TABLE 3 - available via license: Creative Commons Attribution-NonCommercial 3.0 Unported
Content may be subject to copyright.
Source publication
To compare the perioperative outcomes of laparoscopic partial nephrectomy (LPN) and robotic partial nephrectomy (RPN) for moderately or highly complex tumors (RENAL nephrometry score≥7).
A retrospective analysis was performed for 127 consecutive patients who underwent either LPN (n=38) or RPN (n=89) between 2007 and 2013. Perioperative outcomes wer...
Context in source publication
Similar publications
Background
The nephrometry scoring system plays a key role in the preoperative evaluation of partial nephrectomy, and scoring systems based on anatomical characteristics have high similarity in scoring elements. Currently, there is little research on scoring systems related to retroperitoneal laparoscopic partial nephrectomy, and there is a lack of...
Introduction:
There is a lack of validated quality metrics to evaluate the care of patients receiving surgery for renal cell carcinoma (RCC). To address this, the Kidney Cancer Research Network of Canada defined a list of quality indicators (QI) to assess hospital-level performance. We have case-mix adjusted these QIs to benchmark RCC surgical car...
Purpose:
To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses.
Materials and methods:
Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variab...
Objective
To evaluate the feasibility and efficacy of intraoperative ultrasonography in laparoscopic partial nephrectomy (LPN) for intrarenal tumors.
Patients and methods
All patients who underwent LPN for renal tumors in our institution from January 2010 to October 2016 were assessed retrospectively. Patients were divided into two groups, the fir...
Citations
... However, certain technical difficulties, such as intracorporeal suturing skills and an elevated warm ischemia time, are associated with LPN (5). Conversely, RPN provides superior manual dexterity, enhanced visualization, tremor elimination, and an ergonomic environment to augment surgeon comfort, thereby widening the applicability of minimally invasive surgery to encompass more intricate and arduous renal tumors (6). ...
... The process of selecting studies is demonstrated by the PRISMA flowchart ( Figure 1). After excluding duplicates and screening the abstracts and full texts, eight studies (5)(6)(7)(16)(17)(18)(19)(20) published between 2012 and 2022 were included for qualitative and quantitative analysis. The sample size comprised 1346 patients, of which 695 and 651 were treated with RPN and LPN, respectively. ...
... The sample size comprised 1346 patients, of which 695 and 651 were treated with RPN and LPN, respectively. Three studies (7,16,20) were prospective nonrandomized studies, whereas the rest were observational retrospective case-control studies (5,6,(17)(18)(19). Propensity matching analyzes were performed in four studies (6,(18)(19)(20). ...
Objective
To evaluate the current literature comparing outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) treating complex renal tumors (RENAL nephrometry score ≥7).
Methods
We systematically searched the Cochrane Library, PubMed, Google Scholar, EMBASE, and Scopus databases up to March 2023. Review Manager 5.4 performed a pooled analysis of the data for random effects. Besides, sensitivity and subgroup analyses to explore heterogeneity, Newcastle-Ottawa scale, and GRADE to evaluate study quality and level of evidence.
Results
Eight observational studies comprising 1346 patients (RPN: 695; LPN: 651) were included in this study. Compared to LPN, RPN had a shorter operative time (OT) (weight mean difference [WMD]: -14.73 min; p = 0.0003), shorter warm ischemia time (WIT) (WMD: -3.47 min; p = 0.002), lower transfusion rate (odds ratio [OR]: 0.66; p = 0.04), shorter length of stay (LOS) (WMD: -0.65 days; p < 0.00001), lower postoperative estimated glomerular filtration rate (eGFR) change (WMD = -2.33 mL/min/1.73 m2; p = 0.002) and lower intraoperative complications (OR: 0.52; p = 0.04). No significant differences were observed between the two groups in terms of estimated blood loss (EBL) (p = 0.84), conversion to radical nephrectomy (p = 0.12), postoperative complications (p = 0.11), major complications (defined Clavien–Dindo grade 3 (p = 0.43), overall complications (p = 0.15), postoperative eGFR (p = 0.28), local recurrence (p = 0.35), positive surgical margin (PSM) (p = 0.63), overall survival (OS) (p = 0.47), cancer-specific survival (CSS) (p = 0.22) and 3-year recurrence-free survival (RFS) (p = 0.53).
Conclusion
Patients with complex renal tumors (RENAL score ≥7), RPN is superior to LPN in decreasing the OT, WIT, LOS, transfusion rate, change in eGFR and the incidence of intraoperative complications while maintaining oncological control and avoiding a decline in renal function. However, our findings need further validation in a large-sample prospective randomized study.
... По мнению ряда авторов, имеется прямая зависимость частоты развития интра-и послеоперационных осложнений от размера и сложности опухоли [19]. На сегодняшний день робот-ассистированный доступ является приоритетным для опухолей высокой степени сложности, поскольку демонстрирует лучшие результаты (в том числе в уменьшении числа осложнений) по сравнению с лапароскопическим и традиционным открытым доступами [20,21]. Частота послеоперационных осложнений после робот-ассистированной резекции почки при крупных опухолях (стадии Т1b-Т2) составляет 4-23 % [22,23]. ...
Objective : to analyze complications after laparoscopic and robotic-assisted partial nephrectomy.
Materials and methods . In our study was included 246 cases. Intra- and postoperative complications were studied after nephron-sparring surgery. The laparoscopic approach was used in 68 (27.3 %) cases, the robot-assisted - in 178 (71.5 %) cases. Intraoperative complications were assessed according to the Rosenthal classification, postoperative complications - according to the Clavien-Dindo classification.
Results . The overall incidence of intraoperative complications was 12.6 %. The most frequent intraoperative complication was bleeding that did not require blood transfusion (grade I) - 5.69 % (laparoscopic approach - in 3 (4.41 %) cases, robot-assisted approach - in 11 (6,18 %) cases). Bleeding requiring blood transfusion and injuries of internal organs, which were restored intraoperatively (grade II), were recorded in laparoscopic and robot-assisted approaches in 4.41 % and 2.25 % of cases, respectively. Complications leading to the loss of organ (nephrectomy, splenectomy) were observed in 2.94 % and 4.49 % of cases, respectively. Intraoperative deaths (grade IV) were not registered.
The incidence of postoperative complications was 18.29 %. Minor complications (Clavien-Dindo ≤II) were detected in 16 (6.5 %) patients (laparoscopic approach - 7.35 %, robot-assisted approach - 6.18 %). Serious complications (Clavien-Dindo ≥III) were detected in 29 (11.79 %) cases (with laparoscopic approach - 14.71 %, robot-assisted - 10.67 %). In the group of tumors with the RENAL index 4-6, the incidence of postoperative complications was 14.7 % with the laparoscopic approach, and 7.1 % with the robot-assisted approach; in the RENAL 7-9 group - 21.9 % and 13.0 %, respectively. In the group of tumors of high complexity (RENAL 10-12), only the robot-assisted approach was used, the incidence of postoperative complications was 22.0 %.
Conclusion . Partial nephrectomy for kidney tumors is an effective and safe surgical technique. The incidence of complications when using the laparoscopic approach is higher than when using the robot-assisted technique in groups of tumors of simple and medium complexity. For tumors of high complexity, robot-assisted approach is a priority. The largest number of serious complications is observed with partial nephrectomy with complex tumors.
... Seven studies were involved in our study [1,7,[14][15][16][17][18]. The literature searching process is summarized in Fig. 1. ...
Background To compare the perioperative outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score≥7.
Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score≥7. We used RevMan 5.2 to pool the data.
Results Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; p=0.54), hospital stay (WMD: -0.59; 95% CI: -1.24–0.06; p=0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65–1.11; p =0.23), major postoperative complications(OR: 0.90; 95% CI: 0.52–1.54; p=0.69) and transfusion (OR: 0.72; 95% CI: 0.48–1.08; p =0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; p=0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73–5.91; p=0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30–-6.62; p <0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p=0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28–0.97; p=0.04).
Conclusions RPN is a safe and effective alternative to LPNs for or the treatment of complex renal tumors with a RENAL nephrometry score≥7 with a shorter warm ischemic time and better postoperative renal function.
... Seven studies were involved in our study [1,7,[14][15][16][17][18]. The literature searching process is summarized in Fig. 1. ...
Background To compare the perioperative outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) for complex renal tumors with a RENAL nephrometry score≥7.
Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes of RPN and LPN in patients with a RENAL nephrometry score≥7. We used RevMan 5.2 to pool the data.
Results Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: 34.49; 95% CI: -75.16-144.14; p=0.54), hospital stay (WMD: -0.59; 95% CI: -1.24–0.06; p=0.07), positive surgical margin (OR: 0.85; 95% CI: 0.65–1.11; p =0.23), major postoperative complications(OR: 0.90; 95% CI: 0.52–1.54; p=0.69) and transfusion (OR: 0.72; 95% CI: 0.48–1.08; p =0.11) between the groups. RPN showed better outcomes in the operating time (WMD: -22.45; 95% CI: -35.06 to -9.85; p=0.0005), postoperative renal function (WMD: 3.32; 95% CI: 0.73–5.91; p=0.01), warm ischemia time (WMD: -6.96; 95% CI: -7.30–-6.62; p <0.0001), conversion rate to radical nephrectomy (OR: 0.34; 95% CI: 0.17 to 0.66; p=0.002) and intraoperative complications (OR: 0.52; 95% CI: 0.28–0.97; p=0.04).
Conclusions RPN showed better perioperative clinical outcomes than LPN for the treatment of complex renal tumors with a RENAL nephrometry score≥7.
... Seven studies were involved in our study [1,7,[11][12][13][14][15]. The literature searching process is summarized in Fig. 1 ...
Background
To compare the perioperative outcomes of Robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN).
Methods
We searched PubMed, EMBASE and the Cochrane Central Register for studies from 2000 to 2020 to evaluate the perioperative outcomes RPN and LPN in patients with a RENALnephrometry score≥7. We used RevMan 5.2 to pool the data.
Results
Seven studies were acquired in our study. No significant differences were found in the estimated blood loss (WMD: WMD: 34.49, 95% CI -75.16-144.14, p=0.54), hospital stay (WMD: -0.59 95% CI -1.24–0.06, p=0.07), operating time (WMD: -22.45, 95%CI: -35.06 to-9.85, ), postive surgical margin (OR: 0.85, 95% CI 0.65–1.11, p =0.23) and transfusion (OR: 0.72, 95% CI 0.48–1.08, p =0.11).between the two groups. RPN get better outcomes in postoperative renal function (WMD: 3.32, 95% CI 0.73–5.91, p=0.01), warm ischenia time (WMD: -6.96, 95% CI -7.30–-6.62, p <0.0001), conversion( OR: 0.34, 95%CI: 0.17 to 0.66, p=0.002) and intraoperative complication (OR: 0.52, 95% CI 0.28–0.97, p=0.04).
Conclusion
RPN could get better perioerative clinical outcomes than LPN for treatment of Complex Renal Tumors( with a RENALnephrometry score≥7).
... The lowest ratio of overall complications after RPN for complex renal tumors was 20.2%. 9,10,12,30,31 The results about overall complications in the presented analysis were similar to these in reported studies. A reduction of postoperative complications including the low and high grade ones, as an advantage of RPN over LPN, 27,33 seems disappeared when surgically managing complex renal tumors. ...
... Oncological control is of original significance when choosing the approach to surgically treat renal tumors. 11 The median follow-up lengths of both groups in our study were longer than those reported in previous analyses 11, [30][31][32] for complex renal tumors. The inadequate follow-up time had also precluded Gu et al 39 from drawing any conclusions in oncological outcomes of patients with >4 cm renal tumors after LPN and RPN. ...
Objectives:
To present the perioperative, functional, and oncological outcomes of robot-assisted partial nephrectomy (RPN) compared with laparoscopic partial nephrectomy (LPN) for anatomically complex T1b renal tumors with RENAL nephrometry scores ≥7.
Patients and methods:
One hundred and seventy patients, during the study period, were retrospectively reviewed in our analysis according to inclusion criteria. Propensity score matching (PSM) (1:1) method was applied to impose restrictions on the potential baseline confounders. The comparisons of perioperative and functional outcomes between the RPN and LPN groups were conducted and analyzed after PSM, Kaplan-Meier analyses were performed to assess the differences about oncological outcomes between the two groups before and after PSM.
Results:
One hundred and nine and 61 T1b renal tumors with RENAL scores ≥7 were identified in the LPN and RPN groups, respectively. All significant differences in baseline characteristics disappeared after PSM. Except for 3 patients missing an appropriate pair, all the patients in the RPN group were successfully matched to 58 patients in the LPN group in a 1:1 ratio. Within the matched cohort, the RPN group was related to a significantly shorter mean operating time (OT) (P = .040), shorter mean warm ischemia time (WIT) (P = .023), and shorter median postoperative hospital stay (P = .023). The possibilities of surgical conversion, postoperative complication, and positive surgical margin were similar in the LPN and RPN groups. And there was also no significant difference in the pathological, renal functional, and oncological outcomes between the two series.
Conclusions:
For patients with anatomically complex T1b renal tumors with a RENAL nephrometry score ≥7, RPN had an advantage over LPN in reducing OT, WIT, and postoperative hospital stay length without increasing the risk of complications and weakening the oncological control, while the two surgical methods were similar in renal functional preservation.
... From the perspective of surgical intervention for kidney cancer, patients with early T stage cancer would have a larger volume of healthy renal parenchyma for renal preservation, which might result in a better clinical outcome [20]. For partial nephrectomy, outcomes are more favorable for robotic surgery than for laparoscopic surgery in terms of a lower conversion rate to radical nephrectomy, favorable retention of renal function, and shorter warm ischemia time [21][22][23]. These features could partially explain the role of health expenditure in the MIR of kidney cancer. ...
Background:
The advancements in cancer therapy have improved the clinical outcomes of cancer patients in recent decades. However, advanced cancer therapy is expensive and requires good health care systems. For kidney cancer, no studies have yet established an association between clinical outcome and health care disparities.
Methods:
We used the mortality-to-incidence ratio (MIR) for kidney cancer as a marker of clinical outcome to compare World Health Organization (WHO) country rankings and total expenditures on health/gross domestic product (e/GDP) using linear regression analyses.
Results:
We included 57 countries based on data from the GLOBOCAN 2012 database. We found that more highly developed regions have higher crude and age-standardized rates of kidney cancer incidence and mortality, but a lower MIR, when compared to less developed regions. North America has the highest crude rates of incidence, but the lowest MIRs, whereas Africa has the highest MIRs. Furthermore, favorable MIRs are correlated with countries with good WHO rankings and high e/GDP expenditures (p < 0.001 and p = 0.013, respectively).
Conclusions:
Kidney cancer MIRs are positively associated with the ranking of health care systems and health care expenditures.
... From 7 cases per 100,000 population per year in 1975, the incidence has more than doubled to 15.3 cases per 100,000 in 2013. 1 At the same time, there has been a steady decrease in the average size of tumors at presentation. 2 This phenomenon can be attributed to increased incidental detection of renal tumors by noninvasive imaging modalities. There has also been a trend toward using nephron-sparing surgery, 3 and minimally invasive approaches 4 in the management of these tumors. ...
Nephron-sparing surgery, especially through a minimally invasive approach, is increasingly being performed for incidentally detected renal masses with excellent outcomes. Tumors in central location remain a surgical challenge during nephron-sparing surgery. In this chapter, we discuss the minimally invasive management of these tumors, which include complex hilar tumors and endophytic central tumors, with a focus on surgical technique. The key to management of these tumors is to maintain good preoperative hydration, achieving adequate exposure of tumor, and the use of intraoperative ultrasound to plan the resection plane. Individual vessels may be ligated as they enter close to the tumor. Careful renorrhaphy is essential, especially in hilar tumors, which have major blood vessels at the base of the tumor. Selective use of near infrared fluorescence imaging, on-demand ischemia, early unclamping, enucleoresection techniques, and intracorporeal hypothermia may help minimize, or reduce the effect of warm ischemia.
... The superiority of RAPN over LPN has previously been reported, and includes a clear, three-dimensional view of the region of interest and fine movement of surgical instruments, with both of these factors likely contributing to the lower incidence of complications, such as open conversion, postoperative bleeding, urine leakage, shorter ischemia time and better preservation of renal function. 5,7,19,20 In several reports, shortened WIT in RAPN has been associated with better preservation of renal function. 7,16,21 The WIT in the present study was similarly shorter for the RAPN (17 min) than the LPN (25 min) procedure (P < 0.0001), after propensity matching, suggesting that this difference in ischemia time might contribute to better renal function outcome in the RAPN than LPN group. ...
Objectives:
To compare surgical outcomes, including renal function and the preserved renal parenchymal volume, between robot-assisted laparoscopic partial nephrectomy and laparoscopic partial nephrectomy using propensity score-matched analyses.
Methods:
In total, 253 patients, with a normal contralateral kidney, who underwent laparoscopic partial nephrectomy (n = 131) or robot-assisted laparoscopic partial nephrectomy (n = 122) with renal arterial clamping between 2010 and 2015, were included. Patients' background and tumor factors were adjusted by propensity score matching. Surgical outcomes, including postoperative renal function, complications, warm ischemia time and preserved renal parenchymal volume, evaluated by volumetric analysis, were compared between the surgical procedures.
Results:
After matching, 64 patients were assigned to each group. The mean age was 56-57 years, and the mean tumor size was 22 mm. Approximately 50% of patients had low complexity tumors (RENAL nephrometry score 4-7). The incidence rate of acute kidney failure was significantly lower in the robot-assisted laparoscopic partial nephrectomy (11%) than laparoscopic partial nephrectomy (23%) group (P = 0.049), and warm ischemia time shorter in the robot-assisted laparoscopic partial nephrectomy (17 min) than laparoscopic partial nephrectomy (25 min) group (P < 0.0001). The preservation rate of renal function, measured by the estimated glomerular filtration rate, at 6 months post-surgery was 96% for robot-assisted laparoscopic partial nephrectomy and 90% for laparoscopic partial nephrectomy (P < 0.0001). The preserved renal parenchymal volume was higher for robot-assisted laparoscopic partial nephrectomy (89%) than laparoscopic partial nephrectomy (77%; P < 0.0001). The rate of perioperative complications, surgical margin status and length of hospital stay were equivalent for both techniques.
Conclusions:
Robot-assisted laparoscopic partial nephrectomy allows to achieve better preservation of renal function and parenchymal volume than laparoscopic partial nephrectomy.
... While there was no difference regarding the trifecta achievement. On the other hand, Jang et al. [7] compared the perioperative outcomes of robotic-assisted partial nephrectomy RAPN (n Z 89) and laparoscopic partial nephrectomy (n Z 38) for tumors with R.E.N.A.L. score 7. They found no significant differences in warm ischemic time blood loss, intraoperative complications, or operation time between groups. ...
The robotic nurse plays an essential role in a successful robotic surgery. As part of the robotic surgical team, the robotic nursemust demonstrate a high level of professional knowledge, and be an expert in robotic technology and dealing with robotic malfunctions. Each one of the robotic nursing team "nurse coordinator, scrub-nurse and circulating-nurse" has a certain job description to ensure maximum patient's safety and robotic surgical efficiency. Well-structured training programs should be offered to the robotic nurseto be well prepared, feel confident, and maintain high-quality of care.
