Radiofrequency ablation-assisted robotic laparoscopic partial nephrectomy without renal hilar vessel clamping versus laparoscopic partial nephrectomy: A comparison of perioperative outcomes

Simon D. Wu, Davis P. Viprakasit, John Cashy, Norm D. Smith, Kent T Perry Jr, Robert B Nadler

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Abstract

Objectives: Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy (LPN) may allow for improved hemostasis without need for renal hilar vessel clamping and elimination of warm ischemia to the kidney. We compare outcomes in patients undergoing radiofrequency ablation-assisted robotic clampless partial nephrectomy (RF-RCPN) and LPN. Methods: Thirty-six patients and 42 patients underwent LPN and RF-RCPN, respectively. In the RF-RCPN group, the Habib 4× RFA device was used to coagulate a margin of normal parenchyma around the renal mass to allow excision of the mass within a bloodless plane. Unlike in the LPN group, renal hilar vascular occlusion was not performed in the RF-RCPN group. Results: Tumors treated in the RF-RCPN group tended to be larger (2.8vs. 2.0cm) and more often endophytic (52.6% vs. 16.1%). Collecting system reconstruction occurred more often in the RF-RCPN group (78.6% vs. 30.6%). Operative duration was longer in the RF-RCPN group (373vs. 250 minutes), but this included time for cystoscopy, ureteral stenting, and repositioning of the patient. Blood loss, transfusion rates, renal function, and complication rates did not differ between the two groups. No patients required renal hilar vessel clamping or nephrectomy to control bleeding in the RF-RCPN group. Conclusions: The use of RFA-assistance during robotic partial nephrectomy allows excision of renal tumors without hilar vascular clamping, thus eliminating renal warm ischemia. Larger and more centrally located tumors were excised with RF-RCPN. No differences in blood loss, complication rate, postoperative bleeding, renal function, or recurrence rate were noted compared with LPN.

Original languageEnglish (US)
Pages (from-to)385-391
Number of pages7
JournalJournal of Endourology
Volume24
Issue number3
DOIs
StatePublished - Mar 1 2010

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Robotics
Nephrectomy
Constriction
Kidney
Warm Ischemia
Blood Vessels
Hemorrhage
Moving and Lifting Patients
Neoplasms
Cystoscopy
Hemostasis
Blood Transfusion

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Radiofrequency ablation-assisted robotic laparoscopic partial nephrectomy without renal hilar vessel clamping versus laparoscopic partial nephrectomy: A comparison of perioperative outcomes",
abstract = "Objectives: Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy (LPN) may allow for improved hemostasis without need for renal hilar vessel clamping and elimination of warm ischemia to the kidney. We compare outcomes in patients undergoing radiofrequency ablation-assisted robotic clampless partial nephrectomy (RF-RCPN) and LPN. Methods: Thirty-six patients and 42 patients underwent LPN and RF-RCPN, respectively. In the RF-RCPN group, the Habib 4× RFA device was used to coagulate a margin of normal parenchyma around the renal mass to allow excision of the mass within a bloodless plane. Unlike in the LPN group, renal hilar vascular occlusion was not performed in the RF-RCPN group. Results: Tumors treated in the RF-RCPN group tended to be larger (2.8vs. 2.0cm) and more often endophytic (52.6{\%} vs. 16.1{\%}). Collecting system reconstruction occurred more often in the RF-RCPN group (78.6{\%} vs. 30.6{\%}). Operative duration was longer in the RF-RCPN group (373vs. 250 minutes), but this included time for cystoscopy, ureteral stenting, and repositioning of the patient. Blood loss, transfusion rates, renal function, and complication rates did not differ between the two groups. No patients required renal hilar vessel clamping or nephrectomy to control bleeding in the RF-RCPN group. Conclusions: The use of RFA-assistance during robotic partial nephrectomy allows excision of renal tumors without hilar vascular clamping, thus eliminating renal warm ischemia. Larger and more centrally located tumors were excised with RF-RCPN. No differences in blood loss, complication rate, postoperative bleeding, renal function, or recurrence rate were noted compared with LPN.",
author = "Wu, {Simon D.} and Viprakasit, {Davis P.} and John Cashy and Smith, {Norm D.} and {Perry Jr}, {Kent T} and Nadler, {Robert B}",
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TY - JOUR

T1 - Radiofrequency ablation-assisted robotic laparoscopic partial nephrectomy without renal hilar vessel clamping versus laparoscopic partial nephrectomy

T2 - A comparison of perioperative outcomes

AU - Wu, Simon D.

AU - Viprakasit, Davis P.

AU - Cashy, John

AU - Smith, Norm D.

AU - Perry Jr, Kent T

AU - Nadler, Robert B

PY - 2010/3/1

Y1 - 2010/3/1

N2 - Objectives: Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy (LPN) may allow for improved hemostasis without need for renal hilar vessel clamping and elimination of warm ischemia to the kidney. We compare outcomes in patients undergoing radiofrequency ablation-assisted robotic clampless partial nephrectomy (RF-RCPN) and LPN. Methods: Thirty-six patients and 42 patients underwent LPN and RF-RCPN, respectively. In the RF-RCPN group, the Habib 4× RFA device was used to coagulate a margin of normal parenchyma around the renal mass to allow excision of the mass within a bloodless plane. Unlike in the LPN group, renal hilar vascular occlusion was not performed in the RF-RCPN group. Results: Tumors treated in the RF-RCPN group tended to be larger (2.8vs. 2.0cm) and more often endophytic (52.6% vs. 16.1%). Collecting system reconstruction occurred more often in the RF-RCPN group (78.6% vs. 30.6%). Operative duration was longer in the RF-RCPN group (373vs. 250 minutes), but this included time for cystoscopy, ureteral stenting, and repositioning of the patient. Blood loss, transfusion rates, renal function, and complication rates did not differ between the two groups. No patients required renal hilar vessel clamping or nephrectomy to control bleeding in the RF-RCPN group. Conclusions: The use of RFA-assistance during robotic partial nephrectomy allows excision of renal tumors without hilar vascular clamping, thus eliminating renal warm ischemia. Larger and more centrally located tumors were excised with RF-RCPN. No differences in blood loss, complication rate, postoperative bleeding, renal function, or recurrence rate were noted compared with LPN.

AB - Objectives: Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy (LPN) may allow for improved hemostasis without need for renal hilar vessel clamping and elimination of warm ischemia to the kidney. We compare outcomes in patients undergoing radiofrequency ablation-assisted robotic clampless partial nephrectomy (RF-RCPN) and LPN. Methods: Thirty-six patients and 42 patients underwent LPN and RF-RCPN, respectively. In the RF-RCPN group, the Habib 4× RFA device was used to coagulate a margin of normal parenchyma around the renal mass to allow excision of the mass within a bloodless plane. Unlike in the LPN group, renal hilar vascular occlusion was not performed in the RF-RCPN group. Results: Tumors treated in the RF-RCPN group tended to be larger (2.8vs. 2.0cm) and more often endophytic (52.6% vs. 16.1%). Collecting system reconstruction occurred more often in the RF-RCPN group (78.6% vs. 30.6%). Operative duration was longer in the RF-RCPN group (373vs. 250 minutes), but this included time for cystoscopy, ureteral stenting, and repositioning of the patient. Blood loss, transfusion rates, renal function, and complication rates did not differ between the two groups. No patients required renal hilar vessel clamping or nephrectomy to control bleeding in the RF-RCPN group. Conclusions: The use of RFA-assistance during robotic partial nephrectomy allows excision of renal tumors without hilar vascular clamping, thus eliminating renal warm ischemia. Larger and more centrally located tumors were excised with RF-RCPN. No differences in blood loss, complication rate, postoperative bleeding, renal function, or recurrence rate were noted compared with LPN.

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DO - 10.1089/end.2009.0199

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