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Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor

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Chinese Medical Journal 2013年第24期126卷 4629-4632页

作者： SHANG Ji-wen MA Xin ZHANG Xu LI Hong-zhao SHI Tao-ping Department of Urology Chinese People's Liberation Army GeneralHospital Beijing 100853 China Department ot Urology Taiyuan City Center Hospital laiyuanShanxi 030009 China

Background partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self-retaining suture （SRS） in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy （LPN） for a single renal mass of moderate or high complexity by assessing peri-operative outcomes. Methods A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass （RENAL score 〉7） in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture （Quill PDO SRS group; n=34） and absorbable vicryl （non-SRS group; n=30）, respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri-operative complications between SRS group and non-SRS group. Results Mean warm ischemia time （WIT） in SRS group was less than non-SRS group （18.0 vs. 24.8 minutes, P=-0.021）. Renorrhaphy suture cost in SRS group was lower than non-SRS group （$269.6 vs. $335.8, P=0,001）. There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri-operative complications. Conclusion SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.

关键词： kidney neoplasm laparoscopic partial nephrectomy self-retaining barbed suture warm ischemia time,peri-operative complications

Surgical Video Review of Warm Ischemia Time during laparoscopic partial nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications

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Open Journal of Urology 2023年第1期13卷 9-17页

作者： Ovidiu Spiru Barnoiu Alf Ole Tysland Aage Waldemar Andersen Department of Urology Sorlandet Hospital Kristiansand Norway Department of Urology Sorlandet Hospital Arendal Norway

Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning.

关键词： Surgical Video laparoscopic partial nephrectomy Warm Ischemia Time

laparoscopic partial nephrectomy with a remotely activated bulldog clamp in a pig model

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Laparoscopic partial nephrectomy with a remotely activated b...

Prediction of Intraoperative Trifecta Achievement during laparoscopic partial nephrectomy

第十二次全国中西医结合男科学术大会暨全国中西医结合男科...

作者：陈伟郭剑民侯君王国民复旦大学附属中山医院泌尿外科

Purpose:Saving warm ischaemia time(WIT) in laparoscopic partial nephrectomy(LPN) is very *** have designed a new device,a remotely activated bulldog clamp,to facilitate *** present study,the effectiveness,convenience and safety of the new design device were compared with that of standard bulldog vascular clamp in a pig *** and methods:Fifteen cases of LPN were bilaterally operated on upper or lower pole of kidneys in five *** the test group,eight cases involved the remotely activated bulldog clamp whereas the remaining seven cases,as the control group,involved the common standard vascular bulldog *** mean operative time,blood lost and mean WIT were compared between the two ***:The mean operative time and blood lost was not significantly different between the groups(Plaparoscopic partial nephrectomy.

关键词： laparoscopic partial nephrectomy warm ischaemia time remotely activate bulldog clamp

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Open Journal of Urology 2021年第1期11卷 6-16页

作者： Ovidiu-Spiru Barnoiu F. J. Baron T. Sæ ter A. O. Tysland A. Andersen Department of Urology Sorlandet Hospital Kristiansand Norway Department of Biostatistics University of Malaga Malaga Spain Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway Department of Urology Sorlandet Hospital Arendal Norway

Purpose: We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) Methods: We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. Results: The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. Conclusion: We have defined an intraoperative Trifecta concept as the achievement of EBL < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.

关键词： Intraoperative Complications laparoscopic partial nephrectomy Prediction Trifecta

Long-term oncologic outcomes of laparoscopic versus open partial nephrectomy

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Chinese Medical Journal 2013年第15期126卷 2938-2942页

作者： ZHENG Jun-hua ZHANG Xiao-long GENG Jiang GUO Chang-cheng ZHANG Xiao-peng CHE Jian-ping YAN Yang PENG Bo WANG Guang-chun XIA sheng-qiang WU Yan Tongji Univ Dept Urol Shanghai Peoples Hosp 10 Shanghai 200072 Peoples R China Nanjing Med Univ Dept Urol Clin Med Coll 1 Nanjing 210002 Jiangsu Peoples R China

Background Most of the literatures on laparoscopic partial nephrectomy （LPN） versus open partial nephrectomy （OPN） focus on technical details and early or mid-term oncologic outcomes, reflecting that the approach is safe and provides mid- term benefits compared with traditional open surgery. However, the difference of long-term oncologic outcome between LPN and OPN remains unclear. The aim of this meta-analysis was to evaluate the long-term oncologic outcome of LPN in the treatment of localized renal tumors compared with that of OPN. Methods A systematic search of electronic databases including Medline, Embase, and Cochrane library was conducted. Comparative studies reporting on long-term oncologic outcome of LPN versus OPN were regarded eligible. The odds ratio （OR） and its corresponding 95% confidence intervals （CO were calculated for the oncologic outcomes. The methodologic quality of the included studies was evaluated using the strict criteria of the Newcastle-Ottawa scale. Results Six comparative studies （1495 participants including 555 LPN and 940 OPN） were included in the present study. There was no significant difference between LPN and OPN in 5-year overall survival （OS） rates （OR=1.83, 95% Cl （0.80, 4.19））, 5-year cancer specific survival （CSS） rates （OR=1.09, 95% CI （0.62, 1.92））, and 5-year recurrence free survival （RFS） rates （OR=0.68, 95% CI （0.37, 1.26））. Conclusion The results of this meta-analysis revealed that there was no significant difference in long-term oncologic outcome between LPN and OPN for treatment of localized renal tumors.

关键词： laparoscopic partial nephrectomy meta-analysis outcome open partial nephrectomy renal tumor

Synchronous sporadic bilateral multiple chromophobe renal cell carcinoma accompanied by a clear cell carcinoma and a cyst: A case report

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World Journal of Clinical Cases 2020年第14期8卷 3064-3073页

作者： Fan Yang Zi-Chen Zhao A-Jin Hu Peng-Fei Sun Bin Zhang Ming-Chuan Yu Juan Wang Department of Radiology Peking University Shougang HospitalBeijing 100144China Department of Urinary Surgery Peking University Shougang HospitalBeijing 100144China Department of Pathology Peking University Shougang HospitalBeijing 100144China Department of Ultrasound Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Renal cell carcinomas are usually ***,they are bilateral in 2%to 4%of sporadic cases and is considerably more common in familial *** sporadic bilateral multiple chromophobe renal cell carcinoma(CHRCC)with different subtypes is *** SUMMARY In this case report,we describe a case of synchronous bilateral CHRCC with two histological variants,accompanied by a clear cell carcinoma and a cyst in a 50-year-old *** patient underwent retroperitoneal laparoscopic bilateral nephron-sparing surgery and there was no serious postoperative renal *** We report a rare case of synchronous bilateral CHRCC with two histological variants associated with a clear cell carcinoma and a cyst.

关键词： Bilateral sporadic renal cell carcinoma Chromophobe renal cell carcinoma Multiple tumors laparoscopic partial nephrectomy Kidney Case report