomy and nephrourectectomy was 179, 173, 309, and 206 minutes, respectively. CONCLUSION Based on our experience at a single-institution, robot system can be used both safely and efficiently in many areas of urologic surgeries including prostatectomy. Once this system is familiar to surgeons, it will be used in a wide range of urologic surgery.
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Affiliation(s)
- Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Wooju Jeong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Abstract
INTRODUCTION The increasing role of robotic technology to facilitate surgical procedures has attracted much attention from surgeons and patients alike. In particular, the dramatic increase in the number of laparoscopic radical prostatectomies performed using the da Vinci surgical system has led to interest in using this technology for other procedures. We have evaluated our own experience performing ablative and reconstructive laparoscopic renal surgery using the da Vinci system to determine its potential role. AIMS To review our experience of robotic-assisted laparoscopic procedures of the upper urinary tract. MATERIALS AND METHODS Our da Vinci system was installed in June 2004. A prospective database has been maintained concerning all patients and procedures performed from that time. Procedures involving the upper urinary tract were identified and the data was examined. This included patient demographics, operative time, blood loss, hospital stay and patient outcomes. RESULTS Twenty-six robotic procedures involved the upper urinary tract. Of these, two had to be converted to conventional laparoscopic surgery because of da Vinci mechanical failure. Robotic-assisted procedures included pyeloplasty (n = 15), simple nephrectomy (n = 2), radical nephrectomy (n = 1), nephroureterectomy (n = 2), and live donor nephrectomy (n = 4). The mean operative time was 215 min. The anastomotic time for the pyeloplasties averaged 47 min. The mean blood loss was 75 ml. There were no conversions to open surgery. The complication rate was 8.7%. Postoperative stay averaged 2.9 days. CONCLUSION The da Vinci surgical system may be safely used to assist in the performance of laparoscopic renal surgery.
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Affiliation(s)
- D Murphy
- Department of Urology, Guy's & St Thomas' NHS Foundation Trust, King's College London School of Medicine, London, UK.
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