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Inderbir S. Gill - One of the best experts on this subject based on the ideXlab platform.
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Anatomic Partial Nephrectomy: technique evolution.
Current opinion in urology, 2015Co-Authors: Raed A. Azhar, Charles Metcalfe, Inderbir S. GillAbstract:Purpose of review Partial Nephrectomy provides equivalent long-term oncologic and superior functional outcomes as radical Nephrectomy for T1a renal masses. Herein, we review the various vascular clamping techniques employed during minimally invasive Partial Nephrectomy, describe the evolution of our Partial Nephrectomy technique and provide an update on contemporary thinking about the impact of ischemia on renal function. Recent findings Recently, Partial Nephrectomy surgical technique has shifted away from main artery clamping and towards minimizing/eliminating global renal ischemia during Partial Nephrectomy. Supported by high-fidelity three-dimensional imaging, novel anatomic-based Partial Nephrectomy techniques have recently been developed, wherein Partial Nephrectomy can now be performed with segmental, minimal or zero global ischemia to the renal remnant. Sequential innovations have included early unclamping, segmental clamping, super-selective clamping and now culminating in anatomic zero-ischemia surgery. By eliminating ‘under-the-gun’ time pressure of ischemia for the surgeon, these techniques allow an unhurried, tightly contoured tumour excision with point-specific sutured haemostasis. Recent data indicate that zero-ischemia Partial Nephrectomy may provide better functional outcomes by minimizing/eliminating global ischemia and preserving greater vascularized kidney volume. Summary Contemporary Partial Nephrectomy includes a spectrum of surgical techniques ranging from conventional-clamped to novel zero-ischemia approaches. Technique selection should be tailored to each individual case on the basis of tumour characteristics, surgical feasibility, surgeon experience, patient demographics and baseline renal function.
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Partial Nephrectomy--contemporary indications, techniques and outcomes.
Nature reviews. Urology, 2013Co-Authors: Scott Leslie, Alvin C. Goh, Inderbir S. GillAbstract:Increased detection of the small renal mass over the last two decades has led to greater utilization of Partial Nephrectomy techniques. Appreciation of the negative impact of chronic renal impairment has resulted in Partial Nephrectomy surpassing radical Nephrectomy as the preferred treatment for technically feasible lesions. Indeed the management of localized renal tumours has become focused on techniques that maximally preserve nephron quantity and quality, and therefore maximize renal function after surgery. Postoperative renal function is determined primarily by three factors: preoperative renal function, volume of renal mass preserved and surgical renal ischaemia. Minimization of surgical ischaemia is achieved by early unclamping and unclamped (zero ischaemia) techniques. In addition, laparoscopic and robotic approaches to nephron-sparing surgery have significantly reduced the morbidity of the Partial Nephrectomy procedure compared with the traditional open approach. The contemporary techniques used for Partial Nephrectomy demonstrate excellent renal functional and oncological outcomes and minimize perioperative complications.
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trifecta in Partial Nephrectomy
The Journal of Urology, 2013Co-Authors: Andrew J Hung, Matthew N. Simmons, Jie Cai, Inderbir S. GillAbstract:Purpose: We introduce the concept of trifecta outcomes during robotic/laparoscopic Partial Nephrectomy, in which the 3 key outcomes of negative cancer margin, minimal renal functional decrease and no urological complications are simultaneously realized. We report serial trifecta outcomes in patients treated with robotic/laparoscopic Partial Nephrectomy for tumor in a 12-year period.Materials and Methods: A total of 534 patients had complete data available and were retrospectively divided into 4 chronologic eras, including the discovery era—139 from September 1999 to December 2003, conventional hilar clamping era—213 from January 2004 to December 2006, early unclamping era—104 from January 2007 to November 2008 and anatomical zero ischemia era—78 from March 2010 to October 2011. Renal functional decrease was defined as a greater than 10% reduction in the actual vs volume predicted postoperative estimated glomerular filtration rate.Results: Across the 4 eras tumors trended toward larger size (2.9, 2.8, 3.1 ...
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Functional and Oncologic Outcomes of Bilateral Open Partial Nephrectomy Versus Bilateral Laparoscopic Partial Nephrectomy
Journal of endourology, 2011Co-Authors: Christina B. Ching, Inderbir S. Gill, Matthew N. SimmonsAbstract:Abstract Purpose: This study compared operative data and outcomes in patients undergoing either bilateral open Partial Nephrectomy (BOPN) or bilateral laparoscopic Partial Nephrectomy (BLPN) for synchronous bilateral kidney tumors. Patients and Methods: Patients who had undergone bilateral Partial Nephrectomy at our institution between 1992 and 2008 were reviewed retrospectively; 114 patients underwent either BOPN or BLPN. Ischemia time, tumor size, and renal function outcomes immediately after each surgery, at an intermediate time point (≤12 months), and at a late time point (>12 months) were compared. Oncologic outcomes were also evaluated using Kaplan-Meier analysis. Results: BOPN and BLPN were conducted in 92 and 22 patients, respectively. Average tumor size was larger in the BOPN group (4.1 vs 2.7 cm; P=0.001); however, pathologic stage was equivalent (P=0.52). Hospital stay was longer in the BOPN group (5.6 vs 4.0 d; P
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Difficulties in Laparoscopic Partial Nephrectomy
Difficult conditions in laparoscopic urologic surgery, 2010Co-Authors: Ahmed M. Al-kandari, Ricardo Brandina, Robert J. Stein, Inderbir S. GillAbstract:Renal masses are more frequently diagnosed with the advent of routine abdominal imaging like ultrasound followed by computerized tomography (CT) scan, which has resulted in the need for more intervention. Among the different approaches, Partial Nephrectomy has proved the test of time. This has been duplicated by laparoscopic Partial Nephrectomy. Gill et al. have published the largest comparative study between laparoscopic Partial versus open Partial Nephrectomy, in which they proved that laparoscopic Partial Nephrectomy (LPN) had a very comparable oncological benefit with superior functional outcome and minimal morbidity.1 This highly advanced laparoscopic technique is being utilized in more centers around the world with very similar results to what has been published. In this chapter, the technique of laparoscopic Partial Nephrectomy that the authors utilize will be described and the important steps will be explained. This includes surgeon and patient preparation, intraoperative steps including laparoscopic approach, kidney dissection, intraoperative ultrasound, hilar control, Partial Nephrectomy, renal bed management, and finishing the procedure.2 Difficult case scenarios that require special attention will also be discussed, such as renal impairment, solitary kidney, hilar mass, central mass, multiple renal arteries, renal masses with vascular pathology, and previously operated kidneys. LPN in obese patients, cystic masses, renal masses with ureteropelvic junction pathology, and horseshoe kidney will also be discussed. The authors’ aim in this chapter is to provide practical guidelines and to review common and uncommon difficulties and explain ways to overcome them. This chapter will highlight important technical aspects of LPN that are done in the standard laparoscopic way; hand-assisted or robot-assisted techniques will not be discussed.
Michael D. Stifelman - One of the best experts on this subject based on the ideXlab platform.
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Complications of Robotic Partial Nephrectomy
Complications of Laparoscopic and Robotic Urologic Surgery, 2010Co-Authors: Matthew Sand, Elias S. Hyams, Michael D. StifelmanAbstract:Partial Nephrectomy has emerged as the standard of care for the treatment of small renal tumors. Laparoscopic Partial Nephrectomy (LPN) has been performed for over 15 years and has demonstrated satisfactory oncologic outcomes, decreased patient morbidity, and shorter recovery time compared to open surgery [1–3]. Robotic-assisted laparoscopic Partial Nephrectomy (RALPN) is an emerging technique that shares the minimally invasive advantages of LPN and may provide technical advantages specific to robotic systems (e.g., improved visualization and dexterity during reconstruction) [4, 5]. Furthermore, early literature on RALPN has demonstrated possible advantages in terms of warm ischemia time (WIT) and blood loss compared with laparoscopy [4, 5].
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robot assisted Partial Nephrectomy versus laparoscopic Partial Nephrectomy for renal tumors a multi institutional analysis of perioperative outcomes
The Journal of Urology, 2009Co-Authors: Brian M. Benway, Craig G. Rogers, Sam B. Bhayani, Lori M. Dulabon, Manish N. Patel, Michael E. Lipkin, Agnes J. Wang, Michael D. StifelmanAbstract:Purpose: Robot assisted Partial Nephrectomy is rapidly emerging as an alternative to laparoscopic Partial Nephrectomy for the treatment of renal malignancy. We present the largest multi-institution comparison of the 2 approaches to date, describing outcomes from 3 experienced minimally invasive surgeons.Materials and Methods: We performed a retrospective chart review, evaluating 118 consecutive laparoscopic Partial nephrectomies and 129 consecutive robot assisted Partial nephrectomies performed between 2004 and 2008 by 3 experienced minimally invasive surgeons at 3 academic centers. Perioperative data were recorded along with clinical and pathological outcomes.Results: The robot assisted and laparoscopic Partial Nephrectomy groups were equivalent in terms of age, gender, body mass index, American Society of Anesthesiologists classification (2.3 vs 2.4) and radiographic tumor size (2.9 vs 2.6 cm), respectively. Comparison of operative data revealed no significant differences in terms of overall operative t...
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Robot Assisted Partial Nephrectomy Versus Laparoscopic Partial Nephrectomy for Renal Tumors: A Multi-Institutional Analysis of Perioperative Outcomes
The Journal of urology, 2009Co-Authors: Brian M. Benway, Craig G. Rogers, Sam B. Bhayani, Lori M. Dulabon, Manish N. Patel, Michael E. Lipkin, Agnes J. Wang, Michael D. StifelmanAbstract:Robot assisted Partial Nephrectomy is rapidly emerging as an alternative to laparoscopic Partial Nephrectomy for the treatment of renal malignancy. We present the largest multi-institution comparison of the 2 approaches to date, describing outcomes from 3 experienced minimally invasive surgeons. We performed a retrospective chart review, evaluating 118 consecutive laparoscopic Partial nephrectomies and 129 consecutive robot assisted Partial nephrectomies performed between 2004 and 2008 by 3 experienced minimally invasive surgeons at 3 academic centers. Perioperative data were recorded along with clinical and pathological outcomes. The robot assisted and laparoscopic Partial Nephrectomy groups were equivalent in terms of age, gender, body mass index, American Society of Anesthesiologists classification (2.3 vs 2.4) and radiographic tumor size (2.9 vs 2.6 cm), respectively. Comparison of operative data revealed no significant differences in terms of overall operative time (189 vs 174 minutes), collecting system entry (47% vs 54%), pathological tumor size (2.8 vs 2.5 cm) and positive margin rate (3.9% vs 1%) for robot assisted and laparoscopic Partial Nephrectomy, respectively. Intraoperative blood loss was less for robot assisted vs laparoscopic Partial Nephrectomy (155 vs 196 ml, p = 0.03) as was length of hospital stay (2.4 vs 2.7 days, p <0.0001). Warm ischemia times were significantly shorter in the robot assisted Partial Nephrectomy series (19.7 vs 28.4 minutes, p <0.0001). Subset analysis based on complexity revealed that tumor complexity had no effect on operative time or estimated blood loss for robot assisted Partial Nephrectomy, although complexity did affect these factors for laparoscopic Partial Nephrectomy. In addition, for simple and complex tumors robot assisted Partial Nephrectomy provided significantly shorter warm ischemic time than laparoscopic Partial Nephrectomy (15.3 vs 25.2 minutes for simple, p <0.0001; 25.9 vs 36.7 minutes for complex, p = 0.0002). There were no intraoperative complications during robot assisted Partial Nephrectomy vs 1 complication during laparoscopic Partial Nephrectomy. Postoperative complication rates were similar for robot assisted and laparoscopic Partial Nephrectomy (8.6% vs 10.2%). Robot assisted Partial Nephrectomy is a safe and viable alternative to laparoscopic Partial Nephrectomy, providing equivalent early oncological outcomes and comparable morbidity to a traditional laparoscopic approach. Moreover robot assisted Partial Nephrectomy appears to offer the advantages of decreased hospital stay as well as significantly less intraoperative blood loss and shorter warm ischemia time, the latter of which may help to provide maximal preservation of renal reserve. In addition, operative parameters for robot assisted Partial Nephrectomy appear to be less affected by tumor complexity compared to laparoscopic Partial Nephrectomy. Interestingly while the advantages of robotic surgery have historically been believed to aid laparoscopic naïve surgeons, these data indicate that robot assisted Partial Nephrectomy may also benefit experienced laparoscopic surgeons.
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robot assisted laparoscopic Partial Nephrectomy initial experience
The Journal of Urology, 2006Co-Authors: Robert P. Caruso, Courtney K. Phillips, Eric Kau, Samir S. Taneja, Michael D. StifelmanAbstract:Purpose: Advances in laparoscopy have made laparoscopic Partial Nephrectomy a technically feasible procedure but it remains challenging to even experienced laparoscopists. We hypothesized that robotic assisted laparoscopic Partial Nephrectomy may make this procedure more efficacious than the standard laparoscopic approach.Materials and Methods: Ten patients with a mean age of 58 years and mean tumor size of 2.0 cm underwent robotic assisted laparoscopic Partial Nephrectomy and another 10 with a mean age of 61 years and mean tumor size of 2.18 cm underwent laparoscopic Partial Nephrectomy, as performed by a team of 2 surgeons (MS and ST) between May 2002 and January 2004. Demographic data, intraoperative parameters and postoperative data were compared between the 2 groups.Results: There were no significant differences in patient demographics between the 2 groups. Intraoperative data and postoperative outcomes were statistically similar. In the 10 patients who underwent robotic assisted laparoscopic Partial...
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Robot assisted laparoscopic Partial Nephrectomy: initial experience.
The Journal of urology, 2006Co-Authors: Robert P. Caruso, Courtney K. Phillips, Eric Kau, Samir S. Taneja, Michael D. StifelmanAbstract:Advances in laparoscopy have made laparoscopic Partial Nephrectomy a technically feasible procedure but it remains challenging to even experienced laparoscopists. We hypothesized that robotic assisted laparoscopic Partial Nephrectomy may make this procedure more efficacious than the standard laparoscopic approach. Ten patients with a mean age of 58 years and mean tumor size of 2.0 cm underwent robotic assisted laparoscopic Partial Nephrectomy and another 10 with a mean age of 61 years and mean tumor size of 2.18 cm underwent laparoscopic Partial Nephrectomy, as performed by a team of 2 surgeons (MS and ST) between May 2002 and January 2004. Demographic data, intraoperative parameters and postoperative data were compared between the 2 groups. There were no significant differences in patient demographics between the 2 groups. Intraoperative data and postoperative outcomes were statistically similar. In the 10 patients who underwent robotic assisted laparoscopic Partial Nephrectomy there were 2 intraoperative complications. There was 1 conversion in the laparoscopic Partial Nephrectomy group. Robotic assisted laparoscopic Partial Nephrectomy is a safe and feasible procedure in patients with small exophytic masses. The robotic approach to laparoscopic Partial Nephrectomy does not offer any clinical advantage over conventional laparoscopic Nephrectomy.
Craig G. Rogers - One of the best experts on this subject based on the ideXlab platform.
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Practice patterns and outcomes of open and minimally invasive Partial Nephrectomy since the introduction of robotic Partial Nephrectomy: results from the nationwide inpatient sample
The Journal of urology, 2013Co-Authors: Khurshid R. Ghani, Shyam Sukumar, Craig G. Rogers, Jesse D. Sammon, Quoc-dien Trinh, Mani MenonAbstract:We determined practice patterns and perioperative outcomes of open and minimally invasive Partial Nephrectomy in the United States since the introduction of a robot-assisted modifier in the Nationwide Inpatient Sample. We identified all patients with nonmetastatic disease treated with open, laparoscopic or robotic Partial Nephrectomy in the Nationwide Inpatient Sample between October 2008 and December 2010. Utilization rates were assessed by year, patient and hospital characteristics. We evaluated the perioperative outcomes of open vs robotic and open vs laparoscopic Partial Nephrectomy using binary logistic regression models adjusted for patient and hospital covariates. In a weighted sample of 38,064 Partial nephrectomies 66.9%, 23.9% and 9.2% of the procedures were open, robotic and laparoscopic operations, respectively. In 2010 the relative annual increase in open, robotic and laparoscopic Partial Nephrectomy was 7.9%, 45.4% and 6.1%, respectively. Compared to open Partial Nephrectomy patients treated with minimally invasive Partial Nephrectomy were less likely to receive blood transfusion (robotic vs laparoscopic OR 0.56, p <0.001 vs OR 0.68, p = 0.016), postoperative complication (OR 0.63, p <0.001 vs OR 0.78, p <0.009) or prolonged length of stay (OR 0.27 vs OR 0.41, each p <0.001). Only patients who underwent the robotic procedure were less likely to experience an intraoperative complication (robotic vs laparoscopic OR 0.69, p = 0.014 vs OR 0.67, p = 0.069). Excess hospital charges were higher after robotic surgery (OR 1.35, p <0.001). The dissemination of robotic surgery for Partial Nephrectomy in the United States has been rapid and safe. Compared to open Partial Nephrectomy the robotic procedure had lower odds than laparoscopic Partial Nephrectomy for most study outcomes except hospital charges. Robotic Partial Nephrectomy has now supplanted laparoscopic Partial Nephrectomy as the most common minimally invasive approach for Partial Nephrectomy. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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Robotic Partial Nephrectomy: Basic Principles and Techniques
Robotic Renal Surgery, 2013Co-Authors: Bartosz F. Kaczmarek, Craig G. RogersAbstract:Partial Nephrectomy is a standard treatment for the management of small renal masses, and while laparoscopic Partial Nephrectomy (LPN) has been shown to have excellent outcomes, it is technically challenging and has a prohibitive learning curve for many surgeons. Robotic Partial Nephrectomy (RPN) offers technical advantages over LPN and may allow shorter warm ischemia times, reduced morbidity, and a shortened learning curve. We describe our RPN technique and discuss strategies for prevention and management of complications.
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Robotic Partial Nephrectomy: surgical technique.
BJU international, 2011Co-Authors: Shyam Sukumar, Craig G. RogersAbstract:What's known on the subject? and What does the study add? Robotic Partial Nephrectomy has equivalent oncological outcomes, and possibly better functional outcomes in the short-to-intermediate term, when compared to laparoscopic Partial Nephrectomy. Robotic Partial Nephrectomy has a less prohibitive learning curve, better ergonomics, and improved vision when compared to laparoscopic Partial Nephrectomy. We describe our standard transperitoneal technique for robotic Partial Nephrectomy and also highlight the essential steps in an accompanying video. Novel approaches are discussed, including robotic bulldog clamps for hilar clamping, robotic ultrasound probe for tumour identification, flexible Doppler probe for vessel identification, and barbed suture renorrhaphy. Tips and tricks to avoid common pitfalls and manage complications are discussed. • Kidney sparing approaches have become the ‘gold standard’ for the management of small renal masses and have been shown to be equivalent to radical Nephrectomy for oncological outcomes. • Robotic Partial Nephrectomy (RPN) has emerged as a feasible alternative to other minimally invasive approaches for patients requiring nephron-sparing surgery. • Several reports have highlighted the benefits of RPN, including a less demanding learning curve and shorter warm ischaemia time. • We describe our operative technique for transperitoneal RPN, discuss contemporary outcomes and suggest tips to avoid complications.
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Robotic Partial Nephrectomy: A comparison to current techniques
Urologic oncology, 2010Co-Authors: Manish N. Patel, Mani Menon, Craig G. RogersAbstract:The bar has been set high for nephron sparing surgery by experts in both open and laparoscopic approaches. Robotic Partial Nephrectomy has emerged as an option for minimally invasive nephron sparing surgery. We discuss the current literature for robotic Partial Nephrectomy in the context of reported outcomes for open and laparoscopic Partial Nephrectomy.
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robot assisted Partial Nephrectomy versus laparoscopic Partial Nephrectomy for renal tumors a multi institutional analysis of perioperative outcomes
The Journal of Urology, 2009Co-Authors: Brian M. Benway, Craig G. Rogers, Sam B. Bhayani, Lori M. Dulabon, Manish N. Patel, Michael E. Lipkin, Agnes J. Wang, Michael D. StifelmanAbstract:Purpose: Robot assisted Partial Nephrectomy is rapidly emerging as an alternative to laparoscopic Partial Nephrectomy for the treatment of renal malignancy. We present the largest multi-institution comparison of the 2 approaches to date, describing outcomes from 3 experienced minimally invasive surgeons.Materials and Methods: We performed a retrospective chart review, evaluating 118 consecutive laparoscopic Partial nephrectomies and 129 consecutive robot assisted Partial nephrectomies performed between 2004 and 2008 by 3 experienced minimally invasive surgeons at 3 academic centers. Perioperative data were recorded along with clinical and pathological outcomes.Results: The robot assisted and laparoscopic Partial Nephrectomy groups were equivalent in terms of age, gender, body mass index, American Society of Anesthesiologists classification (2.3 vs 2.4) and radiographic tumor size (2.9 vs 2.6 cm), respectively. Comparison of operative data revealed no significant differences in terms of overall operative t...
Sam B. Bhayani - One of the best experts on this subject based on the ideXlab platform.
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Robotic Partial Nephrectomy: Transperitoneal Technique
Atlas of Robotic Urologic Surgery, 2017Co-Authors: John Shields, Sam B. BhayaniAbstract:Partial Nephrectomy has been the standard of care for small renal masses and is endorsed by the American Urological Association for patients with cT1a and select patients with cT1b lesions. Traditionally, this procedure was done through an open incision. With the advent of improved laparoscopic technology, laparoscopic Partial Nephrectomy remained a difficult and challenging procedure. Over the last decade, however, we have seen an increase in the performance of robotic-assisted laparoscopic Partial Nephrectomy due to the improved ergonomics and range of movement, wristed instrumentation, super three-dimensional, high-definition visualization provided by the da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA), and quick adaptation by open surgeons. While there are many techniques that have been described, we herein discuss our technique for robotic transperitoneal Partial Nephrectomy.
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Is there a financial disincentive to perform Partial Nephrectomy
The Journal of urology, 2012Co-Authors: Youssef S. Tanagho, R. Sherburne Figenshau, Gurdarshan S. Sandhu, Sam B. BhayaniAbstract:Despite the explicit endorsement of the American Urological Association guidelines of Partial Nephrectomy as the treatment of choice for T1a renal cell carcinoma, a considerable underuse of nephron sparing surgery characterizes general practice patterns in the United States. We explored possible financial disincentives associated with Partial Nephrectomy that may contribute to this important quality of care deficit. A PubMed® query on perioperative outcomes identified 10 series on open or laparoscopic radical Nephrectomy and 16 on open, laparoscopic or robot-assisted Partial Nephrectomy. Mean operative time and hospital length of stay were calculated for each group. Using these data in conjunction with Health Care Financing Administration data on physician work time, which guides the current Resource-Based Relative Value Scale Medicare fee schedule, we calculated global physician time expenditure and hourly Medicare reimbursement rates for each of these 5 surgical services. Mean±SD operative time for open and laparoscopic radical Nephrectomy, and open, laparoscopic and robot-assisted Partial Nephrectomy was 180.7±24.7 minutes (95% CI 119.3-242.0) in 3 studies, 178.8±16.5 (95% CI 163.5-194.1) in 7, 226.0±36.9 (95% CI 187.2-264.8) in 6, 227.9±40.2 (95% CI 185.8-270.1) in 6 and 227.9±37.8 (95% CI 167.7-288.1) in 4, respectively (p=0.028). Mean length of stay (days) after open and laparoscopic radical Nephrectomy, and open, laparoscopic and robot-assisted Partial Nephrectomy was 5.8±0.7 days (95% CI 4.0-7.7) in 3 studies, 2.5±1.1 (95% CI 1.4-3.6) in 6, 5.8±0.4 (95% CI 5.3-6.2) in 5, 2.9±0.3 (95% CI 2.6-3.3) in 6 and 2.8±1.0 (95% CI 1.2-4.4) in 4, respectively (p<0.001). The hourly reimbursement rate was calculated at $200.61, $242.03, $185.66, $231.27 and $231.97 for open and laparoscopic radical Nephrectomy, and open, laparoscopic and robot-assisted Partial Nephrectomy, respectively. Hence, open Partial Nephrectomy emerged as the lowest paying of these procedures. Inferior compensation for open Partial Nephrectomy relative to that of laparoscopic or open radical Nephrectomy may impede the dissemination of nephron sparing surgery for small renal masses. This may occur particularly in a general practice setting, where the expertise required for laparoscopic or robot-assisted Partial Nephrectomy may be lacking. We propose rectifying this inequity to facilitate wider use of nephron sparing surgery in the clinically appropriate setting. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
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robot assisted Partial Nephrectomy versus laparoscopic Partial Nephrectomy for renal tumors a multi institutional analysis of perioperative outcomes
The Journal of Urology, 2009Co-Authors: Brian M. Benway, Craig G. Rogers, Sam B. Bhayani, Lori M. Dulabon, Manish N. Patel, Michael E. Lipkin, Agnes J. Wang, Michael D. StifelmanAbstract:Purpose: Robot assisted Partial Nephrectomy is rapidly emerging as an alternative to laparoscopic Partial Nephrectomy for the treatment of renal malignancy. We present the largest multi-institution comparison of the 2 approaches to date, describing outcomes from 3 experienced minimally invasive surgeons.Materials and Methods: We performed a retrospective chart review, evaluating 118 consecutive laparoscopic Partial nephrectomies and 129 consecutive robot assisted Partial nephrectomies performed between 2004 and 2008 by 3 experienced minimally invasive surgeons at 3 academic centers. Perioperative data were recorded along with clinical and pathological outcomes.Results: The robot assisted and laparoscopic Partial Nephrectomy groups were equivalent in terms of age, gender, body mass index, American Society of Anesthesiologists classification (2.3 vs 2.4) and radiographic tumor size (2.9 vs 2.6 cm), respectively. Comparison of operative data revealed no significant differences in terms of overall operative t...
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Robot Assisted Partial Nephrectomy Versus Laparoscopic Partial Nephrectomy for Renal Tumors: A Multi-Institutional Analysis of Perioperative Outcomes
The Journal of urology, 2009Co-Authors: Brian M. Benway, Craig G. Rogers, Sam B. Bhayani, Lori M. Dulabon, Manish N. Patel, Michael E. Lipkin, Agnes J. Wang, Michael D. StifelmanAbstract:Robot assisted Partial Nephrectomy is rapidly emerging as an alternative to laparoscopic Partial Nephrectomy for the treatment of renal malignancy. We present the largest multi-institution comparison of the 2 approaches to date, describing outcomes from 3 experienced minimally invasive surgeons. We performed a retrospective chart review, evaluating 118 consecutive laparoscopic Partial nephrectomies and 129 consecutive robot assisted Partial nephrectomies performed between 2004 and 2008 by 3 experienced minimally invasive surgeons at 3 academic centers. Perioperative data were recorded along with clinical and pathological outcomes. The robot assisted and laparoscopic Partial Nephrectomy groups were equivalent in terms of age, gender, body mass index, American Society of Anesthesiologists classification (2.3 vs 2.4) and radiographic tumor size (2.9 vs 2.6 cm), respectively. Comparison of operative data revealed no significant differences in terms of overall operative time (189 vs 174 minutes), collecting system entry (47% vs 54%), pathological tumor size (2.8 vs 2.5 cm) and positive margin rate (3.9% vs 1%) for robot assisted and laparoscopic Partial Nephrectomy, respectively. Intraoperative blood loss was less for robot assisted vs laparoscopic Partial Nephrectomy (155 vs 196 ml, p = 0.03) as was length of hospital stay (2.4 vs 2.7 days, p <0.0001). Warm ischemia times were significantly shorter in the robot assisted Partial Nephrectomy series (19.7 vs 28.4 minutes, p <0.0001). Subset analysis based on complexity revealed that tumor complexity had no effect on operative time or estimated blood loss for robot assisted Partial Nephrectomy, although complexity did affect these factors for laparoscopic Partial Nephrectomy. In addition, for simple and complex tumors robot assisted Partial Nephrectomy provided significantly shorter warm ischemic time than laparoscopic Partial Nephrectomy (15.3 vs 25.2 minutes for simple, p <0.0001; 25.9 vs 36.7 minutes for complex, p = 0.0002). There were no intraoperative complications during robot assisted Partial Nephrectomy vs 1 complication during laparoscopic Partial Nephrectomy. Postoperative complication rates were similar for robot assisted and laparoscopic Partial Nephrectomy (8.6% vs 10.2%). Robot assisted Partial Nephrectomy is a safe and viable alternative to laparoscopic Partial Nephrectomy, providing equivalent early oncological outcomes and comparable morbidity to a traditional laparoscopic approach. Moreover robot assisted Partial Nephrectomy appears to offer the advantages of decreased hospital stay as well as significantly less intraoperative blood loss and shorter warm ischemia time, the latter of which may help to provide maximal preservation of renal reserve. In addition, operative parameters for robot assisted Partial Nephrectomy appear to be less affected by tumor complexity compared to laparoscopic Partial Nephrectomy. Interestingly while the advantages of robotic surgery have historically been believed to aid laparoscopic naïve surgeons, these data indicate that robot assisted Partial Nephrectomy may also benefit experienced laparoscopic surgeons.
Antonio Finelli - One of the best experts on this subject based on the ideXlab platform.
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unintended consequences of laparoscopic surgery on Partial Nephrectomy for kidney cancer
The Journal of Urology, 2010Co-Authors: Robert Abouassaly, Shabbir M.h. Alibhai, George Tomlinson, Narhari Timilshina, Antonio FinelliAbstract:Purpose: Recent evidence suggests that Partial Nephrectomy may be associated with improved survival compared to radical Nephrectomy for renal cell carcinoma but Partial Nephrectomy may be underused. We examined whether the introduction of laparoscopic radical Nephrectomy contributed to low Partial Nephrectomy use with time.Materials and Methods: We identified all patients treated surgically for renal cell carcinoma in Ontario, Canada between 1995 and 2004 using the Ontario Cancer Registry, a population based tumor registry. A multinomial logistic regression model was used to relate the relative numbers of patients with open and laparoscopic radical Nephrectomy, and Partial Nephrectomy to patient age, gender and surgery year. The Partial Nephrectomy time trend was investigated by fitting a segmented regression model.Results: Of 7,830 surgically treated patients 7,042 (89.9%) vs 788 (10.1%) underwent radical vs Partial Nephrectomy. Segmented regression showed a clear change in Partial Nephrectomy use with t...
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Unintended Consequences of Laparoscopic Surgery on Partial Nephrectomy for Kidney Cancer
The Journal of urology, 2009Co-Authors: Robert Abouassaly, Shabbir M.h. Alibhai, George Tomlinson, Narhari Timilshina, Antonio FinelliAbstract:Recent evidence suggests that Partial Nephrectomy may be associated with improved survival compared to radical Nephrectomy for renal cell carcinoma but Partial Nephrectomy may be underused. We examined whether the introduction of laparoscopic radical Nephrectomy contributed to low Partial Nephrectomy use with time. We identified all patients treated surgically for renal cell carcinoma in Ontario, Canada between 1995 and 2004 using the Ontario Cancer Registry, a population based tumor registry. A multinomial logistic regression model was used to relate the relative numbers of patients with open and laparoscopic radical Nephrectomy, and Partial Nephrectomy to patient age, gender and surgery year. The Partial Nephrectomy time trend was investigated by fitting a segmented regression model. Of 7,830 surgically treated patients 7,042 (89.9%) vs 788 (10.1%) underwent radical vs Partial Nephrectomy. Segmented regression showed a clear change in Partial Nephrectomy use with time (p = 0.001), such that the odds of Partial Nephrectomy increased by 18% per year before January 2003 (OR 1.18, 95% CI 1.14-1.23) and subsequently decreased by 12% per year (OR 0.88, 95% CI 0.75-1.02). In the multinomial regression model age and surgery year but not gender were independently associated with Partial Nephrectomy. Partial Nephrectomy use for renal cell carcinoma remains low, particularly in elderly patients. The introduction of laparoscopic radical Nephrectomy coincided with decreased uptake and use of Partial Nephrectomy for renal cell carcinoma. Although it was hypothesized previously, to our knowledge this is the first study to suggest that the introduction of laparoscopy in renal surgery has negatively impacted Partial Nephrectomy use. Copyright 2010 American Urological Association. Published by Elsevier Inc. All rights reserved.
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Laparoscopic Partial Nephrectomy for cancer: techniques and outcomes
International braz j urol : official journal of the Brazilian Society of Urology, 2005Co-Authors: Mauricio Rubinstein, Antonio Finelli, Jose R. Colombo, Inderbir S. GillAbstract:Open Partial Nephrectomy is the gold standard nephron-sparing treatment for small renal tumors. Technical aspects of laparoscopic Partial Nephrectomy have evolved considerably, and the technique is approaching established status at our institution. Over the past 4 years, the senior author has performed more than 400 laparoscopic Partial nephrectomies at the Cleveland Clinic. Herein we present our current technique and review contemporary outcome data.
