Robotic Unclamped “Minimal-margin” Partial Nephrectomy: Ongoing Refinement of the Anatomic Zero-ischemia Concept

Satkunasivam, Raj; Tsai, Sheaumei; Syan, Sumeet; Bernhard, Jean-Christophe; Abreu, André Luís de Castro; Chopra, Sameer; Berger, André; Lee, Dennis; Hung, Andrew J.; Cai, Jie; Desai, Mihir; Gill, Inderbir S.

doi:10.1016/j.eururo.2015.04.044

Cited by 85 publications

(58 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This low complexity of tumors selected for an off-clamp RPN is in accordance with previously published series [17,18] . Very few high-volume expert surgical teams have reported the use of an unclamped technique in complex endophytic or large tumors [19] .…”

Section: Discussionmentioning

confidence: 99%

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Peyronnet¹,

Khene²,

Pradère³

et al. 2017

Urol Int

Self Cite

View full text Add to dashboard Cite

Introduction: The aim of this study was to compare the outcomes of on-clamp and off-clamp robotic partial nephrectomy (RPN). Materials and Methods: The charts of all patients who underwent an RPN at 8 institutions between 2010 and 2014 were retrospectively reviewed. The patients who underwent an off-clamp RPN were matched to on-clamp RPN in a 1-4 fashion according to the following variables: RENAL score, tumor size and surgeon's experience. Pre-, intra-, and postoperative data were compared between both groups. Results: Among 525 RPN, 26 were performed off-clamp (5%). They were matched to 104 on-clamp RPN. The complications rate (15.5 vs. 7.7%, p = 0.53), major complications rate (4.9 vs. 3.9%; p = 0.82), and transfusions rate (0 vs. 4.9%; p = 0.58) did not differ significantly between the clamped and unclamped groups. Conversely, estimated blood loss was higher in the off-clamp group (266.4 vs. 284.6 mL, p = 0.048) and so was the rate of conversion to radical nephrectomy (0 vs. 7.7%, p = 0.04). Postoperative preservation of renal function was comparable in both groups. Conclusion: Off-clamp RPN is feasible for a small subgroup of renal tumors without increased risk of postoperative complications but at the cost of higher estimated blood loss and increased risk of conversion to radical nephrectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Peyronnet¹,

Khene²,

Pradère³

et al. 2017

Urol Int

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recently, several studies showed that having no functional residual renal volume and postoperative renal recovery can also affect postoperative renal functional outcome which was difficult to have precise prediction before surgery 13–15 . Advances in PN techniques have helped to maximize parenchymal volume preservation, leading to the need for a new parameter to predict RPV-unrelated postoperative ePD10 16, 17 .…”

Section: Discussionmentioning

confidence: 99%

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

Zhang

Huang

et al. 2017

Sci Rep

View full text Add to dashboard Cite

The present study aimed to assess the impact of peritumoral artery characteristics on renal function outcome prediction using a novel Peritumoral Artery Scoring System based on computed tomography arteriography. Peritumoral artery characteristics and renal function were evaluated in 220 patients who underwent laparoscopic partial nephrectomy and then validate in 51 patients with split and total glomerular filtration rate (GFR). In particular, peritumoral artery classification and diameter were measured to assign arteries into low, moderate, and high Peritumoral Artery Scoring System risk categories. Univariable and multivariable logistic regression analyses were then used to determine risk factors for major renal functional decline. The Peritumoral Artery Scoring System and four other nephrometry systems were compared using receiver operating characteristic curve analysis. The Peritumoral Artery Scoring System was significantly superior to the other systems for predicting postoperative renal function decline (p < 0.001). In receiver operating characteristic analysis, our category system was a superior independent predictor of estimated glomerular filtration rate (eGFR) decline (area-under-the-curve = 0.865, p < 0.001) and total GFR decline (area-under-the-curve = 0.796, p < 0.001), and split GFR decline (area-under-the-curve = 0.841, p < 0.001). Peritumoral artery characteristics were independent predictors of renal function outcome after laparoscopic partial nephrectomy.

show abstract

“…Bleeding control during PN can be achieved in several ways [5][6][7] , but vascular clamping is still the most important maneuver used for this purpose [19] . Although renal ischemia improves the surgical field, it remains a concern as it represents the most frequent cause of acute and chronic renal failure [3,4] .…”

Section: Discussionmentioning

confidence: 99%

Glomerular Morphology and Renal Function after Warm Ischemia by Main Artery or Selective Clamping in a Porcine Model

Bechara

Damasceno-Ferreira²,

Abreu³

et al. 2017

Urol Int

View full text Add to dashboard Cite

Objective: The study aimed to evaluate the ischemic and non-ischemic areas after selective arterial occlusion by using stereological analysis of glomeruli, and to compare them with main arterial clamping and sham-operated animals. Materials and Methods: Twenty-four male pigs were used in the study. The animals were divided into 3 groups with 8 animals in each as follows: group sham, submitted to laparoscopic dissection of the renal pedicle but not submitted to ischemia; group arterial (A), submitted to left renal artery clamping; and group selective (S), submitted to left renal artery caudal branch occlusion. Groups A and S underwent 30 min of warm ischemia. Left and right kidneys were collected after 21 days and renal fragments were processed for stereological evaluation. Glomerular volume density (Vv[glom]), mean glomerular volume (MGV), and glomerular density were measured. Serum creatinine and urea were assessed preoperatively, 10 days after surgery, and before euthanasia. Results: There was no significant difference among groups with regard to renal function. Renal weight and volume were similar among groups. Also, no difference was observed between the groups with regard to Vv[glom], MGV, and glomerular density, both when compared to its right control or when left kidneys were compared. Conclusions: Selective arterial clamping technique was neither superior nor inferior to main artery clamping.

show abstract

Robotic Unclamped “Minimal-margin” Partial Nephrectomy: Ongoing Refinement of the Anatomic Zero-ischemia Concept

Cited by 85 publications

References 22 publications

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Off-Clamp versus On-Clamp Robotic Partial Nephrectomy: A Multicenter Match-Paired Case-Control Study

Peritumoral Artery Scoring System: a Novel Scoring System to Predict Renal Function Outcome after Laparoscopic Partial Nephrectomy

Glomerular Morphology and Renal Function after Warm Ischemia by Main Artery or Selective Clamping in a Porcine Model

Contact Info

Product

Resources

About