Comparative Outcomes and Assessment of Trifecta in 500 Robotic and Laparoscopic Partial Nephrectomy Cases: A Single Surgeon Experience

Khalifeh, Ali; Autorino, Riccardo; Hillyer, Shahab; Laydner, Humberto; Eyraud, Rémi; Panumatrassamee, Kamol; Long, Jean-Alexandre; Kaouk, Jihad

doi:10.1016/j.juro.2012.10.021

Cited by 226 publications

(181 citation statements)

References 29 publications

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“…20 Although a growing body of evidence suggests that the amount of renal parenchyma removed rather than WIT is the determinant of final degree renal function preservation, 21,22 long WIT, especially in the setting of preexisting renal impairment and solitary kidney, is an important modifiable factor. [23][24][25][26] The rates of intraoperative (3.3%) and postoperative complications (30%) are slightly higher than in some of the published RAPN series, 27 but they are comparable with results from other OPN series for solitary kidneys. 12,28,29 From a functional point of view, with the mean follow-up time of 12 months, the degree of GFR preservation was >80% (82.1 -22.7) for the RAPN patients with low tumor complexity.…”

Section: Surgical Techniquesupporting

confidence: 71%

“…Given the small number of cases and small number of events of interests (complications, PSM), we did not perform any multivariable analysis in this study. Trifecta and margin, ischemia, and complication are some of the composite outcomes that have previously been proposed for assessing perioperative outcomes associated with PN 27,33,34 ; however, given the liberal use of cold ischemia in OPN, direct comparison of clamp time between the two groups was not possible.…”

Section: Surgical Techniquementioning

confidence: 99%

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Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Zargar

Bhayani

Allaf

et al. 2014

Journal of Endourology

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Results: 40 RAPN and 85 OPN cases were identified. For both tumor complexity groups, patients in each treatment modality were comparable. There were higher proportions of OPN cases in the complex group (61.2% vs 25%; P = 0.001). For both complexity tumor groups, there was no statistical difference between the treatment modalities in overall intraoperative/postoperative complications, transfusion rate, and positive surgical margin (PSM) rates. Patients in the RAPN group had a shorter length of hospital stay. For the entire cohort, there was no difference in estimated glomerular filtration rate preservation beyond 1 month (OPN 80.51%, RAPN 81.29%). Limitations include retrospective, nonrandomized nature of the series and small number of cases in the RAPN groups. Conclusions: In the solitary kidney, RAPN offers comparable perioperative and short-term functional outcomes for localized tumors with low R.E.N.A.L. score. For more complex tumors, our early experience suggests comparability, but these results were obtained in selected cases and future studies will need to validate these results.

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Section: Surgical Techniquesupporting

confidence: 71%

Section: Surgical Techniquementioning

confidence: 99%

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Zargar

Bhayani

Allaf

et al. 2014

Journal of Endourology

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“…The cut-offs of 20 or 25 minutes were used in recent series. 27 The retrospective design of our study is one of the main limitations. Some patient characteristics and comorbidities, as well as insignificant postoperative complications, may not have been recorded.…”

Section: Discussionmentioning

confidence: 99%

“…22,26 Despite the increasing tumour complexity, the trifecta outcomes of RALPN improved significantly after 20 cases to achieve the rates (64.3%) reported by the most experienced RALPN teams. 17,27 As compared to larger or multi-institutional series, the strength of our series is its homogeneity concerning the surgical steps, especially in terms of type of clamping and of renorraphy. The largest single institution series published by the Cleveland clinic has described their evolving techniques.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Ploussard

Haddad²,

Kovac³

et al. 2013

CUAJ

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Background: Although robot-assisted partial nephrectomy (RALPN) has been increasingly adopted, open procedures continue to be the reference nephron-sparing technique. We describe our initial surgical outcomes of RALPN in our single institution robotic program. Methods: Between January 2011 and February 2013, 65 consecutive patients underwent a RALPN by 2 surgeons. Preoperative characteristics, including the R.E.N.A.L. nephrometry score, perioperative parameters, and postoperative course, including renal function, were assessed from a retrospective database. The mean follow-up was 12 months. Results: The mean age was 60.2 years and the mean tumour size was 3.9 cm. According to the R.E.N.A.L. nephrometry score, the tumours were classified moderately and highly complex tumours in 51% and 18.5% of cases, respectively. Median warm ischemia time (WIT) was 21 minutes. Factors associated with WIT were R.E.N.A.L. nephrometry score, tumour size, complication rates and surgeon experience. No conversion or grade 4 to 5 complications were reported. The mean hospital stay was 3 days. The overall complication rate was 24.6% (re-admission rate 7.7%), and decreased to 12% after 20 cases. After these initial 20 cases, a trifecta rate (no margins, preserved renal function, no complications) of 64.3% was achieved in moderately and highly complex tumours. The mean change in estimated glomerular filtration rate was 6.7 mL/ min without severe postoperative renal failure. Interpretation: RALPN is a safe and feasible procedure with low specific morbidity, even in moderately or highly complex renal masses. The WIT depends on tumour characteristics, mainly determined by the R.E.N.A.L. nephrometry score and is improved by surgeon experience. Longer follow-up is needed to assess the oncologic mid-term safety of the procedure.

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“…По данным литературы, сложность резекции почки по шкалам RENAL, PADUA и C-index коррелирует с риском развития осложнений и / или потенциаль-ной длительностью ишемии почки. Использование перечисленных выше шкал позволяет достаточно точно прогнозировать уровень риска предстоящей операции и выбрать правильную тактику лечения [20][21][22][23][24].…”

Section: Discussionunclassified

Structure of 90 day complications after solitary kidney resection due to parenchyma tumors

Атдуев¹,

Шейыхов²,

Danilov³

et al. 2017

Cancer Urology

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Comparative Outcomes and Assessment of Trifecta in 500 Robotic and Laparoscopic Partial Nephrectomy Cases: A Single Surgeon Experience

Cited by 226 publications

References 29 publications

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Comparison of Perioperative Outcomes of Robot-Assisted Partial Nephrectomy and Open Partial Nephrectomy in Patients with a Solitary Kidney

Robot-assisted laparoscopic partial nephrectomy: Early single Canadian institution experience

Structure of 90 day complications after solitary kidney resection due to parenchyma tumors

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