Feasibility, safety and efficacy of argon beam coagulation in robot-assisted partial nephrectomy for solid renal masses ≤ 7 cm in size.
Argon beam coagulation
Renal cancer
Renorrhaphy
Robot-assisted partial nephrectomy
Warm ischemia time
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
20
07
2020
accepted:
05
10
2020
pubmed:
14
10
2020
medline:
29
10
2021
entrez:
13
10
2020
Statut:
ppublish
Résumé
One of the most important steps of the partial nephrectomy (PN) is hemostatic control of tumor bed which also effects the warm ischemia time (WIT). Argon beam coagulation (ABC) for decades is a well-known method for surface controls during major open surgical sites. This study aimed to compare peri- and postoperative relevant parameters in patients with ABC or internal renorrhaphy (IR) during robot-assisted partial nephrectomy (RAPN). One hundred seventy patients with ≤ 7 cm tumors, who underwent RAPN at our institutions, were included in this retrospective study. Tumor bed was controlled by either IR or by ABC after closing isolated overt collecting system defects. No additional IR was performed in patients with ABC. Estimated blood loss (EBL), WIT, estimated glomerular filtration rate (eGFR) change, on- vs. off-clamp procedure as well as Clavien-Dindo > 2 complications in both groups were compared. Eighty-seven (51.1%) patients had ABC and 83 (48.9%) had IR as their tumor bed control method. Tumor size, side and RENAL nephrometry score in both groups were similar. Mean warm ischemia time (WIT) was 20.8 min in ABC group and 23.8 min in IR group (p = 0.03). In 4-7 cm tumors, WIT was 19.9 min in ABC group while 26.6 min in IR group (p = 0.026). eGFR change from baseline and EBL favored ABC in entire cohort as well as in 4-7 cm tumors with statistical significance. There were more off-clamp procedures with ABC in ≤ 4 cm tumors. No ABC specific complications were observed. Within 2 years of follow-up, no patient developed recurrences. The control of the tumor base with ABC during RAPN shortens the warm ischemia times significantly compared to IR. Besides, ABC had better EBL and GFR changes outcomes. With close monitoring of intra-abdominal pressure and frequent venting, disturbing complications of ABC could completely be avoided. ABC was found to be feasible, safe and effective during RAPN.
Identifiants
pubmed: 33048263
doi: 10.1007/s11701-020-01158-4
pii: 10.1007/s11701-020-01158-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
671-677Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020. Springer-Verlag London Ltd., part of Springer Nature.
Références
Huang WC, Elkin EB, Levey AS, Jang TL, Russo P (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes? J Urol 181(1):55–61
doi: 10.1016/j.juro.2008.09.017
Kates M, Badalato GM, Pitman M, McKiernan JM (2011) Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol 186(4):1247–1253
doi: 10.1016/j.juro.2011.05.054
Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924
doi: 10.1016/j.eururo.2015.01.005
Chang KD, Abdel Raheem A, Kim KH, Oh CK, Park SY, Kim YS, Ham WS, Han WK, Choi YD, Chung BH et al (2018) Functional and oncological outcomes of open, laparoscopic and robot-assisted partial nephrectomy: a multicentre comparative matched-pair analyses with a median of 5 years' follow-up. BJU Int 122(4):618–626
doi: 10.1111/bju.14250
Zhang C, Xu Y, Zhang Z, Qiao B, Yang K, Liu R, Ma B (2012) Laparoscopic simple enucleation and coagulation on tumor bed using argon beam coagulator for treating small renal cell carcinomas: an animal study followed by clinical application. Med Sci Monit 18(5):193–197
doi: 10.12659/MSM.882729
Quinlan DM, Naslund MJ, Brendler CB (1992) Application of argon beam coagulation in urological surgery. J Urol 147(2):410–412
doi: 10.1016/S0022-5347(17)37252-X
Shin TJ, Song C, Kim CS, Ahn H (2020) Surgical details and renal function change after robot-assisted partial nephrectomy. Int J Urol 27:457–462
doi: 10.1111/iju.14224
Khalifeh A, Autorino R, Eyraud R, Samarasekera D, Laydner H, Panumatrassamee K, Stein RJ, Kaouk JH (2013) Three-year oncologic and renal functional outcomes after robot-assisted partial nephrectomy. Eur Urol 64(5):744–750
doi: 10.1016/j.eururo.2013.03.052
Dagenais J, Maurice MJ, Mouracade P, Kara O, Malkoc E, Kaouk JH (2017) Excisional precision matters: understanding the influence of excisional volume loss on renal function after partial nephrectomy. Eur Urol 72(2):168–170
doi: 10.1016/j.eururo.2017.02.004
Zargar H, Akca O, Ramirez D, Brandao LF, Laydner H, Krishnan J, Stein RJ, Kaouk JH (2015) The impact of extended warm ischemia time on late renal function after robotic partial nephrectomy. J Endourol 29(4):444–448
doi: 10.1089/end.2014.0557
Orvieto MA, Tolhurst SR, Chuang MS, Lyon MB, Ritch CR, Rapp DE, Shalhav AL (2005) Defining maximal renal tolerance to warm ischemia in porcine laparoscopic and open surgery model. Urology 66(5):1111–1115
doi: 10.1016/j.urology.2005.05.027
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
Acar O, Esen T, Musaoglu A, Vural M (2014) Do we need to clamp the renal hilum liberally during the initial phase of the learning curve of robot-assisted nephron-sparing surgery? ScientificWorldJournal 2014:498917
doi: 10.1155/2014/498917
Antonelli A, Veccia A, Francavilla S, Bertolo R, Bove P, Hampton LJ, Mari A, Palumbo C, Simeone C, Minervini A et al (2019) On-clamp versus off-clamp robotic partial nephrectomy: a systematic review and meta-analysis. Urologia 86(2):52–62
doi: 10.1177/0391560319847847
Bertolo R, Simone G, Garisto J, Nakhoul G, Armanyous S, Agudelo J, Costantini M, Tuderti G, Gallucci M, Kaouk J (2019) Off-clamp vs on-clamp robotic partial nephrectomy: perioperative, functional and oncological outcomes from a propensity-score matching between two high-volume centers. Eur J Surg Oncol 45(7):1232–1237
doi: 10.1016/j.ejso.2018.12.005
Cohenpour M, Strauss S, Gottlieb P, Peer A, Rimon U, Stav K, Gayer G (2007) Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 62(11):1104–1109
doi: 10.1016/j.crad.2007.06.004
Bahler CD, Sundaram CP (2016) Effect of renal reconstruction on renal function after partial nephrectomy. J Endourol 30(Suppl 1):S37–41
doi: 10.1089/end.2016.0055
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 26(6):642–646
doi: 10.1089/end.2011.0340
Ficarra V, Bhayani S, Porter J, Buffi N, Lee R, Cestari A, Novara G, Mottrie A (2012) Robot-assisted partial nephrectomy for renal tumors larger than 4 cm: results of a multicenter, international series. World J Urol 30(5):665–670
doi: 10.1007/s00345-012-0943-9
Takagi T, Kondo T, Tajima T, Campbell SC, Tanabe K (2014) Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm. Int J Urol 21(9):880–885
doi: 10.1111/iju.12462
Tohi Y, Murata S, Makita N, Suzuki I, Kubota M, Sugino Y, Inoue K, Ueda H, Kawakita M (2020) Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy. Asian J Urol 7(1):24–28
doi: 10.1016/j.ajur.2019.07.006
Tachibana H, Takagi T, Kondo T, Ishida H, Tanabe K (2018) Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: a propensity score-matched analysis. Int Braz J Urol 44(3):467–474
doi: 10.1590/s1677-5538.ibju.2016.0581
Hernandez AD, Smith JA Jr, Jeppson KG, Terreros DA (1990) A controlled study of the argon beam coagulator for partial nephrectomy. J Urol 143(5):1062–1065
doi: 10.1016/S0022-5347(17)40184-4
Wolf JS Jr, Stoller ML (1994) The physiology of laparoscopy: basic principles, complications and other considerations. J Urol 152(2 Pt 1):294–302
doi: 10.1016/S0022-5347(17)32724-6
Neuhaus SJ, Gupta A, Watson DI (2001) Helium and other alternative insufflation gases for laparoscopy. Surg Endosc 15(6):553–560
doi: 10.1007/s004640080060
Weld KJ, Ames CD, Landman J, Morrissey K, Connor T, Hruby G, Allaf ME, Bhayani SB (2005) Evaluation of intra-abdominal pressures and gas embolism during laparoscopic partial nephrectomy in a porcine model. J Urol 174(4 Pt 1):1457–1459
doi: 10.1097/01.ju.0000173010.96639.85
Shanberg AM, Zagnoev M, Clougherty TP (2002) Tension pneumothorax caused by the argon beam coagulator during laparoscopic partial nephrectomy. J Urol 168(5):2162
doi: 10.1016/S0022-5347(05)64342-X
Choi JE, You JH, Kim DK, Rha KH, Lee SH (2015) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67(5):891–901
doi: 10.1016/j.eururo.2014.12.028