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Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses

Nicolomaria Buffi, Alessandro Uleri, Marco Paciotti, Giovanni Lughezzani, Paolo Casale, Pietro Diana, Ruben De Groote, Luca Sarchi, Angelo Mottaran, Carlo Bravi, et al.
(2023) MINERVA UROLOGY AND NEPHROLOGY. 75(2). p.223-230
Author
Organization
Abstract
BACKGROUND: Patients with multiple ipsilateral renal masses have an augmented risk of metachronous contralateral lesions and are likely to undergo repeated surgeries. We report our experience with the technologies currently available and the surgical techniques to preserve healthy parenchyma while guaranteeing oncological radicality during robot-assisted partial nephrectomy (RAPN). METHODS: The data were collected at three tertiary-care centers, where 61 patients with multiple ipsilateral renal masses were treated with RAPN between 2012 and 2021. RAPN was performed with da Vinci Si or Xi surgical system using TilePro (Life360; San Francisco, CA, USA), indocyanine green fluorescence and intraoperative ultrasound. Three-dimensional reconstructions were built in some cases preoperatively. Different techniques were employed for hilum management. The primary endpoint is to report intra-and postoperative complications. Secondary endpoints were the estimated blood loss (EBL), warm ischemia time (WIT) and positive surgical margins (PSM) rate.RESULTS: Median preoperative size of the largest mass was 37.5 mm (24-51) with a median PADUA and R.E.N.A.L. score of 8 (7-9) and 7 (6-9). One hundred forty-two tumors were excised, with a mean number of 2.32. The median WIT was 17 (12-24) minutes, and the median EBL was 200 (100-400) mL. Intraoperative ultrasound was employed in 40 (67.8%) patients. The rate of early unclamping, selective clamping and zero-ischemia were respectively 13 (21.3%), 6 (9.8%) and 13 (21.3%). ICG fluorescence was employed in 21 (34.42%) patients and three-dimensional reconstructions were built in 7 (11.47%) patients. Three (4.8%) intraoperative complications occurred, all classified as grade-1 according to EAUiaiC. Postoperative complications were reported in 14 (22.9%) cases with 2 Clavien-Dindo grade >2 complica-tions. Four (6.56%) patients had PSM. Mean period of follow-up was 21 months.CONCLUSIONS: In experienced hands, with the employment of the currently available technologies and surgical tech-niques, RAPN can guarantee optimal outcomes in patients with multiple ipsilateral renal masses.(Cite this article as: Buffi N, Uleri A, Paciotti M, Lughezzani G, Casale P, Diana P, et al. Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses. Minerva Urol Nephrol 2023;75:223-30. DOI: 10.23736/S2724-6051.23.05161-3)
Keywords
Urology, Nephrology, X-ray computed, Tomography, Nephrectomy, Kidney neoplasms

Citation

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MLA
Buffi, Nicolomaria, et al. “Techniques and Outcomes of Robot-Assisted Partial Nephrectomy for the Treatment of Multiple Ipsilateral Renal Masses.” MINERVA UROLOGY AND NEPHROLOGY, vol. 75, no. 2, Edizioni Minerva Medica, 2023, pp. 223–30, doi:10.23736/s2724-6051.23.05161-3.
APA
Buffi, N., Uleri, A., Paciotti, M., Lughezzani, G., Casale, P., Diana, P., … Mottrie, A. (2023). Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses. MINERVA UROLOGY AND NEPHROLOGY, 75(2), 223–230. https://doi.org/10.23736/s2724-6051.23.05161-3
Chicago author-date
Buffi, Nicolomaria, Alessandro Uleri, Marco Paciotti, Giovanni Lughezzani, Paolo Casale, Pietro Diana, Ruben De Groote, et al. 2023. “Techniques and Outcomes of Robot-Assisted Partial Nephrectomy for the Treatment of Multiple Ipsilateral Renal Masses.” MINERVA UROLOGY AND NEPHROLOGY 75 (2): 223–30. https://doi.org/10.23736/s2724-6051.23.05161-3.
Chicago author-date (all authors)
Buffi, Nicolomaria, Alessandro Uleri, Marco Paciotti, Giovanni Lughezzani, Paolo Casale, Pietro Diana, Ruben De Groote, Luca Sarchi, Angelo Mottaran, Carlo Bravi, Pieter De Backer, Daniele Amparore, Cristian Fiori, Francesco Porpiglia, and Alexandre Mottrie. 2023. “Techniques and Outcomes of Robot-Assisted Partial Nephrectomy for the Treatment of Multiple Ipsilateral Renal Masses.” MINERVA UROLOGY AND NEPHROLOGY 75 (2): 223–230. doi:10.23736/s2724-6051.23.05161-3.
Vancouver
1.
Buffi N, Uleri A, Paciotti M, Lughezzani G, Casale P, Diana P, et al. Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses. MINERVA UROLOGY AND NEPHROLOGY. 2023;75(2):223–30.
IEEE
[1]
N. Buffi et al., “Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses,” MINERVA UROLOGY AND NEPHROLOGY, vol. 75, no. 2, pp. 223–230, 2023.
@article{01H6VZCPDWW3SGZZ1TY75340AW,
  abstract     = {{BACKGROUND: Patients with multiple ipsilateral renal masses have an augmented risk of metachronous contralateral lesions and are likely to undergo repeated surgeries. We report our experience with the technologies currently available and the surgical techniques to preserve healthy parenchyma while guaranteeing oncological radicality during robot-assisted partial nephrectomy (RAPN). METHODS: The data were collected at three tertiary-care centers, where 61 patients with multiple ipsilateral renal masses were treated with RAPN between 2012 and 2021. RAPN was performed with da Vinci Si or Xi surgical system using TilePro (Life360; San Francisco, CA, USA), indocyanine green fluorescence and intraoperative ultrasound. Three-dimensional reconstructions were built in some cases preoperatively. Different techniques were employed for hilum management. The primary endpoint is to report intra-and postoperative complications. Secondary endpoints were the estimated blood loss (EBL), warm ischemia time (WIT) and positive surgical margins (PSM) rate.RESULTS: Median preoperative size of the largest mass was 37.5 mm (24-51) with a median PADUA and R.E.N.A.L. score of 8 (7-9) and 7 (6-9). One hundred forty-two tumors were excised, with a mean number of 2.32. The median WIT was 17 (12-24) minutes, and the median EBL was 200 (100-400) mL. Intraoperative ultrasound was employed in 40 (67.8%) patients. The rate of early unclamping, selective clamping and zero-ischemia were respectively 13 (21.3%), 6 (9.8%) and 13 (21.3%). ICG fluorescence was employed in 21 (34.42%) patients and three-dimensional reconstructions were built in 7 (11.47%) patients. Three (4.8%) intraoperative complications occurred, all classified as grade-1 according to EAUiaiC. Postoperative complications were reported in 14 (22.9%) cases with 2 Clavien-Dindo grade >2 complica-tions. Four (6.56%) patients had PSM. Mean period of follow-up was 21 months.CONCLUSIONS: In experienced hands, with the employment of the currently available technologies and surgical tech-niques, RAPN can guarantee optimal outcomes in patients with multiple ipsilateral renal masses.(Cite this article as: Buffi N, Uleri A, Paciotti M, Lughezzani G, Casale P, Diana P, et al. Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses. Minerva Urol Nephrol 2023;75:223-30. DOI: 10.23736/S2724-6051.23.05161-3)}},
  author       = {{Buffi, Nicolomaria and Uleri, Alessandro and Paciotti, Marco and Lughezzani, Giovanni and Casale, Paolo and Diana, Pietro and De Groote, Ruben and Sarchi, Luca and Mottaran, Angelo and Bravi, Carlo and De Backer, Pieter and Amparore, Daniele and Fiori, Cristian and Porpiglia, Francesco and Mottrie, Alexandre}},
  issn         = {{2724-6051}},
  journal      = {{MINERVA UROLOGY AND NEPHROLOGY}},
  keywords     = {{Urology,Nephrology,X-ray computed,Tomography,Nephrectomy,Kidney neoplasms}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{223--230}},
  publisher    = {{Edizioni Minerva Medica}},
  title        = {{Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses}},
  url          = {{http://doi.org/10.23736/s2724-6051.23.05161-3}},
  volume       = {{75}},
  year         = {{2023}},
}
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