Self-retaining barbed suture during laparoscopic partial nephrectomy

ObjectiveThis study was conducted to investigate the safety and feasibility of self-retaining barbed absorbable suture application in laparoscopic partial nephrectomy (LPN).Materials and methodsFrom January 2010 to September 2014, 38 cases of LPN were performed at Changhua Christian Hospital, Changhua, Taiwan. The patients were divided into two groups: the nonself-retaining barbed suture (non-SRBS) group (n = 21) and the SRBS group (n = 17). There was no significant difference in age, RENAL (Radius, Exophytic/Endophytic properties, Nearness of the tumor to the collecting system or sinus, Anterior/Posterior, Location relative to polar lines) nephrometry score, and tumor type between the two groups. Clinical data and outcomes were analyzed retrospectively.ResultsAll 38 cases of LPN were successfully performed, without conversion to open surgery or serious intraoperative complications. In the SRBS group, renorrhaphy time and length of hospital stay were significantly shorter than those of the non-SRBS group (p = 0.015 and p = 0.009, respectively).ConclusionsThe application of SRBS in LPN could shorten renorrhaphy time and hospital stay with good safety and feasibility.     

Complications of laparoscopic partial nephrectomy

OBJECTIVES: To review the current evidence about laparoscopic partial nephrectomy (LPN) and its complications to define the role of this technique and to demonstrate specific operative modifications developed in a high volume laparoscopy centre. METHODS: The most recent literature was reviewed based on a PubMed search to evaluate the current types and rates of surgical complications following laparoscopic partial nephrectomy. Own data and experiences were added. Particular alert was dedicated to detailed operative knowledge to avoid typical pitfalls. RESULTS: LPN is still a challenging option for treatment of small renal cell cancer (RCC) and the technique is under development. The intermediate-term functional and oncological results of LPN can compete with the standard options at least in laparoscopy dedicated centres. The learning curve has to be considered because of its great impact on the reduction of the risk of complications. Advantages of LPN are less blood loss, shorter hospital stay and less blood loss. A careful case selection is required in reliance on the surgeons; experience. CONCLUSION: LPN is an additional but still challenging option for selected cases of RCC, which should be managed by the hands of experienced surgeons. Respecting these restrictions LPN has been shown to be equivalent to open partial nephrectomy. Distinctive attention has to be dedicated for improvement and standardization of operative techniques to decrease the learning curve of future users.     

Improvement on parenchymal suturing technique in laparoscopic partial nephrectomy

Abstract: This report aims to describe a new parenchymal continuous suturing technique for laparoscopic partial nephrectomy. In this new technique, the thread is not tightened or cinched until all stitches are completed. At the final step of the running suture, each thread is tightened and fixed by using Hem‐o‐lok clips. We performed laparoscopic partial nephrectomy with this procedure on eight patients between January and October 2007. The mean ischemic time was 35 min (range: 28–44 min). The mean time of parenchymal suturing was 9.9 min (range: 7–11 min). This procedure allowed us a clear vision during the suturing.     

新型倒刺缝线在腹腔镜下肾部分切除术中的疗效及安全性的荟萃分析

目的:系统评价新型倒刺缝线与普通缝线在腹腔镜下肾部分切除术(LPN)中应用的疗效及安全性,为临床选择提供循证依据。方法:制定检索策略计算机分别检索PubMed、Medline、Cochrane Central Register of Controlled Trials、维普、万方、中国生物医学文献数据库、中国科学引文数据库(CSCD)及中国期刊全文数据库(CNKI)。手工检索:中华泌尿外科杂志、临床泌尿外科杂志、现代泌尿外科杂志、微创泌尿外科杂志4种杂志。检索时间均从建库至2017年4月。检索国内外有关新型倒刺缝线与普通缝线在LPN中应用疗效的临床对照研究,按Cochrane系统评价方法提取资料,由2名评价员对纳入文献的质量进行评价,采用RevMan 5.3统计软件进行统计分析。结果:共纳入13篇临床对照研究,中文11篇,外文2篇,共包括1 100例患者,其中新型倒刺缝线566例,普通缝线534例。Meta分析结果显示:2种缝线在肿瘤直径(MD=0.01,95%CI:0.08~0.09,P=0.81)方面差异无统计学意义,但在肾脏热缺血时间(MD=-4.99,95%CI:-6.11^-3.86,P<0.00001)、手术时间(MD=-6.61,95%CI:-10.30^-2.93,P=0.0004)、R.E.N.A.L.评分(MD=0.32,95%CI:0.08~0.55,P=0.008)、术后并发症发生率(MD=0.49,95%CI:0.26~0.92,P=0.03)、术中出血量(MD=-9.54,95%CI:-18.08^-1.00,P=0.03)及术后住院时间(MD=-0.35,95%CI:-0.69^-0.01,P=0.04)等方面比较差异有统计学意义。结论:LPN中,与普通缝线相比,新型倒刺缝线在肾脏热缺血时间、手术时间、术中出血量、术后并发症及术后住院时间等方面具有明显优势。但鉴于纳入文献有限,关于新型倒刺缝线与普通缝线在LPN中应用的疗效及安全性有待于多中心、高质量的随机对照试验进一步验证。     

单向倒刺可吸收缝线应用于腹腔镜肾部分切除术中的安全性及有效性研究

目的 了解单向倒刺可吸收缝线是否能有效应用于腹腔镜下肾部分切除术中肾脏的缝合操作.方法 自2013年3月-2014年3月,共有27例肾脏肿瘤患者纳入本研究,均接受腹腔镜下肾部分切除术.患者抽签分为两组,A组(n=12)在剜除肾脏肿瘤之后,采用普通抗菌涂层薇乔缝合集合系统及肾脏实质创面,B组(n=15)则使用单向倒刺可吸收缝合线(Ⅴ-Loc180)缝合.采用t检验及Fisher精确检验对两组患者从一般人口学资料、肿瘤大小、热缺血时间、术中出血量以及手术时间等方面进行对比研究.结果 A组患者12例,平均年龄62.0岁,肾脏肿瘤平均直径2.6 cm.RENAL评分(6.3±0.8)分,热缺血时间28 min,手术时间(137±20.2) min,1例术中中转开放,术中出血量(79.1±48.5) mL.B组患者15例,平均年龄61.3岁,肾脏肿瘤直径3.3 cm,RENAL评分(6.5±0.5)分,热缺血时间(22.8±3.8) min,手术时间(120±15.7) min,2例因肿瘤较大腔镜下缝合困难中转开放.在肾脏热缺血时间方面,B组优于A组且差异具有统计学意义,其余各项指标两组间差异均未见统计学意义.结论 Ⅴ-Loc单向倒刺可吸收缝线可以安全有效用于腹腔镜下肾部分切除术,且能显著缩短术中肾脏热缺血的时间,为临床推广使用提供了有效依据.     

980 nm半导体红激光辅助后腹腔镜下“零缺血”肾部分切除术的应用经验

目的:探讨980 nm半导体红激光辅助后腹腔镜下"零缺血"肾部分切除术的安全性和疗效。方法:回顾性分析2018年6月—2020年6月杭州市第一人民医院泌尿外科住院同意接受980 nm半导体红激光辅助"零缺血"后腹腔镜下肾部分切除术的外生型肾肿瘤患者的临床资料,其中男15例,女4例;年龄38～75岁,平均(55.4±10.7)岁;肿瘤直径2.1～4.0 cm,平均(3.22±0.75) cm;左侧8例,右侧11例;所有病例R.E.N.A.L.评分均为4～7分。19例患者均采用980 nm半导体红激光在不阻断肾动脉下行后腹腔镜下肾部分切除术。采用西班牙斗牛士公司红激光机、配套光纤(直径为550μm)以及配套光纤手件。结果:19例均顺利完成手术,均未阻断肾动脉,无中转开放手术或根治性肾全切术。手术时间104～178 min,平均(133.95±20.67) min;术中出血量50～280 mL,平均(158.42±70.65) mL;术后拔除引流管时间4～8 d,平均(5.84±1.25) d;术后住院天数8～17 d,平均(10.42±2.29) d。切缘均为阴性,无术后出血及其他严重并发...     

Comparison of gelatine matrix-thrombin sealants used during laparoscopic partial nephrectomy

OBJECTIVE

To compare haemostasis and other outcomes after the use of bovine‐derived or porcine‐derived gelatine matrix‐thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).

PATIENTS AND METHODS

Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine‐derived GMTS and Group 2 (10 patients) a porcine‐derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.

RESULTS

Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self‐limited gross haematuria.

CONCLUSIONS

Both the porcine‐ and bovine‐derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.     

氮质血症期肾癌患者接受腹腔镜肾部分切除术后的肾功能转归

目的总结氮质血症期肾癌(RCC)患者接受腹腔镜下肾部分切除术(LPN)治疗后的肾功能变化规律,并初步探讨影响其术后透析事件的可能临床因素。方法回顾性总结26例氮质血症期RCC患者的所有临床病理资料及肾功能随诊资料,观察血尿素氮(BUN)、血肌酐(Scr)以及总肾小球滤过率(GFR)的变化趋势,并分析可能影响患者术后透析的临床因素。结果所有患者的年龄范围在54~76岁之间,中位年龄64岁。术后1年内,全组患者中共5例患者(19.2%)的肾功能进入了衰竭期,3例患者(11.5%)接受了血液透析治疗。术后1年时,BUN和Scr分别增长了54.5%和58.5%,而总GFR则减少了32.5%。单因素分析显示:肾功能不全的病因、肿瘤原位分期以及术中失血量可能是影响术后是否需要透析治疗的有意义因素。多因素分析显示:肾功能不全的病因才是术后透析的独立风险因素。结论是否存在术前肾血管狭窄性病变可能是氮质血症期RCC患者术后透析事件的独立风险因素。     

Prospective study of robotic partial nephrectomy for renal cancer in Japan: Comparison with a historical control undergoing laparoscopic partial nephrectomy

Objectives

To evaluate the outcomes of robotic partial nephrectomy compared with those of laparoscopic partial nephrectomy for T1 renal tumors in Japanese centers.

Methods

Patients with a T1 renal tumor who underwent robotic partial nephrectomy were eligible for inclusion in the present study. The primary end‐point consisted of three components: a negative surgical margin, no conversion to open or laparoscopic surgery and a warm ischemia time ≤25 min. We compared data from these patients with the data from a retrospective study of laparoscopic partial nephrectomy carried out in Japan.

Results

A total of 108 patients were registered in the present study; 105 underwent robotic partial nephrectomy. The proportion of patients who met the primary end‐point was 91.3% (95% confidence interval 84.1–95.9%), which was significantly higher than 23.3% in the historical data. Major complications were seen in 19 patients (18.1%). The mean change in the estimated glomerular filtration rate in the operated kidney, 180 days postoperatively, was ?10.8 mL/min/1.73 m² (95% confidence interval ?12.3–9.4%).

Conclusions

Robotic partial nephrectomy for patients with a T1 renal tumor is a safe, feasible and more effective operative method compared with laparoscopic partial nephrectomy. It can be anticipated that robotic partial nephrectomy will become more widely used in Japan in the future.

     

捆绑缝合法在机器人辅助腹腔镜肾脏部分切除术中的疗效观察

目的探讨机器人辅助腹腔镜肾部分切除术中捆绑缝合法的安全性及有效性。方法回顾性收集并分析2018年12月-2019年12月期间由同一术者采用捆绑式缝合法完成的机器人辅助腹腔镜肾部分切除术患者的一般特征、手术参数、病理结果和术后并发症等。结果共106例患者纳入研究,平均年龄(53.3±14.1)岁、肿瘤最大径(38.2±13.0)mm,R.E.N.A.L.评分为(8.2±1.8)分;所有患者均未转开放或者根治性手术,术后病理切缘均为阴性;平均手术时间、术中失血量、热缺血时间以及术后住院时间分别为(119.8±47.3)min、(81.9±64.3)mL、(14.2±3.3)min、(6.9±1.3)d,术后患者整体肾脏功能平均下降13.4%;术后7例(6.6%)患者发生并发症,其中2例(1.9%)患者发生ClavienⅢ级并发症。中位随访时间为13.4(IQR:10.2~16.4)个月,1例患者于术后8个月出现局部复发,1例患者于术后12个月出现骨转移,分别予以行根治性手术及靶向药物治疗,目前带瘤生存。结论捆绑缝合法机器人辅助腹腔镜肾部分切除术可缩短肾脏热缺血时间、减少术中出血量、降低术后并发症发生率,有利于术后肾脏功能恢复,安全有效。     

后腹腔镜肾肿瘤根治切除术围手术期细胞免疫的变化

目的探讨后腹腔镜肾癌根治术围手术期细胞免疫的变化,并同传统的开放手术相比较。方法本组53例,后腹腔镜组（LN）27例,开放手术组f0N）26例年龄在25—82岁,平均（51．45±15．39）岁。分别行后腹腔镜肾肿瘤根治切除术（IN）,开放手术肾肿瘤根治切除术（ON）。采用流式细胞学技术,分别对两组手术前、术后1d、术后3d、术后5d T淋巴细胞亚群（CD3、CD4、CD8、CD28、CD4^＋／CD25^＋、CD8^＋／CD28^＋）和NK细胞进行检测,并采用重复测量方差分析进行比较。结果两组手术均获成功,后腹腔镜组平均手术时间为（66．66±10．37）min,而开放手术组为（69．08±11．22）min,两组差异无显著性（P=0．6922）;后腹腔镜组术后住院天数（6．92±0．96）d,明显少于开放手术组（11．42±1．57）d（P=0．018）;后腹腔镜组术中失血（72．03±10．37）ml,明显少于开放手术组（154．42±20．42）ml（P=0．00）。后腹腔镜组术后2人次用止痛剂,开放手术组术后20人次应用度冷丁止痛,两组差异有显著性（χ^2=21．4,P〈0．01）。两组患者的细胞亚群术前与参考值相比,ON组CD3的四个水平间68．8±11．73、62．63±11．62、64．10±13．38、68．92±10．28差异有显著性（P〈0．05）。ON组CD4的四个水平间42．15±7．81、36．39±7．97、38．10±7．58、42．61±8．81差异有显著性（P=0．0061）。ON组术后1、5dCD8（24．80±10．97、23．54±9．86）高于LN组术后1、5dCD8（23．01±6．73、21．42±5．92）,差异有显著性（P〈0．05）。ON组CD4^＋／CD25^＋的四个水平间8．58±3．62、8．71±4．91、10．7±4．56、9．16±4．26无统计学差异,（P〉0．05）。LN组CD4^＋/CD25^＋的四个水平间8．45±3．76、7．34±4．50、8．43±4．61、9．14±4．76无统计学差异（P〉0．05）。ON组术后3dCD4^＋/CD25^＋（10．7±4．56）高于IN组术后3dCD4^＋／CD25^?     

肥胖患者后腹腔镜下根治性肾切除术中辅助性套管的应用体会

目的 探讨肥胖型肾癌患者后腹腔镜下根治性肾切除术中不同位置辅助性套管的应用体会. 方法 回顾性分析2004年3月至2010年12月完成61例肥胖型T1～T2肾癌患者后腹腔镜下根治性肾切除术,根据肿瘤部位合理选择不同位置辅助性套管:肿瘤位于中上极者于腋中线肋缘下1 cm处置入辅助性套管,肿瘤位于中下极者于腋中线髂嵴上1 cm腹侧4 cm处置入辅助性套管,观察临床效果. 结果 61例手术均成功,无中转开放手术者.手术时间(153.1±23.5)min,术中出血量(57.6±29.7) ml,术后住院时间(5.7±2.6)d,术中发生腹膜破裂5例,切口脂肪液化4例,无严重并发症发生. 结论 肥胖患者后腹腔镜下根治性肾切除术中根据肿瘤部位合理选择不同位置的辅助性套管手术安全性高,患者能更好地受益于微创手术治疗.     

Intermediate-term prospective results of radiofrequency-assisted laparoscopic partial nephrectomy: a non-ischaemic coagulative technique

OBJECTIVE To report the first intermediate-term oncological outcomes of laparoscopic radiofrequency coagulation followed by laparoscopic partial nephrectomy (RF-LPN) to treat small renal masses, as LPN is limited by the technical difficulty of efficient tumour resection and parenchymal repair during warm ischaemia of the kidney. PATIENTS AND METHODS A prospective database was searched to identify patients treated with RF-LPN; in each case the tumour was first RF coagulated with a margin of normal parenchyma, and then excised. Only fibrin glue was applied to the haemostatic resection site to prevent urinary leaks. In all, 32 tumours were treated with this approach, and a radiographic follow-up was completed yearly. RESULTS All PNs were accomplished with no hilar clamping, with a mean blood loss of 80 mL; 72% of masses were renal cell carcinoma. There was a positive margin in four masses (13%); 29 tumours (mean size 1.9 cm) were eligible for analysis of oncological outcomes, with a mean follow-up of 31 months. There were no tumour recurrences at the last follow-up, giving a cancer-specific survival rate of 100%. CONCLUSIONS RF-LPN with no hilar clamping simplifies the surgical technique and appears to have excellent cancer control in the intermediate term. In the few patients with a positive surgical margin, it is possible that coagulation beyond the tumour margin kills any residual microscopic tumour, minimizing or obviating the risk of tumour recurrence. Nevertheless, vigilance during tumour excision and margin identification is mandatory.     

Propensity-matched pair analysis of safety and efficacy between laparoscopic and open radical nephrectomy for the treatment of large renal masses (>10 cm): a retrospective cohort study

BackgroundOpen radical nephrectomy (ORN) is a practical procedure for treating patients with large renal carcinomas >10 cm in size, and few studies have focused on feasibility and safety of laparoscopic radical nephrectomy (LRN). The current study was to assess the safety and effectiveness of LRN and ORN in large renal carcinoma patients by propensity matched pair analysis.MethodsIn this cohort study, a retrospective review of radical nephrectomy data from October 2010 to October 2018 at Changhai Hospital was conducted. Patients with renal carcinomas >10 cm in size by pre-operative images were included. Patients’ demographics including age, gender, body mass index (BMI), tumor size, operation time, hospitalization days, etc. were collected. Renal tumor patients undergoing LRN or ORN were match-paired by gender, BMI, age, and tumor size. Peri-operative outcomes including estimated blood loss and complications were compared. The follow-up contents included survival time, disease progression, and cause of death, and cancer-specific and progression-free survival were estimated via Kaplan-Meier curve analysis.ResultsAmong 92 patients with clinical T2b renal masses, 37 pairs were matched. The average tumor sizes of the LRN and ORN groups were 11.37±0.30 and 11.67±0.33 cm (P=0.375), respectively. The average operating time for LRN was slightly longer (204.32±11.17 vs. 192.78±8.50 min, P=0.414). Estimated blood loss (EBL) (336.49±63.58 mL for LRN vs. 545.95±74.52 mL for ORN, P=0.036), the length of postoperative stay [6.0 (5.0–9.0) for LRN vs. 9.0 (6.0–11.5) days for ORN, P=0.015], and removal time of the drainage tube [4.0 (3.0–5.0) days for LRN vs. 5.0 (4.0–6.0) for ORN, P<0.001] were less than in the LRN group. The pathological subtype and Fuhrman grade were comparable. Both groups were followed up for a similar period, and no difference was observed in 5-year survival rates.ConclusionsConsidering the conversion rates and overall complication rates, it seems that LRN for large renal carcinomas demonstrated equivalent peri-operative safety and effectiveness compared with ORN, with no adverse effects on midterm oncological outcomes.