Ipsilateral retroperitoneal papillary renal cell carcinoma 27 years after simple nephrectomy for a renal abscess:A case report

BACKGROUND Cases of severe inflammatory renal disease and renal cell carcinoma(RCC)that occur simultaneously in the same kidney have been occasionally reported.However,extrarenal RCC that does not originate from the native kidney has rarely been reported.To our knowledge,this is the first reported case of RCC developing in the ipsilateral retroperitoneal space after a simple nephrectomy(SN)for inflammatory renal disease.CASE SUMMARY A 63-year-old woman was referred to our hospital following the incidental discovery of a left retroperitoneal mass without specific symptoms.Her medical history revealed a left SN 27 years ago due to a renal abscess.Magnetic resonance imaging of the abdomen revealed three oval masses in the left retroperitoneum.The masses were successfully excised,and subsequent pathology confirmed papillary RCC.After surgery,the patient remained disease-free for 11 years without adjuvant therapy.CONCLUSION Clinicians should be vigilant of RCC in patients with retroperitoneal masses,especially after SN for inflammatory renal disease.

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

“A stitch in time”: Intraoperative diaphragmatic injury during laparoscopic nephrectomy - A case of immediate recognition and expert management

Laparoscopy within the urology field has undergone a noteworthy surge in popularity over the past decade,with particular importance given to renal surgeries such as simple nephrectomy,radical nephrectomy,donor nephrectomy,nephroureterectomy,and partial nephrectomy.1 This shift toward laparoscopic procedures among urologists can be attributed to the many benefits of these procedures,including reduced postoperative pain,shorter hospital stays,and faster recovery times.2 However,as with any evolving surgical technique,laparoscopic procedures in renal surgery bring forth their own set of distinctive challenges and complications.

Incidental renal cell carcinoma post bilateral nephrectomy in autosomal dominant polycystic kidney disease

BACKGROUND Renal cell carcinoma(RCC)is more common in patients with autosomal dominant polycystic kidney disease(ADPKD)than in the general population.Diagnosing RCC in ADPKD is challenging due to the presence of multiple renal cysts,often leading to delays and difficulties in distinguishing RCC from cyst infection or hemorrhage.A total of 38 kidneys were excised from 19 patients,with a mean age of 56.8 years and an average hemodialysis duration of 84.2 months.Eight patients underwent open nephrectomies,and 11 underwent hand-assisted laparoscopic nephrec-tomies.RCC was detected in 15.8%of kidneys,affecting 21.1%of patients.Two patients had multifocal RCC in both kidneys.All RCC cases were pT1 stage,with the largest lesion averaging 16.5 mm in diameter.The average operative duration was 120 minutes,with intraoperative blood loss averaging 184.2 mL.Five patients required blood transfusions.Postoperative complications occurred in five patients,with a mean hospital stay of 17.1 days.The mean follow-up period was 28.1 months.CONCLUSION The prevalence of RCC is higher in patients with ADPKD with ESRD than in those with ESRD alone.Thus,clinicians should be cautious and implement surveillance programs to monitor the development of RCC in patients with ADPKD,particularly those on dialysis.

Clinical Nursing for Patients Undergoing Prone-Position Laparoscopic Partial Nephrectomy

Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were selected,with hospital admission spanning from January 2024 to June 2024.Patients were randomly divided into the study group(n=10)and the control group(n=9).The control group received basic nursing care,while the study group received comprehensive high-quality nursing care.The recovery period,length of hospital stay,complication rates,SCL-90 scores,and nursing quality scores were compared between the two groups.Results:The recovery period and hospital stay were significantly shorter in the study group compared to the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).After the nursing intervention,the SCL-90 scores of the study group were lower than those of the control group(P<0.05).Nursing quality scores were higher in the study group than in the control group(P<0.05).Conclusion:Comprehensive high-quality nursing intervention for patients undergoing prone-position laparoscopic partial nephrectomy can shorten the recovery period and hospital stay,reduce the complication rate,improve mental health,and enhance nursing quality,making it suitable for wider application in medical institutions.

Right versus left fully robotic live donor nephrectomy and open kidney transplantation:Does the laterality of the donor kidney really matter?

Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.

Can preoperative planning using IRIS™three-dimensional anatomical virtual models predict operative findings during robot-assisted partial nephrectomy?

Objective To evaluate the predictive validity of IRIS™(Intuitive Surgical®,Sunnyvale,CA,USA)as a planning tool for robot-assisted partial nephrectomy(RAPN)by assessing the degree of overlap with intraoperative execution.Methods Thirty-one patients scheduled for RAPN by four experienced urologists were enrolled in a prospective study.Prior to surgery,urologists reviewed the IRIS™three-dimensional model on an iphone Operating System(iOS)app and completed a questionnaire outlining their surgical plan including surgical approach,and ischemia technique as well as confidence in executing this plan.Postoperatively,questionnaires assessing the procedural approach,clinical utility,efficiency,and effectiveness of IRIS™were completed.The degree of overlap between the preoperative and intraoperative questionnaires and between the planned approach and actual execution of the procedure was analyzed.Questionnaires were answered on a 5-point Likert scale and scores of 4 or greater were considered positive.Results Mean age was 65.1 years with a mean tumor size of 27.7 mm(interquartile range 17.5-44.0 mm).Hilar tumors consisted of 32.3%;48.4%of patients had R.E.N.A.L.nephrometry scores of 7-9.On preoperative questionnaires,the surgeons reported that in 67.7%cases they were confident that they can perform the procedure successfully,and on intraoperative questionnaires,the surgeons reported that in 96.8%cases IRIS™helped achieve good spatial sensation of the anatomy.There was a high degree of overlap between preoperative and intraoperative questionnaires for the surgical approach,interpreting anatomical details and clinical utility.When comparing plans for selective or off-clamp,the preoperative plan was executed in 90.0%of cases intraoperatively.Conclusion A high degree of overlap between the preoperative surgical approach and intraoperative RAPN execution was found using IRIS™.This is the first study to evaluate the predictive accuracy of IRIS™during RAPN by comparing preoperative plan and intraoperative execution.

A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

The application of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy with a new robotic system KangDuo Surgical Robot-01:Initial experience

Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)system(Suzhou KangDuo Robot Co.,Ltd.,Suzhou,China)and discuss its surgical technique.Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney.The R.E.N.A.L.nephrometry score of this patient was 4x.This patient underwent rRAPN with KD-SR-01.The perinephric fat between the tumor and Gerota's fascia was preserved,which was used for internal suspension traction during tumor resection.Postoperative follow-up data were collected.Results The surgery was successfully carried out with a duration of 127 min,in which the docking time was 6 min 25 s and console time was 60 min.The warm ischemia time was 19 min 53 s,and the estimated blood loss was 0 mL.The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma,with a negative surgical margin.The World Health Organization/International Society of Urological Pathology(WHO/ISUP)grade of this patient was Grade 2.No recurrence was observed during the 6-month follow-up.Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.

Transcatheter embolization for hemorrhage from aberrant testicular artery after partial nephrectomy:A case report

BACKGROUND Arterial bleeding typically involves the renal artery following partial nephrectomy;in this study,we present a case of bleeding originating from the testicular artery that has not been reported in previous studies.CASE SUMMARY A 52-year-old man suffered hemorrhage from a perinephric branch of the aberrant left testicular artery after an open nephron-sparing surgery for renal cell carcinoma.Clinical signs of bleeding were manifested by the patient,such as fresh blood drainage from the catheter,decreased hemoglobin levels,and significant vital sign changes.Since computed tomography did not show evidence of active bleeding,transcatheter angiography was conducted to identify the bleeding site.Fluoroscopic spot images confirmed bleeding derived from a perinephric branch of the testicular artery originating from the segmental artery of the left renal artery.Using n-butyl-2-cyanoacrylate,successful transcatheter arterial embolization of the affected branch was performed.Immediately after the embolization procedure,the bleeding ceased,and the patient experienced complete recovery devoid of complications.CONCLUSION In patients with postoperative arterial hemorrhage after partial nephrectomy,the testicular artery can be a rare but notable source of bleeding.Accurate bleeding site localization via angiographic evaluation,followed by transcatheter arterial embolization,can be instrumental for safe,prompt,and effective hemostasis.

Single omental metastasis of renal cell carcinoma after radical nephrectomy:A case report

BACKGROUND Renal cell carcinoma(RCC)is the third most common malignancy in the genitourinary tract.The lungs,bone,lymph nodes,liver,and brain are common metastatic sites of RCC.However,there is limited literature on single omental metastasis of RCC.CASE SUMMARY We present the case of a 44-year-old man with single omental metastasis of RCC after laparoscopic radical nephrectomy.Pathological diagnosis of the resected left kidney revealed pT3a clear cell RCC(Fuhrman grade III).At 6 mo postoperatively,abdominal computed tomography revealed a 12-mm enhancing nodule in the left lower peritoneum.At 7 mo after initial operation,laparoscopic removal of the left omental nodule was performed.The pathological results indicated metastatic clear cell RCC.Currently,the patient is being treated with adjuvant pembrolizumab.CONCLUSION Omental metastasis of RCC owing to laparoscopic radical nephrectomy is rare.Urologists should be aware of the diverse nature of RCC.

Surgical Video Review of Warm Ischemia Time during Laparoscopic Partial Nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications

Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning.

Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy

Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in literature.This review aims to provide an overview of the current strategies and further perspectives on this patient setting.Methods:A non-systematic review of the literature was completed.The research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific tools.No clear evidence is reported about these methods.Regarding PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by surgery.Regarding local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous PN.In this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive alternative.Salvage surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic approach.Overall,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ablation.Conclusion:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after PN.Active surveillance is likely to be the optimal first-line management option for most patients with PSMs.Ablation and salvage surgery both represent valid options in patients with local recurrence after PN.Conversely,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to TA.In this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectomy outcomes.

Comparison of the oncological,perioperative and functional outcomes of partial nephrectomy versus radical nephrectomy for clinical T1b renal cell carcinoma:A systematic review and metaanalysis of retrospective studies

Objective:To conduct a meta-analysis assessing the perioperative,functional and oncological outcomes of partial nephrectomy(PN)and radical nephrectomy(RN)for T1b tumours.The primary endpoints were the oncological outcomes.The secondary endpoints were the perioperative and functional outcomes.Methods:A systematic literature review was performed by searching multiple databases through February 2019 to identify eligible comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement.Identified reports were assessed according to the Newcastle-Ottawa Scale for nonrandomized controlled trials.Results:Overall,13 retrospective cohort studies were included in the analysis.Patients undergoing PN were younger(weighted mean difference[WMD]3.49 years,95%confidence interval[CI]5.16 to1.82;p<0.0001)and had smaller masses(WMD0.45 cm,95%CI0.59 to0.31;p<0.0001).There were no differences in the oncological outcome,which was demonstrated by progression-free survival(hazard ratio[HR]0.70;pZ0.22),cancerspecific mortality(HR 0.91;pZ0.57)and all-cause mortality(HR 1.01;pZ0.96).The two procedures were similar in estimated blood loss(WMD16.47 mL;pZ0.53)and postoperative complications(risk ratio[RR]1.32;pZ0.10),and PN provided better renal function preservation and was related to a lower likelihood of chronic kidney disease onset(RR 0.38;pZ0.006).Conclusion:PN is an effective treatment for T1b tumours because it offers similar surgical morbidity,equivalent cancer control,and better renal preservation compared to RN.

Solitary Fibrous Tumor of the Kidney Treated with Laparoscopic Partial Nephrectomy: A Case Report

We herein reported a 27-year-old woman with a right renal mass for two years.She underwent laparoscopic partial nephrectomy.Immunohistochemical examination of the specimen confirmed the diagnosis of solitary fibrous tumor by revealing its positive staining for cluster of differentiation(CD)34,epithelial membrane antigen(EMA),B-cell lymphoma-2(Bcl-2)and CD99 in the tumor cells.No adjuvant treatment was carried out.The patient was in good health without local recurrence or metastasis during 2 years of follow-up.Laparoscopic partial nephrectomy for renal solitary fibrous tumor is an alternative treatment to radical nephrectomy.It can provide a good outcome.However,further follow-up and more cases of renal solitary fibrous tumor treated with laparoscopic partial nephrectomy are necessary to compare the oncological outcome with radical nephrectomy.

Laparoscopic vs open donor nephrectomy:Lessons learnt from single academic center experience

AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy （LLDN） and 211 undergoing open donor nephrectomy （OLDN）. Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular fltration rate and creatinine （Cr）, donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant differencebetween the LLDN and the OLDN groups regardingoperating time, donor preoperative renal function, donorand recipient postoperative kidney function, delayed graftfunction or the incidence of major complications. Whenthe last 100 laparoscopic cases were analyzed, there wasa statistically significant difference regarding operatingtime in favor of the LLDN, pointing out the importanceof the learning curve. Furthermore, another significantdifference between the two groups was the decreasedlength of stay for the LLDN （2.87 d for LLDN vs 3.6 d for OLDN）.CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profle comparable to OLDN and decreased length of stay for the donor.

Current practice of live donor nephrectomy in Turkey

BACKGROUND Over the last few years,the deceased donor organ donation rate was declined or remained stable,whereas the live donor organ donation rate has increased to compensate for the demand.Minimally invasive techniques for live donor nephrectomy(LDN)have also improved the live donor kidney donation rates.This increase has led to an interest in the surgical procedures used for LDN.AIM To evaluate the LDN techniques performed in Turkey,the structure of surgical teams,and the training received.Additionally,the number of kidney transplantations at different centers,the surgeon experience level,differences in surgical approach during donor surgeries,and outcomes were assessed.METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers.It inquired of the number of LDN surgeries,surgical techniques,complications,optimization protocols,the experience of surgeons,and the training.Descriptive statistics were outlined as follows:Discrete numeric variables were expressed as medians(minimum-maximum),while categorical variables were shown as numbers and percentages.As a result of the goodness-of-fit tests,if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met,data were analyzed with the Mann Whitney U test and theχ^(2)test.RESULTS The questionnaire was sent to 72 transplant centers,all of which replied.Five centers that reported not performing LDN procedures were excluded.Responses from the remaining 67 centers were analyzed.In 2019,the median number of kidney transplants performed was 45,and the median number of kidney transplants from living donors was 28(1-238).Eleven(16.5%)centers performed 5-10,while 34(50.7%)centers performed more than 100 live donor kidney transplants in 2019.While 19(28.4%)centers performed the LDN procedures using the open technique,48(71.6%)centers implemented minimally invasive techniques.Among the centers preferring minimally invasive techniques for LDN,eight(16.6%)used more than one surgical technique.The most and the least common surgical techniques were transperitoneal laparoscopic(43 centers,89.6%)and single port laparoscopic LDN(1 center,2.1%)techniques,respectively.A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center,both in the total number and live donor kidney transplants(15 vs 55,P=0.001 and 9 vs 42,P≤0001 respectively).The most frequently reported complication was postoperative atelectasis(n=33,49.2%).There was no difference between the techniques concerning complications except for the chyle leak.CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques.Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.

Open Partial Nephrectomy: One Night Length of Stay Is Safe and Cost Effective

Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.

Ultrasound-Guided Transmuscular Quadratus Lumbar Block Reduces Opioid Consumption after Laparoscopic Partial Nephrectomy

Objectives Transmuscular quadratus lumborum block(TQLB)may provide postoperative analgesia in patients undergoing intraperitoneal surgeries.The purpose of this study was to examine the potential efficacy of TQLB among patients undergoing retroperitoneal procedures,such as the laparoscopic partial nephrectomy(LPN).Methods This prospective,randomized,controlled study was conducted from August 2017 to November 2018 at Peking Union Medical College Hospital(Beijing,China).Patients who were scheduled for a LPN,aged 18・70 years old with an ASA physical status score of I-II were randomly assigned to receive either TQLB with 0.6 ml/kg of 0.5%ropivacaine plus general anesthesia(TQLB group)or general anesthesia alone(control group).Patient-controlled intravenous analgesia with morphine was initiated immediately upon surgery completion.The primary outcome was the cumulative consumption of morphine within 8 h after surgery.The secondary outcome included postoperative consump廿ons of morphine at other time points,pain score at rest and during activity,postoperative nausa and vomitting(PONV),and recovery related parameters.Results Totally 30 patients per group were recruited in the study.The 8 h consumption of morphine was lower in theTQLB group than in the control group(median,0.023 mg/kg vs.0.068 mg/kg,U=207.5,P<0.001).No significant differences were observed in postoperative pain scores between the two groups.Patients in the TQLB group had fewer episodes of PONV(20%vs.47%,χ2=4.&P=0.028)in the first 24 h after surgery and higher scores for quality of recovery(mean,13&6 vs.131.9,t=-2.164,P=0.035)120 h after surgery than the controls.Conclusions TQLB resulted in an opioid-sparing effect during the early postoperative period following LPN,as well as a lower incidence of PONV and improved quality of recovery.

Retroperitoneal Versus Transperitoneal Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis

Objective To review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy(RLPN) with transperitoneal laparoscopic partial nephrectomy(TLPN) and provide reference for clinical work. Methods The search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate. Results The literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference(MD)=-33.68, 95% confidence interval(CI) within(-60.35,-7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within(-2.18,-0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes. Conclusions RLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.