Laparoscopic partial nephrectomy: the University of Saskatchewan (Regina division) experience

Tse, Andrew; Knaus, Russel; Tse, Edward

doi:10.5489/cuaj.1037

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…By contrast, laparoscopic partial nephrectomy, owing to its technical difficulty, has not been widely adopted in the management of large tumors. In our recent systematic review of all manuscripts in the PubMed database including partial nephrectomy for tumors greater than 7 cm from 1999 to 2009, only 12 reported cases from nine centers were performed laparoscopically [67][68][69][70][71][72][73][74][75]. By contrast, in series ranging from 2007 to 2010, ten more cases from three centers were performed with robotic assistance (including four from our institution) [76][77][78].…”

Section: Role Of Minimally Invasive Surgical Approaches In Large Tumorsmentioning

confidence: 87%

Surgical management of large renal tumors

Vourganti

Shuch

Bratslavsky

2011

Expert Review of Anticancer Therapy

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The surgical management of patients with renal cell carcinoma has undergone many changes. With equivalent oncologic outcomes and appreciation of the importance of renal functional preservation, the utilization of nephron-sparing partial nephrectomy has increased in recent years. Nevertheless, tumors of larger size continue to be preferentially treated with radical nephrectomy. Here, we present evidence that improvements in techniques and durability of oncologic outcomes has justified the use of nephron sparing to accomplish renal functional preservation even in patients with large renal tumors. In addition, surgical technical considerations when managing such tumors are discussed. Finally, we discuss cytoreductive surgery and the evolving role of systemic targeted therapies in the management of advanced metastatic disease.

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Section: Role Of Minimally Invasive Surgical Approaches In Large Tumorsmentioning

confidence: 87%

Surgical management of large renal tumors

Vourganti

Shuch

Bratslavsky

2011

Expert Review of Anticancer Therapy

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“…I n this issue of CUAJ, Tse and colleagues 1 present an interesting study on the Regina experience with laparoscopic partial nephrectomy (LPN) for T1 renal tumours. The authors describe a single-institution experience of 47 cases of LPN with the introduction of an LPN utilization rate parameter, from a centre with a high volume of laparoscopic urological cases.…”

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confidence: 99%

Laparoscopic partial nephrectomy: a challenging operation with a steep learning curve

Kapoor

2013

CUAJ

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I n this issue of CUAJ, Tse and colleagues 1 present an interesting study on the Regina experience with laparoscopic partial nephrectomy (LPN) for T1 renal tumours. The authors describe a single-institution experience of 47 cases of LPN with the introduction of an LPN utilization rate parameter, from a centre with a high volume of laparoscopic urological cases. Of this experience, 31 lesions resected were nonhilar tumours and 16 tumours were in hilar locations. Twenty-five percent of tumours resected were T1b tumours, with a maximum tumour size of 7.2 cm. Eighty percent of renal lesions resected were malignant tumours. The mean tumour size was 3.8 cm, and the mean operating time was 2.8 hours. The average hospital stay was 5 days, which seems somewhat higher than expected for laparoscopic procedures.Operative hilar clamping in this experience was with en bloc clamping. This is in contrast to many centres, such as St. Joseph's Hospital, which preferentially clamps the renal artery only. This may decrease the intraoperative blood loss, and allows some renal perfusion. En bloc hilar clamping has the advantage that the individual renal artery and vein do not need to be dissected out, and may decrease the risk of injury to the major vessels during the procedure. It has become fairly standard that LPN requires some clamping of the renal hilum (either en bloc or renal artery only) to minimize intraoperative blood loss. This can be done with laparoscopic locking Satinsky clamps (Teleflex), locking DeBakey clamps or detachable laparoscopic bulldog clamps.The authors discuss their experience with complications from LPN, which are not insignificant. The reported blood transfusion rate is 13% (6 patients), 1 patient required emergent postoperative nephrectomy for bleeding, 1 patient developed prolonged urinary leakage and 1 patient developed late calyceal stricture. Two patients had positive surgical margins (which likely will not compromise cancer control in the long term). These complications attest to the steep learning curve of this operation. Of almost 200 cases of LPN at St. Joseph's Hospital, the blood transfusion rate is not insignificant at 6%, with 4 cases of postoperative pseudoaneurysm requiring radiological embolization. These postoperative issues are echoed by other high-volume centres. Meticulous suturing of transected blood vessels and collecting system reconstruction with parenchymal repair is required, all within an optimal warm ischemic clamp time of 30 minutes. In our experience, use of the absorbable Lapra-Ty (Ethicon) suture allows quick suturing to minimize ischemic time. Some centres use the permanent Hem-O-Lok (Pilling Weck) for parenchymal suturing to minimize ischemic time. Use of either Tisseel (Baxter) or Floseal (Baxter) may improve intraoperative hemostasis after parenchymal repair.Is LPN a procedure that all urologists should be doing, or is this a procedure that should be done only in highvolume centres? The learning curve for this operation is steep, with the optimal number of cases likely ...

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Robotic versus traditional laparoscopic partial nephrectomy: comparison of outcomes with a transition of techniques

et al. 2014

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We aimed to evaluate the effect of a transition from laparoscopic partial nephrectomy (LPN) to robotic-assisted laparoscopic partial nephrectomy (RALPN) on peri-operative and oncological patient outcomes. We present the results of the last 50 LPN (group 1) compared with our first 50 RALPN (group 2). The peri-operative data was evaluated using appropriate comparison tests. The parameters compared included operative times, warm ischaemia time (WIT), estimated blood loss (EBL), complications using the Clavien-Dindo (CD) grading system and oncological outcomes including positive surgical margin (PSM) rates. Patients in group 1 (n = 50) and group 2 (n = 50) had comparable pre-operative RENAL scores, ASA scores and tumour size characteristics. Ninety-four percent of the patients in group 1 underwent retroperitoneal LPN while 96 % of patients in group 2 underwent transperitoneal RALP. The mean total operative time in groups 1 and 2 was 163 versus 195 min, respectively (p = 0.003), and EBL was 294 versus 187 ml (p < 0.001). There was no statistically significant difference in WIT between groups 1 and 2 (24.7 and 21.8 min, respectively, p = 0.18). Post-operative histology was comparable in the two groups and the PSM rate was 8 versus 4 % (p = 0.58). The CD major complication rate was 16 % in group 1 versus 4 % in group 2 (p < 0.001). In our series, RALPN appears to have a longer initial total operative time than LPN; however, this reduces after the first 20 cases. RALP has a significant reduction in EBL and post-operative major complication rates, including immediate peri-operative complication rates such as the risk of acute haemorrhage or urinoma. Our data indicates that it is safe to change from LPN to RALPN with no compromise in patient safety or oncological outcomes.

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Laparoscopic partial nephrectomy: the University of Saskatchewan (Regina division) experience

Cited by 5 publications

References 21 publications

Surgical management of large renal tumors

Surgical management of large renal tumors

Laparoscopic partial nephrectomy: a challenging operation with a steep learning curve

Robotic versus traditional laparoscopic partial nephrectomy: comparison of outcomes with a transition of techniques

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