Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database11Financial Support: JTL is supported by Award no. DK089086 from the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Liu, Jen Jane; Leppert, John T.; Maxwell, Bryan G.; Panousis, P.; Chung, Benjamin I.

doi:10.1016/j.urolonc.2013.09.012

Cited by 64 publications

(15 citation statements)

References 26 publications

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“…The association between fellow or resident involvement and longer operating times has been reported by others . In a large multi‐institutional prospective database of uro‐oncological procedures, Ruhotina et al observed longer operating times when residents were scrubbed, but did not observe any association between resident involvement and complication rates.…”

Section: Discussionmentioning

confidence: 72%

“…They found that resident and fellow involvement was associated with an increased rate of overall surgical site infections, bleeding and sepsis. Liu et al found resident involvement to be an independent predictor of major complications in both PN and radical nephrectomy; however, the authors cautioned that their finding was probably confounded by the possibility that procedures involving residents may reflect more complex and higher risk tumours, as they were more likely to be performed at tertiary care centres.…”

Section: Discussionmentioning

confidence: 98%

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Does training of fellows affect peri‐operative outcomes of robot‐assisted partial nephrectomy?

et al. 2017

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 98%

Does training of fellows affect peri‐operative outcomes of robot‐assisted partial nephrectomy?

et al. 2017

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“…21 Finally, two recently published comparative reports attempt to compare minimally-invasive surgery for prostatectomy and nephrectomy to their open counterparts. 22,23 While trends in safety over time, demonstrated by Liu et al, are an admirable application of NSQIP, direct comparisons between these procedures may be more limited until specific disease characteristics are obtainable through NSQIP or clinical practice evolves to a point that selection bias is less of a concern.…”

Section: Commentmentioning

confidence: 99%

Morbidity of Urologic Surgical Procedures: An Analysis of Rates, Risk Factors, and Outcomes

Patel

Ball

Cohen

et al. 2015

Urology

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Objectives To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urological procedures to demonstrate background rates and discuss benchmarking. Methods Urologic procedures from NSQIP (2006–2011) were analyzed to identify 30-day rates of 21 complications, outcomes (length of stay (LOS), reoperation, death), and predictors including resident involvement for 18 specific procedures. Multivariable logistic regression models assessed predictors for any complication and for Clavien IV or V complication. Results A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days LOS, 3.2% mortality) with 56% experiencing any complication followed by nephrectomy (21%), RPLND (20%), and RRP (19%). TURBT (11%) and TURP (10%) had highest rates for endoscopic procedures. Older age, ASA class, dependent functional status, AKI [OR2.70(1.89–3.87)], and ≥5 units preoperative transfusion [OR4.44(3.40–5.80)] were strongest predictors of any complication. Higher ORs of similar predictors along with COPD [OR1.52(1.21–1.92)] and steroid use [OR1.51(1.07–2.14)] were associated with Clavien IV or V complication. Resident involvement increased odds of any complication [OR1.18(1.09–1.29)], mostly for abdominopelvic and urogynecologic procedures, but not Clavien IV or V complication (p=0.55). Conclusions Complication rates of urological procedures based on the retrospective experience of few surgeons does not allow for appropriate benchmarking. Baseline rates and benchmarks derived from NSQIP may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).

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“…Given that each AC value is an integer in the range [1, 5], ∆ TAC must be an integer in the range [− 12, 12]. A positive value of ∆ TAC implies that the participant believed themselves to have gained a better understanding of the overall patient anatomy from the virtual 3D model than from VRI.…”

Section: Methodsmentioning

confidence: 99%

“…The evolution and uptake of laparoscopic and robotic-assisted techniques have led to an increase in the use of minimally invasive partial nephrectomy (PN), also known as nephron-sparing surgery, for the treatment of the small renal mass [1–3]. A key driver behind this trend is the accumulating evidence that post-operative healthy kidney volume is positively correlated with improved kidney function as measured by the estimated glomerular filtration rate (eGFR) [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

et al. 2019

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PurposeTo determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations.MethodsFive historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.ResultsTwenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages.ConclusionThe use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes.Electronic supplementary materialThe online version of this article (10.1007/s11548-019-01913-5) contains supplementary material, which is available to authorized users.

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Cited by 64 publications

References 26 publications

Does training of fellows affect peri‐operative outcomes of robot‐assisted partial nephrectomy?

Does training of fellows affect peri‐operative outcomes of robot‐assisted partial nephrectomy?

Morbidity of Urologic Surgical Procedures: An Analysis of Rates, Risk Factors, and Outcomes

Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

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