DOI: https://doi.org/10.30841/2307-5090.3.2020.215602

Our Experience of Laparoscopic Partial Nephrectomy: Technique and Results

С. В. Головко, В. Р. Балабаник

Abstract


Laparoscopic partial nephrectomy (LPN) is considered an effective modern minimally invasive surgical intervention and is an alternative to open partial nephrectomy (OPN) in the surgical treatment of kidney cancer.

The objective: to provide modern evidence of the effectiveness of LPN in the surgical treatment of patients and to describe the further evolution of this minimally invasive technique.

Materials and methods. We prospectively analyzed the data of 63 patients who underwent LPN for clinically localized kidney cancer since September 2015 to October2019 in the urology clinic of theNationalMilitaryClinicalHospital «GVKG» of the Ukrainian Ministry of Defense. LPN was performed using anOlympus endoscopic stand. Clinical data were obtained through a prospective analysis of surgical interventions, including intra- and postoperative results and complications. Descriptive statistical analysis and a multivariate logistic regression model were used to predict surgical outcomes.

Results. The average age of the patients was 60.7 years; the average preoperative tumor size was33.0 mm. According to the PADUA-scale, 22 (35.0 %) patients were categorized as low difficulty, 23 (36.5 %) to the intermediate difficulty category and 18 (28.5 %) to the high difficulty category. All patients had transperitoneal access. The average surgery time was 156 minutes. The average blood loss was 171 ml. Overall, significant postoperative complications occurred in 2 (3.2 %) patients (Clavien-Dindo >2). We did not find any statistically significant differences between pre- and postoperative level of creatinine (p<0.05). In general, optimal surgical results, including analysis of the surgical margin, degree of ischemia, and level of complications, were achieved in 44 (69.8 %) patients. During an average of 26 months of observation, only two local and two distant metastases were recorded. In the end, using the multivariate logistic regression model, it was revealed that the degree of complexity of the tumor was associated with a greater risk of obtaining a non-optimal surgical result.

Conclusions. LPN is an effective minimally invasive alternative to OPN in the treatment of clinically localized renal cell carcinoma. We presented the current experience of the use of LPN in the surgical treatment of kidney cancer. LPN, as it turned out, is an effective and safe minimally invasive operation that provides optimal results in most patients with varying degrees of tumor complexity.

Keywords


laparoscopic partial nephrectomy; nephrometric score

References


Winfield H.N., Donovan J.F., Godet A.S., Clayman R.V. Laparoscopic partial nephrectomy: Initial case report for benign disease // J. Endourol. – 1993. – N 7. – P. 521–526.

McDougall E.M., Elbahnasy A.M., Clayman R.V. Laparoscopic wedge resection and partial nephrectomy: The Washington University experience and review of the literature // JSLS. – 1998. – N 2. – P. 15–23.

Gettman MT, Blute MI, Chow GK, Neururer R, Bartsch G, Peschel R. Robot-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology 2004; 64: 914–8.

Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 2015; 67: 913–24.

Haber GP, White WM, Crouzet S, et al. Robotic versus laparoscopic partial nephrectomy: single-surgeon matched cohort study of 150 patients. Urology 2010; 76: 754–8.

Long JA, Yakoubi R, Lee B, et al. Robotic versus laparoscopic partial nephrectomy for complex tumors: comparision of perioperative outcomes. Eur Urol 2012; 61: 1257–62.

Zhang X, Shen Z, Zhong S, Zhu Z, Wang X, Xu T. Comparision of perioperative outcomes of robot-assisted vs laparoscopic partial nephrectomy: a meta-analysis. BJU Int 2013; 112: 1133–42.

Masson-Lecomte A, Bensalah K, Seringe E, et al. A prospective comparision of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumors: results from a French multicentre collaborative study. BJU Int 2013; 111: 256–63.

Wang W, Ma X, Huang Q, et al. Comparision of robot-assisted and laparoscopic partial nephrectomy for complex renal tumours with a RENAL nephrometry score>=7: peri-operative and oncological outcomes. BJU Int 2016; 117: 126–30.

Minervini A, Vittory G, Antonelli A, et al. Open versus robotic-assisted partial nephrectomy: a multicenter comparision study of perioperative results and complications. World J Urol 2014; 32: 287–93.

Bezinque A, Lane BR. Comparision of 1800 robotic and open partial nephrectomies for renal tumors. Ann Surg Oncol 2016; 23: 4137–8.

Buffi N, Lista G, Larcher A, et al. Margin, ischemia, and complications (MIC) score in partial nephrectomy: a new system for evaluating achievement of optimal outcomes in nephron-sparing surgery. Eur Urol 2012; 62: 617–8.

Lista G, Buffi NM, Lughezzani G, et al. Margin, ischemia, and complications system to report perioperative outcomes of robotic partial nephrectomy: a European Multicenter Observational Study (EMOS project). Urology 2015; 85: 589–95.

Gill IS, Eisenberg MS, Aron M, et al. «Zero ischemia» partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol 2011; 59: 128–34.

Benway BM, Wang AJ, Cabello JM, Bhayani SB. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol 2009; 55: 592–9.

Gin GE, Maschino AC, Spaliviero M, Vertosick EA, Bernstein MI, Coleman JA.Comparision of perioperative outcomes of retroperitoneal and transperitoneal minimally invasive partial nephrectomy after adjusting for tumor complexity. Urology 2014; 84: 1355–60.

Choo SH, Lee SY, Sung HH, et al. Transperitoneal versus retroperitoneal robotic partial nephrectomy: matched-pair comparisions by nephrometry scores. World J Urol 2014; 32: 1523–9.

Xia L, Zhang X, Wang X, et al. Transperitoneal versus retroperitoneal robot-assisted partial nephrectomy: a systemic review and meta-analysis. Int J Surg 2016; 30: 109–15.

Borofsky MS, Gill IS, Hemal AK, et al. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischemia robotic partial nephrectomy. BJU Int 2013; 111: 604–10.

Bjurlin MA, Gan M, McClintock TR, et al. Near-infrared fluorescence imaging: emerging appiications in robotic upper urinary tract surgery. Eur Urol 2014; 65: 793–801.

Bjurlin MA, McClintock TR, Stifelman MD, et al. Near-infrared fluorescence imaging with intraoperative administration of indocyanine green for robotic partial nephrectomy. Curr Urol Rep 2015; 16: 20.

Cohen J, Jayram G, Mullins JK, Ball MW, Allaf ME. Do fibrin sealants impact negative outcomes after robot-assisted partial nephrectomy? J Endourol 2013; 27: 1236–9.

Desai MM, de Castro Abreu AI, Leslie S, et al. Robotic partial nephrectomy with superselective versus main artery clamping: a retrospective comparisions. Eur Urol 2014; 66: 713–9.

Komninos C, Shin TY, Tuliao P, et al. Renal function is the same 6 month after after robot-assisted partial nephrectomy regardless of clamp technique: analysis of outcomes for off-clamp, selective arterial clamp and main arterial clamp techniques, with a minimum follow-up of 1 year. BJU Int 2015; 115: 921–8.

Davidiuk AJ, Parker AS, Thomas CS, et al. Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric flat in partial nephrectomy. Eur Urol 2014; 66: 1165–71.

Benway BM, Bhayani SB, Rogers CG, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 2009; 182: 866–72.

Hanzly M, Frederick A, Creighton T, et al. Learning curves for robot-assisted and laparoscopic partial nephrectomy. J Endourol 2015; 29: 297–303.

Goonewardene SS, Brown M, Challacombe B. Single-versus dual-console robotic surgery: dual improves the educational experience for trainees.World J Urol 2016; 34: 1337–9.

Jarc AM, Shah SH, Adebar T, et al. Beyond 2D telestrations: an evaluation of novel proctoring tools for robot-assisted minimally invasive surgery. J Robot Surg 2016; 10: 103–9.

Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009;182:844–53.

Gallucci M, Guaglianone S, Carpanese L, et al. Superselective embolization as first step of laparoscopic partial nephrectomy. Urology 2007; 69: 642–5.

Simone G, Gill IS, Mottrie A, et al. Indications, techniques, outcomes, and limitations for minimally ischemic and off-clamp partial nephrectomy: a systematic review of the literature. Eur Urol 2015; 68: 632–40.

Shao P, Tang L, Li P, et al. Precise segmental renal artery clamping under the guidance of dual-source computed tomography angiography during laparoscopic partial nephrectomy. Eur Urol 2012; 62: 1001–8.

Merklin RJ, Michels NA. The variant renal and suprarenal blood supply with data on the inferior phrenic, ureteral and gonadal arteries: a statistical analysis based on 185 dissections and review of the literature. J Int Coll Surg 1958; 29: 41–76.

Ozkan U, Oguzkurt L, Tercan F, Kizilkiliç O, Koç Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 con-secutive patients. Diagn Interv Radiol Ank Turk 2006;12:183–6.

Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surg Radiol Anat 2004; 26: 474–9.

Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001; 23: 33–8.

Khamanarong K, Prachaney P, Utraravichien A, Tong-Un T, Sripaoraya K. Anatomy of renal arterial supply. Clin Anat N Y N 2004; 17: 334–6.

Kabore FA, Fall PA, Diao B, et al. Extraparenchymental distribution and feasibility of selective clamping of segmental renal arteries during partial nephrectomy: a study of the dissection of 30 kidneys from recent nonformolised corpses. Progres En Urol J Assoc Francaise Urol Soc Francaise Urol févr 2009; 19: 101–6.

Roy C, Tuchmann C, Morel M, Saussine C, Jacqmin D, Tongio J. Is there still a place for angiography in the management of renal mass lesions? Eur Radiol 1999; 9: 329–35.




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