Robotic partial nephrectomy is associated with a significantly decreased rate of postoperative pseudoaneurysm compared to open and laparoscopic partial nephrectomy.
Humans
Nephrectomy
/ methods
Aneurysm, False
/ surgery
Robotic Surgical Procedures
/ methods
Male
Female
Middle Aged
Laparoscopy
/ methods
Retrospective Studies
Postoperative Complications
/ epidemiology
Aged
Renal Artery
/ surgery
Kidney Neoplasms
/ surgery
Incidence
Treatment Outcome
Embolization, Therapeutic
/ methods
Angiography
Laparoscopic partial nephrectomy
Open partial nephrectomy
Postoperative
Pseudoaneurysm
Renal artery
Robotic partial nephrectomy
Selective embolization
Journal
Journal of robotic surgery
ISSN: 1863-2491
Titre abrégé: J Robot Surg
Pays: England
ID NLM: 101300401
Informations de publication
Date de publication:
04 Jun 2024
04 Jun 2024
Historique:
received:
14
04
2024
accepted:
27
05
2024
medline:
4
6
2024
pubmed:
4
6
2024
entrez:
4
6
2024
Statut:
epublish
Résumé
While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.
Identifiants
pubmed: 38833079
doi: 10.1007/s11701-024-01999-3
pii: 10.1007/s11701-024-01999-3
doi:
Types de publication
Journal Article
Comparative Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
241Informations de copyright
© 2024. The Author(s).
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