Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results

Minervini, Andrea; Tuccio, Agostino; Masieri, Lorenzo; Veneziano, Domenico; Vittori, Gianni; Siena, Giampaolo; Gacci, Mauro; Vignolini, Graziano; Mari, Andrea; Sebastianelli, Arcangelo; Salvi, Matteo; Serni, Sergio; Carini, Marco

doi:10.1007/s00464-014-3807-0

Cited by 37 publications

(35 citation statements)

References 32 publications

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“…As shown before in the robotic SE published series, the rate of procedures performed without WI is clearly higher, [7] than in open setting. [3] …”

Section: Discussionmentioning

confidence: 57%

“…[7] In our series, the rate was lower (1.5%) even if there are at least 2 major differences between the 2 series: the percentage of benign lesions (17.7% vs 14.7%) and the percentage of clamp-less procedures (33.9% vs 60.5%). In fact, we choose this approach mainly to be performed without clamping or with a deferred pedicle clamping.…”

Section: Discussionmentioning

confidence: 57%

“…[3–5,7] They only concluded that the robotic approach can achieve better surgical results by reducing the need for clamping, warm ischemia time (WIT), EBL, and length of stay, mainly due to a clearly lower complication rate. [7] …”

Section: Discussionmentioning

confidence: 99%

“…[3,4,7] Nonetheless, as shown for open surgery, dimension, anatomical aspects of the tumor as well as vascular variants of the renal blood supply may increase the procedure complexity and difficulty, with a possible impact on the complication rate in a robot-assisted approach, too.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of robot-assisted simple enucleation of renal masses

et al. 2017

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The aim of this study was to assess the ability of pre-and intraoperative parameters, to predict the risk of perioperative complications after robot-assisted laparoscopic simple enucleation (RASE) of renal masses, and to evaluate the rate of trifecta achievement of this approach stratifying the cohort according to the use of ischemia during the enucleation.From April 2009 to June 2016, 129 patients underwent RASE at our Institution. We stratified the procedures in 2 groups: clamping and clamp-less RASE. After RASE, all specimens were retrospectively reviewed to assess the surface–intermediate–base (SIB) scoring system. Patients were followed-up according to the European Association of Urology guidelines recommendations. All pre-, intra-, and postoperative outcomes were prospectively collected in a customized database and retrospectively analyzed.A total of 112 (86.8%) patients underwent a pure RASE and 17 (13.2%) had a hybrid according to SIB classification system. The mean age was 61.17 years. In 21 patients (16.3%), complications occurred, 13 (61.9%) were Clavien 1 and 2, while 8 were Clavien 3a and b complications. Statistical significant association with complications was found in patients with American Society of Anestesiology (ASA) score 3 (44.5%, P = .04), longer mean operative time (OT) 195 versus 161.36 minutes (P =.03), mean postoperative hemoglobin (Hb) 10.1 versus 11.8 (P <.001), and mean ΔHb 3.59 versus 2.18 (P <.001). In multivariate logistic regression, only longer OT and ΔHb were statistical significant predictive factors for complications. In sub-group analysis, clamp-less RASE was safe in terms of complications (14.1%), positive surgical margins (1.3%), and mid-term local recurrence (1.3%). Although in this approach there is higher EBL (P = .01), this had no impact on ΔHb (P = .28). A clamp-less approach was associated with a higher rate of SIB 0 (71.8% vs 51%, P = .02), higher trifecta achievement (84.6% vs 62.7%, P = .004), and better impact on serum creatinine (mean 0.83 vs 0.91, P = .01).RASE of renal tumors is a safe technique with very good postoperative outcomes. Complication rate is low and associated with ASA score >3, longer OT, and ΔHb. RASE is suitable for the clamp-less approach, which allows to perform easier the pure enucleation (SIB 0) and to obtain higher rates of trifecta outcomes.

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“…As shown before in the robotic SE published series, the rate of procedures performed without WI is clearly higher, [7] than in open setting. [3] …”

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of robot-assisted simple enucleation of renal masses

et al. 2017

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“…The description of the surgical technique was reported in previous papers [15,16]. For the present series, a 4S Da Vinci robot (Intuitive Surgical, Sunnyvale, CA, USA) in a three-arm configuration was always used.…”

Section: Methodsmentioning

confidence: 99%

Impact of the off-clamp endoscopic robot-assisted simple enucleation (ERASE) of clinical T1 renal tumors on the postoperative renal function: Results from a matched-pair comparison

Mari

Morselli

Sessa

et al. 2018

European Journal of Surgical Oncology

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a b s t r a c tPurpose: To evaluate the surgical and functional outcomes of a matched-paired series of on-clamp vs offclamp endoscopic robot-assisted simple enucleation (ERASE) and standardized renorraphy in a tertiary referral institution, to search for predictors of functional drop after surgery and to investigate the influence of off-clamp technique in patients presenting these characteristics. Materials and methods: A matched-pair comparison of 120 on-clamp vs 120 off-clamp over 491 patients treated with ERASE was performed. Perioperative and functional outcomes were compared between groups. Results: Patients treated with on-clamp and off-clamp technique had comparable complication and positive surgical margin rate. The off-clamp group had a significantly lower eGFR drop compared to the on-clamp group at 3rd postoperative day (POD) (1% vs 7%, p ¼ 0.0001) and at 30th POD (2.5% vs 9%, p ¼ 0.01) from baseline. This difference lost its statistical significance at 6th month and at last follow-up (median 40 months). At multivariable analysis the Charlson comorbidity index (OR 2.06, p < 0.0001), uncontrolled type 2 diabetes mellitus (OR 4.13, p < 0.001) were independent predictive factors of a >15% eGFR drop from baseline to last follow-up. In a subanalysis over 64 comorbid patients, those patients who underwent off-clamp ERASE had a significantly lower eGFR drop compared to the comorbid counterpart during the whole follow-up. Conclusions: The off-clamp ERASE is a safe surgical technique with a significantly lower renal function drop compared to on-clamp ERASE in the early perioperative time. Patients with comorbidity might represent a subgroup of patients having a functional benefit after off-clamp RAPN even in the long-term period.

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Robotic‐assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study

Liu

Zhao

Feng

et al. 2021

Journal of Surgical Oncology

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Background and Objective This study aimed to evaluate the safety and efficacy of robot‐assisted laparoscopic tumor enucleation (RAE) for the treatment of renal hilar tumors and to describe our experience with renorrhaphy‐related surgical techniques. Methods Retrospective data were collected from 173 consecutive patients who underwent RAE for localized renal tumors (cT1–cT2N0M0) at our hospital between September 2014 and November 2019. Results Seventy‐five patients had renal hilar tumors and 98 patients had nonhilar tumors. There were no statistical differences between the hilar and nonhilar groups in operation time (190 [115–390] vs. 190 [110–390] min, p = 0.889), warm ischemia time (26 [12–60] vs. 27 [17–41] min, p = 0.257), hospital stay duration (8 [3–16] vs. 7.5 [4–18] days, p = 0.386), renal function (estimated glomerular filtration rate, 102.5 [29.4–144] vs. 101.3 [64.2–134.7] ml/min/1.73 m2, p = 0.631); creatinine level, (76 [43–169] vs. 78.5 [50–281.3] µmol/L, p = 0.673), perioperative complications rate, or surgical margin status. However, patients with hilar tumors lost significantly more blood than did those with nonhilar tumors (250 [50–1500] vs. 200 [20–1200] ml, p = 0.007). During the follow‐up period (median, 30 months), three patients in each group experienced recurrence. The 5‐year recurrence‐free rates were 93.0% and 95.4% in the hilar and nonhilar tumor groups, respectively (p = 0.640). Conclusions For experienced robot laparoscopists, RAE is a safe, effective, and feasible procedure for renal hilar tumors, without increased risk of positive surgical margins or worse midterm oncologic outcomes compared with nonhilar tumors.

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Endoscopic robot-assisted simple enucleation (ERASE) for clinical T1 renal masses: description of the technique and early postoperative results

Cited by 37 publications

References 32 publications

Outcomes of robot-assisted simple enucleation of renal masses

Outcomes of robot-assisted simple enucleation of renal masses

Impact of the off-clamp endoscopic robot-assisted simple enucleation (ERASE) of clinical T1 renal tumors on the postoperative renal function: Results from a matched-pair comparison

Robotic‐assisted laparoscopic tumor enucleation is a feasible technique for renal hilar tumors: A retrospective study

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