Skip to main content
SpringerLink
Log in

A multi-institutional report of peri-operative and functional outcomes after robot-assisted partial nephrectomy in patients with a solitary kidney

  • Original Article
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

To evaluate peri- and post-operative outcomes after robotic partial nephrectomy (RPN) in patients with a solitary kidney. A multi-institutional database of 1868 patients was used to identify 35 patients with a solitary kidney who underwent RPN at six different centers from 2007 to 2016. Peri-operative outcomes were summarized with descriptive statistics. We assessed the change in eGFR over time with a linear mixed-effects model. Median operative time, ischemia time, and estimated blood loss were 172 min, 16 min, and 113 mL, respectively. There were no positive surgical margins. The median length of stay was 1 day (range 1–7), and over half (54.3%) of patients were discharged one post-operative day 1. Seven post-operative complications occurred in six patients (17.1%); of which four were Clavien I, two were Clavien II, and one was Clavien III. The linear decline in eGFR up to 24 month post-RPN was marginal and not significant (ß = − 0.14; 95% CI = − 0.51, 0.23; p = 0.453), with predicted mean eGFR decreasing from 59.2 to 55.8 mL/min/1.73 m2 at 24 months. These results suggest that, in patients with a solitary kidney, RPN is a safe and feasible treatment option. In patients with a solitary kidney, RPN did not significantly compromise renal function for up to 2 years after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol. https://doi.org/10.1016/j.juro.2017.04.100 (In press)

  2. Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406. https://doi.org/10.1016/j.eururo.2010.06.032

    Article  PubMed  Google Scholar 

  3. Hillyer SP, Bhayani SB, Allaf ME et al (2013) Robotic partial nephrectomy for solitary kidney: a multi-institutional analysis. Urology 81(1):93–97. https://doi.org/10.1016/j.urology.2012.08.055

    Article  PubMed  Google Scholar 

  4. Panumatrassamee K, Autorino R, Laydner H et al (2013) Robotic versus laparoscopic partial nephrectomy for tumor in a solitary kidney: a single institution comparative analysis. Int J Urol 20(5):484–491. https://doi.org/10.1111/j.1442-2042.2012.03205.x

    Article  PubMed  Google Scholar 

  5. Zargar H, Bhayani S, Allaf ME et al (2014) Comparison of perioperative outcomes of robot-assisted partial nephrectomy and open partial nephrectomy in patients with a solitary kidney. J Endourol 28(10):1224–1230. https://doi.org/10.1089/end.2014.0297

    Article  PubMed  Google Scholar 

  6. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. https://doi.org/10.1016/j.jbi.2008.08.010

    Article  PubMed  Google Scholar 

  7. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  8. Arora S, Abaza R, Adshead JM et al (2018) ‘Trifecta’ outcomes of robot-assisted partial nephrectomy in solitary kidney: a Vattikuti Collective Quality Initiative (VCQI) database analysis. BJU Int. https://doi.org/10.1111/bju.13967

    Article  PubMed  Google Scholar 

  9. Chapman D, Moore R, Klarenbach S, Braam B (2010) Residual renal function after partial or radical nephrectomy for renal cell carcinoma. Can Urol Assoc J 4:337

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ghoneim TP, Sjoberg DD, Lowrance W et al (2015) Partial nephrectomy for renal tumors in solitary kidneys: postoperative renal function dynamics. World J Urol. https://doi.org/10.1007/s00345-015-1581-9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Saranchuk JW, Touijer AK, Hakimian P, Snyder ME, Russo P (2004) Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan-Kettering experience. BJU Int. https://doi.org/10.1111/j.1464-410X.2004.05165.x

    Article  PubMed  Google Scholar 

  12. Adkins KL, Chang SS, Cookson MS, Smith JA Jr (2003) Partial nephrectomy safely preserves renal function in patients with a solitary kidney. J Urol. https://doi.org/10.1097/01.ju.0000037112.65243.1e

    Article  PubMed  Google Scholar 

  13. Fergany AF, Saad IR, Woo L, Novick AC (2006) Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. J Urol. https://doi.org/10.1016/S0022-5347(05)00991-2

    Article  PubMed  Google Scholar 

  14. Khalifeh A, Kaouk JH, Bhayani S et al (2013) Positive surgical margins in robot-assisted partial nephrectomy: a multi-institutional analysis of oncologic outcomes (Leave no tumor behind). J Urol. https://doi.org/10.1016/j.juro.2013.05.110

    Article  PubMed  Google Scholar 

  15. Benway BM, Bhayani SB, Rogers CG et al (2010) Robot-assisted partial nephrectomy: an international experience. Eur Urol. https://doi.org/10.1016/j.eururo.2010.01.011

    Article  PubMed  Google Scholar 

  16. Tsai TC, Orav EJ, Jha AK (2015) Patient satisfaction and quality of surgical care in US hospitals. Ann Surg 261(1):2–8. https://doi.org/10.1097/SLA.0000000000000765

    Article  PubMed  PubMed Central  Google Scholar 

  17. Simmons MN, Hillyer SP, Lee BH, Fergany AF, Kaouk J, Campbell SC (2012) Functional recovery after partial nephrectomy: effects of volume loss and ischemic injury. J Urol 187(5):1667–1673. https://doi.org/10.1016/j.juro.2011.12.068

    Article  Google Scholar 

  18. Porter J (2015) Renal ischemia during partial nephrectomy: does every minute still count? Eur Urol 68(1):75–76. https://doi.org/10.1016/j.eururo.2015.02.037

    Article  PubMed  Google Scholar 

  19. Volpe A, Blute ML, Ficarra V et al (2015) Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol 68(1):61–74. https://doi.org/10.1016/j.eururo.2015.01.025

    Article  Google Scholar 

  20. Thompson RH, Lane BR, Lohse CM et al (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58(3):340–345. https://doi.org/10.1016/j.eururo.2010.05.047

    Article  PubMed  Google Scholar 

  21. Ficarra V, Bhayani S, Porter J et al (2012) Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. Eur Urol. https://doi.org/10.1016/j.eururo.2011.10.046

    Article  PubMed  Google Scholar 

  22. Bylund JR, Gayheart D, Fleming T et al (2012) Association of tumor size, location, RENAL, PADUA and centrality index score with perioperative outcomes and postoperative renal function. J Urol. https://doi.org/10.1016/j.juro.2012.07.043

    Article  PubMed  Google Scholar 

Download references

Funding

This study did not receive any funding.

Author information

Authors and Affiliations

  1. Department of Urology, Icahn School of Medicine at Mount Sinai, 5 E 98th Street, 6th Floor, 10029, New York City, NY, USA

    Zeynep Gul, Kyle A. Blum, David J. Paulucci & Ketan K. Badani

  2. OhioHealth Dublin Methodist Hospital, 7500 Hospital Dr., Dublin, OH, 43016, USA

    Ronney Abaza

  3. Temple University School of Medicine, 255 South 17th Street, 7th floor, Philadelphia, PA, 19103, USA

    Daniel D. Eun

  4. Division of Urology, Mount Sinai Medical Center, Columbia University at Mount Sinai, 4302 Alton Road, Suite 540, Miami Beach, FL, 33140, USA

    Akshay Bhandari

  5. Wake Forest School of Medicine, Medical Center Blvd., Wake Forest University Baptist Medical Center, Winston-Salem, NC, 27157, USA

    Ashok K. Hemal

  6. Swedish Urology Group, Swedish Medical Center, 1101 Madison Suite 1400, Seattle, WA, 98104, USA

    James Porter

Authors
  1. Zeynep Gul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyle A. Blum
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David J. Paulucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronney Abaza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel D. Eun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akshay Bhandari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ashok K. Hemal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. James Porter
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ketan K. Badani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ketan K. Badani.

Ethics declarations

Conflict of interest

Ronney Abaza has received research funding from Conmed Inc. and educational program funding from Intuitive Surgical. James Porter has received research support from Ceerva, is on the advisory board for C-SATS, and is a speaker for Intuitive Surgical. Zeynep Gul, Kyle Blum, David Paulucci, Daniel Eun, Akshay Bhandari, Ashok Hemal, and Ketan Badani have no conflicts of interest to report.

Informed consent

Informed consent was obtained from all individual participants included in this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gul, Z., Blum, K.A., Paulucci, D.J. et al. A multi-institutional report of peri-operative and functional outcomes after robot-assisted partial nephrectomy in patients with a solitary kidney. J Robotic Surg 13, 423–428 (2019). https://doi.org/10.1007/s11701-018-0883-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11701-018-0883-5

Keywords

Search

Navigation