Need for intraoperative ultrasound and surgical recommendation for partial nephrectomy: correlation with tumor imaging features and urologist practice patterns.
ABSTRACT This study aimed to evaluate the need for intraoperative ultrasound (IOUS) and recommendation for surgical approach in the resection of renal tumors through a survey of practicing urologists, with correlation to tumor imaging features and urologist practice pattern.
An institutional review board-approved retrospective review, compliant with the Health Insurance Portability and Accountability Act, of 44 renal tumors that underwent laparoscopic partial nephrectomy at the study institution was performed. The numeric component of the RENAL nephrometry score (radius [diameter], % exophytic, nearness [to collecting system/renal sinus], location) was calculated for each case using preoperative computed tomography/magnetic resonance imaging. Five anonymized images of each tumor were presented to 4 academic urologists with varying practice patterns. Reviewers independently scored each case for its need for IOUS, for recommendation of a surgical technique, and for the difficulty of the proposed surgery.
The RENAL scores were as follows: RENAL 1 (low complexity, score 4-6; n = 19); RENAL 2 (moderate complexity, score 7-9; n = 23); RENAL 3 (high complexity, score 10-12; n = 2). The only RENAL score component significantly influencing need for IOUS was percentage exophytic (P = 0.00002). There was an inverse relationship between normalized and averaged need for IOUS and percentage exophytic (P < 0.0001). The predominant influence for recommendation of surgical method was the reviewer him/herself, with each reviewer's recommendations closely matching his/her practice pattern. Size and percentage exophytic represented the only tumor features significantly (P = 0.03) influencing surgical recommendation.
There was a significant difference in the perceived need for IOUS and surgical recommendation when 4 academic urologists reviewed a series of renal masses requiring resection. Percentage exophytic correlated inversely with need for IOUS. Urologist's practice pattern and tumor size and percentage exophytic were most predictive of surgical recommendation.
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ABSTRACT: Minimally invasive partial nephrectomy (MIPN) for upper pole masses, particularly for those located posteriorly, is challenging due to difficult visualization during tumor resection and renorrhaphy. Complete renal transposition facilitates access to and excision of upper pole renal masses during MIPN. Sixteen patients with upper pole renal masses underwent laparoscopic or robot-assisted partial nephrectomy with renal transposition from October 2009 to March 2012 with a mean follow-up of 22 months. Mean operative time was 242.6 minutes and mean warm ischemic time was 14.7 minutes. No patient required an intraoperative or postoperative blood transfusion. Five patients (31%) had a postoperative complication (four Clavien grade I, one Clavien grade II). There were no delayed complications, positive surgical margins, or tumor recurrences. Mean postoperative eGFR change within 3 months was -9.4%. These results show that complete renal transposition can be safely employed to facilitate excision of upper pole tumors.Journal of endourology / Endourological Society 06/2013; 27(9). DOI:10.1089/end.2013.0225 · 2.10 Impact Factor
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ABSTRACT: Objectives To evaluate and compare perioperative outcomes of robotic partial nephrectomy (RPN) using robotic and laparoscopic ultrasound probe for tumor identification. Materials and Methods Data from 75 consecutive RPN procedures using a laparoscopic ultrasound probe (January 2009 - November 2010) and 75 consecutive RPN procedures using a robotic ultrasound probe (November 2010 - November 2011) were collected. Perioperative outcomes of the two groups were retrospectively analyzed. Results A total of 72 patients underwent 75 consecutive RPN using the laparoscopic ultrasound probe followed by 73 patients that underwent 75 consecutive RPNs using the robotic ultrasound probe. Characteristics were similar between groups and tumors had similar complexity (mean nephrometry score 6.6 vs 6.8, p=0.534), mean OR time (234 vs. 218 min, p=0.095), mean console time (173 vs. 156 min, p=0.071) mean blood loss (171 mL vs. 164 mL, p=0.79) and positive tumor margin rates (1.2% vs. 2.2%, p=1) did not achieve significance. All patients are free of cancer recurrence after a mean followup of 25.7 months in the laparoscopic probe group and 10.2 months in the robotic probe group. Conclusions Robotic ultrasound probe for tumor identification during RPN had comparable perioperative outcomes and surgical margin rates as a laparoscopic ultrasound probe, but with the advantage of surgeon autonomy.Journal of endourology / Endourological Society 03/2013; 27(9). DOI:10.1089/end.2012.0528 · 2.10 Impact Factor
European Urology 11/2013; 65(3). DOI:10.1016/j.eururo.2013.11.001 · 12.48 Impact Factor