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A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

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Asian Journal of Urology 2023年第4期10卷 390-406页

作者： Savio Domenico Pandolfo Clara Cerrato Zhenjie Wu Antonio Franco francesco Del Giudice Alessandro Sciarra Paolo Verze Giuseppe Lucarelli Ciro Imbimbo Sisto Perdonà Edward E.Cherullo francesco porpiglia Ithaar H.Derweesh Riccardo Autorino Department of Urology Rush University Medical CenterChicagoILUSA Department of Neurosciences Reproductive Sciences and Odontostomatology“Federico II”UniversityNaplesItaly Department of Urology University of VeronaVeronaItaly Department of Urology Changhai HospitalNaval Medical UniversityShanghaiChina European Association of Urology(EAU)Young Academic Urologists(YAU)Renal Cancer Working Group Arnhemthe Netherlands Department of Urology Sant’Andrea HospitalLa Sapienza UniversityRomeItaly Department of Maternal-Infant and Urologic Sciences La Sapienza UniversityPoliclinico Umberto I HospitalRomeItaly Department of Medicine and Surgery Scuola Medica SalernitanaUniversity of SalernoFiscianoItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Department Uro-Gynecology IRCCS G.Pascale FoundationNaplesItaly Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly Department of Urology University of California San DiegoLa JollaCAUSA

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal *** aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple ***:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language *** primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses *** secondary endpoint was to evaluate the surgical and functional ***:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 *** and thirteen studies reported data for endophytic and hilar renal masses,*** and three studies reported outcomes for cT2-T3 and solitary kidney patients,*** studies focused on redo-RAPN for recurrent *** studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral ***:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously *** limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological ***,a higher likelihood of complication might be expected when facing extremely challenging ***,none of these indications should be considered per se an exclusion criterion for performing ***,a risk-adapted approach s

关键词： Robot-assisted partial nephrectomy Complex renal mass Solitary kidney Larger tumors(cT2-T3) Endophytic and hilar mass Recurrent tumor Simultaneous and multiple tumor

Three-dimensional imaging reconstruction of the kidney’s anatomy for a tailored minimally invasive partial nephrectomy:A pilot study

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Asian Journal of Urology 2022年第3期9卷 263-271页

作者： Daniele Amparore Angela Pecoraro Federico Piramide Paolo Verri Enrico Checcucci Sabrina De Cillis Alberto Piana Mariano Burgio Michele Di Dio Matteo Manfredi Cristian Fiori francesco porpiglia Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoTurinItaly European Association of Urology(EAU)Young Academic Urologists(YAU)Renal Cancer Working Group ArnhemNetherlands European Association of Urology(EAU)Young Academic Urologists(YAU)Uro-technology and SoMe Working Group ArnhemNetherlands Division of Urology Department of SurgerySS Annunziata HospitalCosenzaItaly

Objective:The aim of the study was to evaluate three-dimensional virtual models(3DVMs)usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal ***:At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score≥10 treated with minimally-invasive partial nephrectomy were considered for the present *** inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs,the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were *** patients,in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance,were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments,but without *** logistic regression models were used to predict the margin,ischemia,and complication score ***:Overall,79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM *** 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate(-17.7%vs.-22.2%,p=0.03),postoperative complications(16.5%vs.23.1%,p=0.03),and major complications(Clavien Dindo>III,2.5%vs.5.6%,p=0.03).At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy(odds ratio:1.42,p=0.03).Conclusion:3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex *** can be used in different ways,matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase,leading towards maximum safety and efficacy outcomes.

关键词： Three-dimensional Kidney cancer Renal cell carcinoma Robotic Laparoscopic Nephron-sparing surgery Complex renal mass

A snapshot into the future of image-guided surgery for renal cancer

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Asian Journal of Urology 2022年第3期9卷 201-203页

作者： Enrico Checcucci Gabriele Volpi Department of Surgery Candiolo Cancer InstituteFPOIRCCSCandioloTurinItaly Department of OncologyDivision of UrologyUniversity of TurinTurinItaly Uro-technology and SoMe Working Group of the Young Academic Urologists(YAU)Working Party of the European Association of Urology(EAU) Arnhemthe Netherlands Daniele Amparore Department of Oncology Division of UrologyUniversity of TurinTurinItaly Renal Cancer Working Group of the Young Academic Urologists(YAU)Working Party of the European Association of Urology(EAU) Arnhemthe Netherlands francesco porpiglia Department of Oncology Division of UrologyUniversity of TurinTurinItaly

Robot-assisted partial nephrectomy(RAPN)is certainly one of the most fascinating and complex urological *** is ascribable to its vast heterogeneity from one case to another,related to patient’s anatomical variability and tumour’s *** the last years,with the aim to assist the surgeons in handling ever more difficult lesions(totally endophytic or large volume[1,2])suitable for RAPN,several technologies were proposed and tested,from preoperative planning to intraoperative assistance or navigation[3].

关键词： image surgery totally

Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy:A feasibility and accuracy study

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Asian Journal of Urology 2023年第4期10卷 407-415页

作者： Enrico Checcucci Alberto Piana Gabriele Volpi Pietro Piazzolla Daniele Amparore Sabrina De Cillis Federico Piramide Cecilia Gatti Ilaria Stura Enrico Bollito Federica Massa Michele Di Dio Cristian Fiori francesco porpiglia Department of Surgery Candiolo Cancer InstituteFPO-IRCCSCandioloTurinItaly Department of Oncology Division of UrologyUniversity of TurinSan Luigi Gonzaga HospitalOrbassanoToItaly Department of Mechanical Engineering Politecnico di MilanoMilanItaly Department of Public Health and Pediatric Sciences School of MedicineUniversity of TurinItaly Department of Pathology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly SS Annunziata Hospital Department of SurgeryDivision of UrologyCosenzaItaly

Objective:To evaluate the accuracy of our new three-dimensional(3D)automatic augmented reality(AAR)system guided by artificial intelligence in the identification of tumour’s location at the level of the preserved neurovascular bundle(NVB)at the end of the extirpative phase of nerve-sparing robot-assisted radical ***:In this prospective study,we enrolled patients with prostate cancer(clinical stages cT1ce3,cN0,and cM0)with a positive index lesion at target biopsy,suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance *** underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital(Orbassano,Turin,Italy),from December 2020 to December *** the end of extirpative phase,thanks to our new AAR artificial intelligence driven system,the virtual prostate 3D model allowed to identify the tumour’s location at the level of the preserved NVB and to perform a selective excisional biopsy,sparing the remaining portion of the *** and postoperative data were evaluated,especially focusing on the positive surgical margin(PSM)rates,potency,continence recovery,and biochemical ***:Thirty-four patients were *** 15(44.1%)cases,the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging(Wheeler grade L2)while in 19(55.9%)cases extracapsular extension was detected(Wheeler grade L3).3D AAR guided biopsies were negative in all pathological tumour stage 2(pT2)patients while they revealed the presence of cancer in 14 cases in the pT3 cohort(14/16;87.5%).PSM rates were 0%and 7.1%in the pathological stages pT2 and pT3(<3 mm,Gleason score 3),***:With the proposed 3D AAR system,it is possible to correctly identify the lesion’s location on the NVB in 87.5%of pT3 patients and perform a 3D-guided tailored nerve-sparing even in locally advanced diseases,without compromising the oncological safety

关键词： Prostate cancer Augmented reality Artificial intelligence Robotics Radical prostatectomy

经腹机器人辅助腹腔镜肾部分切除术治疗T2期肾肿瘤的国际多中心临床研究

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中华泌尿外科杂志 2018年第6期39卷 407-412页

作者：过菲张超王富博王林辉杨庆叶华茂吕晨肖成武汪洋 Giuseppe Simone Ithaar Derweesh Andrea Minervini Daniel Eun francesco porpiglia Sisto Perdona James Porter Matteo Ferro Alexandre Mottrie Robert Uzzo Luigi Schips Wesley White Ken Jacobsohn Prokar Dasgupta Riccardo Autorino Clayton Lau Chandru Sundaram Umberto Capitanio 孙颖浩杨波上海长海医院泌尿外科 200433 上海长征医院泌尿外科意大利里贾纳埃琳娜国家癌症研究所泌尿中心美国加州大学圣地亚哥分校泌尿中心意大利佛罗伦萨大学CARGGI医院泌尿外科美国天普大学路易斯卡茨医学院泌尿外科意大利都灵大学圣路易吉冈萨加医院意大利PASCALE基金会和癌症研究和护理研究所泌尿中心美国西雅图瑞典泌尿组意大利米兰IEO泌尿外科比利时OLV医院泌尿中心美国福克斯蔡斯癌症中心泌尿外科意大利安南齐塔医院泌尿外科美国田纳西大学医学中心泌尿外科美国威斯康星医学院泌尿外科英国盖伊医院泌尿外科美国弗吉尼亚联邦大学泌尿外科美国希望之城医学中心泌尿外科印第安纳大学泌尿外科意大利米兰圣拉斐尔奥克斯代尔IRCCS中心泌尿外科

目的通过国际多中心研究探讨临床T2期肾肿瘤行经腹机器人辅助腹腔镜肾部分切除术的安全性及有效性。方法回顾性分析2012年1月至2017年12月国际19家泌尿中心378例临床T2期肾肿瘤行经腹机器人肾部分切除术和经腹机器人根治性肾切除术患者... 详细信息

目的通过国际多中心研究探讨临床T2期肾肿瘤行经腹机器人辅助腹腔镜肾部分切除术的安全性及有效性。方法回顾性分析2012年1月至2017年12月国际19家泌尿中心378例临床T2期肾肿瘤行经腹机器人肾部分切除术和经腹机器人根治性肾切除术患者的临床资料。根据手术方式不同，分为部分切除组和根治组。部分切除组159例，男118例，女41例；年龄（59.3±13.2）岁，体重指数（28.7±5.4） kg/m^2，术前GFR （77.3±22.1）ml/min；肿瘤位于左侧72例，右侧87例；肿瘤直径（83±16）mm；R.E.N.A.L.评分（8.6±2.2）分。根治组219例，男156例，女63例；年龄（62.0±12.9）岁，体重指数（28.7±6.1） kg/m^2，术前GFR （71.4±20.3）ml/min；肿瘤位于左侧112例，右侧105例，双侧2例；肿瘤直径（92±25）mm；R.E.N.A.L.评分（9.7±1.5）分。两组患者性别、体重指数、肿瘤位置的差异均无统计学意义（P〉0.05）。部分切除组患者年龄、肿瘤直径、R.E.N.A.L.评分均低于根治组（P〈0.05），术前GFR优于根治组（P=0.012）。比较两组围手术期资料、肿瘤病理类型、随访时间、复发时间及术后GFR等。结果378例手术均顺利完成。部分切除组手术时间中位值150 min（65-353 min），短于根治组[180 min（85-361 min），P〈0.001]，术中出血量中位值150 ml（40-3 000 ml），多于根治组[100 ml （10-1 100 ml），P〈0.001]。术中并发症发生率部分切除组为5.7%（9/159），根治组为3.2%（7/219），两组差异无统计学意义（P=0.240）。部分切除组术后并发症发生率高于根治组[19.5%（31/159）与10.5%（23/219），P=0.014]，但≥3级并发症发生率的差异无统计学意义[4.4%（7/159）与2.3%（5/219），P=0.246]。部分切除组无复发生存率高于根治组[91.4%（117/128）与81.9%（167/204），P=0.013]。部分切除组术后GFR降低值16.9 ml/min（10.4-84.7 ml/min）明显少于根治组29.0 ml/min（14.0-54.0 ml/min），肾部分切除术更利于术后肾功能的保护（P〈0.001）。结论临床T2期肾肿瘤行机器人肾部分切除术可获得有效的肿瘤控制率，同时可以更好地保护肾功能，可作为临床T2期肾肿瘤有效的手术方式。

关键词：肾肿瘤局部进展期肾部分切除术肾功能根治性肾切除术