A comparative analysis of various surgical approaches of nephron-sparing surgery and correlation of histopathological grade with RENAL nephrometry score in renal cell carcinoma

Garg, Harshit; Tiwari, Deviprasad; Nayak, Brusabhanu; Singh, Prabhjot; Yadav, Siddharth; Kumar, Rajeev; Seth, Amlesh; Nayyar, Rishi; Dogra, Prem Nath

doi:10.4103/jmas.jmas_208_18

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…7 In our study, we identified that EBL was lower in the RALPN group when compared to OPN (P<0.05) and was comparable to the LPN group (P=0.15). These findings were in keeping with those reported by Garg et al 8 Of interest, our data also demonstrated a significantly lower mean procedure and total OR time for RALPN in addition to LPN when compared to OPN (P<0.05), contrary to what is found in the literature as many previous studies have reported longer mean operative time with RALPN when compared to other modalities. [5][6][7][8] One possible reason for the shorter procedure and OR time with RALPN could be that there was greater staff surgeon involvement in RALPNs during the early phase of our robotics program as opposed to the well-established LPN and OPN program where resident operative experience and training was prioritized more.…”

Section: Discussionsupporting

confidence: 91%

“…These findings were similar to studies already in the literature demonstrating similar intraoperative and postoperative complication rates. [5][6][7][8] Although not statistically significant, we did observe the RALPN group to have a lower number of intraoperative complications and no Clavien-Dindo Grade IV-V complications when compared to OPN and LPN. Interestingly, we found WIT to be significantly longer in the RALPN group compared to the other two groups, with a median of 17 minutes for RALPN versus 14.5 and 15 minutes for OPN and LPN, respectively.…”

Section: Discussioncontrasting

confidence: 57%

“…Our findings were in keeping with numerous other studies in the literature that observed shorter LOS for RALPN for cT1 and cT2 renal masses when compared to non-robotic modalities. [5][6][7][8][9] This was an important finding from our study as RALPN was associated with lower LOS and similar operating room time and procedure time as LPN, while There was no significant difference observed in the number of intraoperative complications or Clavien-Dindo Grade between the three groups. These findings were similar to studies already in the literature demonstrating similar intraoperative and postoperative complication rates.…”

Section: Discussionsupporting

confidence: 55%

“…Despite this increased WIT and operative time in the literature, a lower LOS for RALPN as well as similar intraoperative complication rates between RALPN and OPN has been observed as well as lower postoperative analgesic use associated with RALPN performed for SRMs. 5,6,8 Conversely, in one single-surgeon matched cohort Korean study comparing RALPN to OPN, they observed that while mean operative time was longer in the RALPN group, there was no significant difference in WIT and post-operative renal function when compared to the OPN group. This group also found that there was no significant difference in EBL, transfusion rate, or complications between the two groups, while LOS was once again found to be lower in the RALPN group.…”

Section: Discussionmentioning

confidence: 97%

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Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy

Masoumi-Ravandi,

Mason,

Ricardo

2024

CUAJ

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Introduction: In 2019, our center attempted to transition all partial nephrectomies (PNs) to robotic-assisted laparoscopic PN (RALPN). The purpose of this study was to compare RALPN outcomes to laparoscopic PN (LPN) and open PN (OPN) at our institution, as there is limited literature from Canadian centers. Methods: In this single-center, two-surgeon, retrospective cohort study, we compared RALPN outcomes during the early phase of our robotics program to OPN and LPN performed just before the introduction of RALPN. Results: A total of 106 patients underwent OPN, 83 LPN, and 82 RALPN during the study period. Median RALPN RENAL score was 7 vs. 6 for LPN (p<0.05) and 8 for OPN (p=0.10). Median RALPN length of stay (LOS) was two days vs. three and four days for LPN and OPN (p<0.05), respectively. OPN median procedure time was 104 minutes vs. 94 and 82 minutes for LPN and RALPN (p<0.05), respectively. Median OPN operating room (OR) time was 160 minutes vs. 150 and 146 minutes for LPN and RALPN (p<0.05), respectively. There were no significant differences in intraoperative (p=0.92) or postoperative complications rates (p=0.47). RALPN warm ischemia time (WIT) was 17 minutes vs 14.5 and 15 minutes for OPN and LPN (p<0.05), respectively. Median RALPN estimated blood loss (EBL) was 165 ml vs. 250 ml for OPN (p<0.05) and 125 ml for LPN (p=0.15). Conclusions: Although patients who underwent RALPN had longer WIT, they had similar rates of complications, required less total OR time, and had shorter procedure time and LOS compared with OPN and LPN despite similar RENAL score compared to OPN and greater score than LPN.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 57%

Section: Discussionsupporting

confidence: 55%

Section: Discussionmentioning

confidence: 97%

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Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy

Masoumi-Ravandi,

Mason,

Ricardo

2024

CUAJ

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“…They found the RAPN group to have lesser blood loss and lesser hospital stay as compared to the open approach. [ 18 ] In the past 10 years, multiple meta-analyses have reported the advantages of robotic-assisted surgery over other techniques in managing small renal masses. [ 19 ] A 2023 meta-analysis included comparative randomized and nonrandomized studies of open and robotic PN for highly complex renal masses.…”

Section: Discussionmentioning

confidence: 99%

Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database

Rawal,

Ganpule,

Singh

et al. 2024

Indian Journal of Urology

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Introduction: There is an unmet need for high-quality data for Robot-assisted partial nephrectomy (RAPN) in the Indian population. Indian study group on partial nephrectomy (ISGPN) is a consortium of Indian centers contributing to the partial nephrectomy (PN) database. The current study is a descriptive analysis of perioperative and functional outcomes following RAPN. Methods: For this study, the retrospective ISGPN database was reviewed, which included patients who underwent RAPN for renal masses at 14 centers across India from September 2010 to September 2022. Demographic, clinical, radiological, perioperative, and functional data were collected and analyzed. Ethics approval was obtained from each of the participating centers. Results: In this study, 782 patients were included, and 69.7% were male. The median age was 53 years (interquartile range [IQR 44–62]), median operative time was 180 min (IQR 133–240), median estimated blood loss was 100 mL (IQR 50–200), mean warm ischemia time was 22.7 min and positive surgical margin rates were 2.5%. The complication rate was 16.2%, and most of them were of minor grade. Trifecta and pentafecta outcomes were attained in 61.4% and 60% of patients, respectively. Conclusions: This is the largest Indian multi-centric study using the Indian Robotic PN Collaborative database to evaluate the outcomes of robot-assisted PN, and has proven its safety and efficacy in the management of renal masses.

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Comparison of 3-dimensional laparoscopy and conventional laparoscopy in the treatment of complex renal tumor with partial nephrectomy

Chen

et al. 2019

Medicine

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To compare the efficacies of 3-dimensional laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy for complex renal tumors. The complex renal tumors was defined as Preoperative Aspects and Dimensions Used for an anatomical (PADAU) ≥10, including some cT1b tumors.This was a retrospective analysis of patients with local complex renal tumors who presented to our hospital from January 2014 to January 2018. All patients were managed with laparoscopic partial nephrectomy (LPN) or 3-dimensional partial nephrectomy (3DLPN).There were 48 patients in the LPN group and 60 in the 3DLPN group. In the matched groups, demographic and tumor characteristics including Charlson Comorbidity Index, PADUA, based on the preoperative images, were similar. By contrast, 3DLPN achieved better results in terms of warm ischemia time (19 vs 27 minutes), operation time (105 vs 128 minutes), postoperative complications (14.9% vs 23.4%), and marginal width (0.6 cm vs 0.4 cm). We found statistically significant differences in terms of length of stay, estimated blood loss (EBL), positive surgical margin (PSM), and conversion to open or radical nephrectomy (RN). Median follow-up time was 17 and 18.5 months for the LPN and 3DLPN groups, respectively. The recovery of renal function (% change eGFR, 0 vs −8.7) was significantly different between the 3DLPN and LPN groups, whereas 12-month recurrence-free survival did not differ.Both 3-dimensional laparoscopic nephron-sparing nephrectomy and conventional laparoscopic partial nephrectomy are safe, effective, and acceptable approaches to treating complex renal tumors, while the former may facilitate tumor resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.

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A comparative analysis of various surgical approaches of nephron-sparing surgery and correlation of histopathological grade with RENAL nephrometry score in renal cell carcinoma

Cited by 4 publications

References 27 publications

Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy

Robotic-assisted laparoscopic partial nephrectomy vs. laparoscopic and open partial nephrectomy

Perioperative and functional outcomes following robot-assisted partial nephrectomy: Descriptive analysis of Indian study group on partial nephrectomy database

Comparison of 3-dimensional laparoscopy and conventional laparoscopy in the treatment of complex renal tumor with partial nephrectomy

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