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Robotic surgery and hemostatic agents in partial nephrectomy: a high rate of success without vascular clamping

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Abstract

Robot-assisted partial nephrectomy has been proposed as a technique to overcome technical challenges of laparoscopic partial nephrectomy. We prospectively collected and analyzed data from 31 patients who underwent robotic partial nephrectomy with systematic use of hemostatic agents, between February 2009 and October 2014. Thirty-three renal tumors were treated in 31 patients. There were no conversions to open surgery, intraoperative complications, or blood transfusions. The mean size of the resected tumors was 27 mm (median 20 mm, range 5–40 mm). Twenty-seven of 33 lesions (82 %) did not require vascular clamping and therefore were treated in the absence of ischemia. All margins were negative. The high partial nephrectomy success rate without vascular clamping suggests that robotic nephron-sparing surgery with systematic use of hemostatic agents may be a safe, effective method to completely avoid ischemia in the treatment of selected renal masses.

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References

  1. Hock LM, Lynch J, Balaji KC (2002) Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol 167(1):57–60

    Article  PubMed  Google Scholar 

  2. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351(13):1296–1305. doi:10.1056/NEJMoa041031

    Article  CAS  PubMed  Google Scholar 

  3. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7(9):735–740. doi:10.1016/s1470-2045(06)70803-8

    Article  PubMed Central  PubMed  Google Scholar 

  4. Fergany AF, Saad IR, Woo L, Novick AC (2006) Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. The Journal of urology 175(5):1630–1633; discussion 1633. doi:10.1016/s0022-5347(05)00991-2

  5. McKiernan J, Simmons R, Katz J, Russo P (2002) Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 59(6):816–820

    Article  PubMed  Google Scholar 

  6. McDougall EM, Clayman RV, Chandhoke PS, Kerbl K, Stone AM, Wick MR, Hicks M, Figenshau RS (1993) Laparoscopic partial nephrectomy in the pig model. J Urol 149(6):1633–1636

    CAS  PubMed  Google Scholar 

  7. Winfield HN, Donovan JF, Godet AS, Clayman RV (1993) Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol/Endourol Soc 7(6):521–526

    Article  CAS  Google Scholar 

  8. Lavery HJ, Small AC, Samadi DB, Palese MA (2011) Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS J Soc Laparoendosc Surg/Soc Laparoendosc Surg 15(3):291–297. doi:10.4293/108680811x13071180407357

    Article  Google Scholar 

  9. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178(1):41–46. doi:10.1016/j.juro.2007.03.038

    Article  PubMed  Google Scholar 

  10. Nguyen MM, Gill IS (2008) Halving ischemia time during laparoscopic partial nephrectomy. J Urol 179(2):627–632; discussion 632. doi:10.1016/j.juro.2007.09.086

  11. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Blute ML, Campbell SC (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58(3):340–345. doi:10.1016/j.eururo.2010.05.047

    Article  PubMed  Google Scholar 

  12. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Campbell SC, Blute ML (2010) Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney. Eur Urol 58(3):331–336. doi:10.1016/j.eururo.2010.05.048

    Article  PubMed  Google Scholar 

  13. Rais-Bahrami S, George AK, Herati AS, Srinivasan AK, Richstone L, Kavoussi LR (2012) Off-clamp versus complete hilar control laparoscopic partial nephrectomy: comparison by clinical stage. BJU Int 109(9):1376–1381. doi:10.1111/j.1464-410X.2011.10592.x

    Article  PubMed  Google Scholar 

  14. Cha EK, Lee DJ, Del Pizzo JJ (2011) Current status of robotic partial nephrectomy (RPN). BJU Int 108(6 Pt 2):935–941. doi:10.1111/j.1464-410X.2011.10556.x

    Article  PubMed  Google Scholar 

  15. White WM, Goel RK, Haber GP, Kaouk JH (2010) Robotic partial nephrectomy without renal hilar occlusion. BJU Int 105(11):1580–1584. doi:10.1111/j.1464-410X.2009.09033.x

    Article  PubMed  Google Scholar 

  16. Brody F, Richards NG (2014) Review of robotic versus conventional laparoscopic surgery. Surg Endosc 28(5):1413–1424. doi:10.1007/s00464-013-3342-4

    Article  PubMed  Google Scholar 

  17. Wang L, Lee BR (2013) Robotic partial nephrectomy: current technique and outcomes. Int J Urol Offi J Jpn Urol Assoc 20(9):848–859. doi:10.1111/iju.12177

    Google Scholar 

  18. Dionigi G, Boni L, Rovera F, Dionigi R (2007) Dissection and hemostasis with hydroxylated polyvinyl acetal tampons in open thyroid surgery. Ann Surg Innov Res 1:3. doi:10.1186/1750-1164-1-3

    Article  PubMed Central  PubMed  Google Scholar 

  19. Richter F, Schnorr D, Deger S, Trk I, Roigas J, Wille A, Loening SA (2003) Improvement of hemostasis in open and laparoscopically performed partial nephrectomy using a gelatin matrix-thrombin tissue sealant (FloSeal). Urology 61(1):73–77

    Article  PubMed  Google Scholar 

  20. Baumert H, Ballaro A, Shah N, Mansouri D, Zafar N, Molinie V, Neal D (2007) Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques. Eur Urol 52(4):1164–1169. doi:10.1016/j.eururo.2007.03.060

    Article  PubMed  Google Scholar 

  21. Rouach Y, Delongchamps NB, Patey N, Fontaine E, Timsit MO, Thiounn N, Mejean A (2009) Suture or hemostatic agent during laparoscopic partial nephrectomy? A randomized study using a hypertensive porcine model. Urology 73(1):172–177. doi:10.1016/j.urology.2008.08.477

    Article  PubMed  Google Scholar 

  22. Gill IS, Ramani AP, Spaliviero M, Xu M, Finelli A, Kaouk JH, Desai MM (2005) Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant. Urology 65(3):463–466. doi:10.1016/j.urology.2004.10.030

    Article  PubMed  Google Scholar 

  23. Petros F, Sukumar S, Haber GP, Dulabon L, Bhayani S, Stifelman M, Kaouk J, Rogers C (2012) Multi-institutional analysis of robot-assisted partial nephrectomy for renal tumors >4 cm versus ≤4 cm in 445 consecutive patients. J Endourol/Endourol Soc 26(6):642–646. doi:10.1089/end.2011.0340

    Article  Google Scholar 

  24. Herr HW (2005) A history of partial nephrectomy for renal tumors. J Urol 173(3):705–708. doi:10.1097/01.ju.0000146270.65101.1d

    Article  PubMed  Google Scholar 

  25. Mottrie A, De Naeyer G, Schatteman P, Carpentier P, Sangalli M, Ficarra V (2010) Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. Eur Urol 58(1):127–132. doi:10.1016/j.eururo.2010.03.045

    Article  PubMed  Google Scholar 

  26. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853. doi:10.1016/j.juro.2009.05.035

    Article  PubMed  Google Scholar 

  27. Rogers CG, Singh A, Blatt AM, Linehan WM, Pinto PA (2008) Robotic partial nephrectomy for complex renal tumors: surgical technique. Eur Urol 53(3):514–521. doi:10.1016/j.eururo.2007.09.047

    Article  PubMed Central  PubMed  Google Scholar 

  28. Hennus PM, Kroeze SG, Bosch JL, Jans JJ (2012) Impact of comorbidity on complications after nephrectomy: use of the Clavien Classification of Surgical Complications. BJU Int 110(5):682–687. doi:10.1111/j.1464-410X.2011.10889.x

    Article  PubMed  Google Scholar 

  29. Kopple JD, Berg R, Houser H, Steinman TI, Teschan P (1989) Nutritional status of patients with different levels of chronic renal insufficiency. Modification of Diet in Renal Disease (MDRD) Study Group. Kidney Int Suppl 27:S184–S194

    CAS  PubMed  Google Scholar 

  30. Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S (2009) Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol 55(5):1171–1178. doi:10.1016/j.eururo.2009.01.042

    Article  PubMed  Google Scholar 

  31. Lane BR, Babineau DC, Poggio ED, Weight CJ, Larson BT, Gill IS, Novick AC (2008) Factors predicting renal functional outcome after partial nephrectomy. J Urol 180(6):2363–2368; discussion 2368–2369. doi:10.1016/j.juro.2008.08.036

  32. Rogers CG, Metwalli A, Blatt AM, Bratslavsky G, Menon M, Linehan WM, Pinto PA (2008) Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis. J Urol 180(6):2353–2356; discussion 2356. doi:10.1016/j.juro.2008.08.022

  33. Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, Montorsi F, Russo P, Stockle M (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56(4):625–634. doi:10.1016/j.eururo.2009.07.016

    Article  PubMed  Google Scholar 

  34. Thompson RH, Frank I, Lohse CM, Saad IR, Fergany A, Zincke H, Leibovich BC, Blute ML, Novick AC (2007) The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol 177(2):471–476. doi:10.1016/j.juro.2006.09.036

    Article  PubMed  Google Scholar 

  35. Azhar RA, Gill IS, Aron M (2014) Robotic nephron-sparing surgery for renal tumors: current status. Indian J Urol IJU J Urol Soc India 30(3):275–282. doi:10.4103/0970-1591.135667

    Article  Google Scholar 

  36. Michli EE, Parra RO (2009) Robotic-assisted laparoscopic partial nephrectomy: initial clinical experience. Urology 73(2):302–305. doi:10.1016/j.urology.2008.09.056

    Article  PubMed  Google Scholar 

  37. Gill IS, Patil MB, Abreu AL, Ng C, Cai J, Berger A, Eisenberg MS, Nakamoto M, Ukimura O, Goh AC, Thangathurai D, Aron M, Desai MM (2012) Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol 187(3):807–814. doi:10.1016/j.juro.2011.10.146

    Article  PubMed  Google Scholar 

  38. Benway BM, Wang AJ, Cabello JM, Bhayani SB (2009) Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. Eur Urol 55(3):592–599. doi:10.1016/j.eururo.2008.12.028

    Article  PubMed  Google Scholar 

  39. San Francisco IF, Sweeney MC, Wagner AA (2011) Robot-assisted partial nephrectomy: early unclamping technique. J Endourol/Endourol Soc 25(2):305–308. doi:10.1089/end.2010.0436

    Article  Google Scholar 

  40. Richstone L, Kavoussi LR (2007) Re: the impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. Thompson RH, Frank I, Lohse CM, Saad IR, Fergany A, Zincke H, Leibovich BC, Blute ML, Novick AC. J Urol 2007; 177: 471–476. J Urol 178(3 Pt 1):1119; author reply 1119–1120. doi:10.1016/j.juro.2007.05.066

  41. Baldwin DD, Maynes LJ, Berger KA, Desai PJ, Zuppan CW, Zimmerman GJ, Winkielman AM, Sterling TH, Tsai CK, Ruckle HC (2004) Laparoscopic warm renal ischemia in the solitary porcine kidney model. Urology 64(3):592–597. doi:10.1016/j.urology.2004.04.019

    Article  PubMed  Google Scholar 

  42. Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, Wang AJ, Stifelman MD (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182(3):866–872. doi:10.1016/j.juro.2009.05.037

    Article  PubMed  Google Scholar 

  43. Yasui T, Itoh Y, Kojima Y, Umemoto Y, Tozawa K, Sasaki S, Hayashi Y, Kohri K (2008) Impact of microwave tissue coagulation during laparoscopic partial nephrectomy on postoperative renal function. Int Urol Nephrol 40(2):277–282. doi:10.1007/s11255-007-9271-1

    Article  PubMed  Google Scholar 

  44. Hillyer SP, Autorino R, Laydner H, Yang B, Altunrende F, White M, Spana G, Khanna R, Isac W, Hernandez AV, Simmons M, Stein R, Haber GP, Kaouk J (2011) Robotic versus laparoscopic partial nephrectomy for bilateral synchronous kidney tumors: single-institution comparative analysis. Urology 78(4):808–812. doi:10.1016/j.urology.2011.06.012

    Article  PubMed  Google Scholar 

  45. Wang AJ, Bhayani SB (2009) Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of >100 consecutive procedures. Urology 73(2):306–310. doi:10.1016/j.urology.2008.09.049

    Article  PubMed  Google Scholar 

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Acknowledgments

Study supported by ARPA foundation, http://www.fondazionearpa.it.

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Authors and Affiliations

  1. General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Luca Morelli, Matteo Palmeri, Cristiano D’Isidoro, Emanuele Federico Kauffmann, Dario Tartaglia, Giovanni Caprili, Roberta Pisano, Simone Guadagni, Gregorio Di Franco & Giulio Di Candio

  2. Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA

    John Morelli

  3. EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy

    Luca Morelli, Roberta Pisano & Franco Mosca

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  1. Luca Morelli
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Correspondence to Matteo Palmeri.

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Luca Morelli, John Morelli, Matteo Palmeri, Cristiano D’Isidoro, Emanuele Federico Kauffmann, Dario Tartaglia, Giovanni Caprili, Roberta Pisano, Simone Guadagni, Gregorio Di Franco, Giulio Di Candio, Franco Mosca declare that they have no conflict of interest or financial ties.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Informed consent was obtained from all patients for being included in the study.

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Morelli, L., Morelli, J., Palmeri, M. et al. Robotic surgery and hemostatic agents in partial nephrectomy: a high rate of success without vascular clamping. J Robotic Surg 9, 215–222 (2015). https://doi.org/10.1007/s11701-015-0519-y

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  • DOI: https://doi.org/10.1007/s11701-015-0519-y

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