Perioperative Complications of Robot-assisted Partial Nephrectomy: Analysis of 886 Patients at 5 United States Centers

Tanagho, Youssef S.; Kaouk, Jihad; Allaf, Mohamad E.; Rogers, Craig G.; Stifelman, Michael; Kaczmarek, B; Hillyer, Shahab; Mullins, Jeffrey K.; Chiu, Yi-Chun; Bhayani, Sam B.

doi:10.1016/j.urology.2012.10.067

Cited by 127 publications

(100 citation statements)

References 19 publications

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“…score in the preoperative assessment of RALPN has previously been highlighted. 15,19,20 As expected, this score was significantly correlated with the WIT, operative time, estimated blood loss and complication rate. 21 Surgery for a deep endophytic hilar mass will be more technically challenging than that for an exophytic lower pole T1a tumour.…”

Section: Discussionsupporting

confidence: 78%

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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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Section: Discussionsupporting

confidence: 78%

“…22 In a large multicenter series of 886 patients, Tanagho and colleagues reported a complication rate of 23% in complex tumours. 20 The learning curve of the technique needs to be emphasized. Our overall complication rate was only 12% after the 20 initial cases for each surgeon, in line with published values.…”

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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“…This in turn, increases the likelihood of subsequent urine leak. This has been previously reported in large multi--institutional series (3,21). Bruner et al identified tumor's R.E.N.A.L nephrometry score was associated with risk of urine leak after PN (10).…”

Section: Discussionsupporting

confidence: 68%

“…EBL increased the odds of urinary leak, and this is likely a surrogate for complexity of surgery. The rate of urine leak in contemporary PN series is around 1-5% (3,23,24). Kundu et al reported that larger tumor sizes, higher estimated blood loss and longer ischemia time were associated with fistula formation.…”

Section: Discussionmentioning

confidence: 99%

“…With widespread uptake of PN, complications unique to this surgery became more recognized. Among them, postoperative urine leak is regarded as a clinically significant entity, which negatively impacts patient's recovery (2)(3)(4)(5). Inadequate repair of a violated collecting system during renorrhaphy is the cause of postoperative urine leak.…”

Section: Introductionmentioning

confidence: 99%

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Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Purpose: To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods: MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak.Results: A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon's early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion: Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall operative time.

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Subtotal Nephrectomy and Tumour Ablation

Nicol¹,

Elstob²,

Anderson³

et al. 2017

Radiology and Follow‐up of Urologic Surgery

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Perioperative Complications of Robot-assisted Partial Nephrectomy: Analysis of 886 Patients at 5 United States Centers

Cited by 127 publications

References 19 publications

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

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

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

Subtotal Nephrectomy and Tumour Ablation

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