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Warm Ischemia During Robotic Partial Nephrectomy

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Robotic Urology

Abstract

The last two decades have seen the sunset of the radical nephrectomy era in favor of nephron sparing techniques for the surgical treatment of renal masses, especially for T1 renal tumors. The rationale of this evolution was based on the evidence of similar oncological results with a better postoperative renal function in case of nephron sparing approach (Ljungberg et al., Eur Urol 67:913–924, 2015). Simultaneously the new minimally invasive techniques, such as pure and robot-assisted laparoscopy, have been developed and used as the preferred approach to nephron sparing surgery (Pierorazio et al., Urology 78:813–819, 2011). Particularly, the three-dimensional visualization and the optical magnification allowed by robotic technology haveincreased the indication to nephron sparing surgery regardless the surgeon experience, shortening the learning curve of beginner surgeons. In experienced hands, robotic approach has pushed forward the limits of nephron sparing surgery with the aim of saving renal units the more as possible (Long et al., Eur Urol 61:1257–1262, 2012; Lavery et al., JSLS 15:291–297, 2011).

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References

  1. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913–24.

    Article  PubMed  Google Scholar 

  2. Pierorazio PM, Patel HD, Feng T, Yohannan J, Hyams ES, Allaf ME. Robotic-assisted versus traditional laparoscopic partial nephrectomy: comparison of outcomes and evaluation of learning curve. Urology. 2011;78(4):813–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Long JA, Yakoubi R, Lee B, Guillotreau J, Autorino R, Laydner H, Eyraud R, Stein RJ, Kaouk JH, Haber GP. Robotic versus laparoscopic partial nephrectomy for complex tumors: comparison of perioperative outcomes. Eur Urol. 2012;61(6):1257–62.

    Article  PubMed  Google Scholar 

  4. Lavery HJ, Small AC, Samadi DB, Palese MA. Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS. 2011;15(3):291–7.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Blute ML, Campbell SC. Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney. Urology. 2012;79(2):356–60.

    Article  PubMed  Google Scholar 

  6. Klatte T, Ficarra V, Gratzke C, Kaouk J, Kutikov A, Macchi V, Mottrie A, Porpiglia F, Porter J, Rogers CG, Russo P, Thompson RH, Uzzo RG, Wood CG, Gill IS. A literature review of renal surgical anatomy and surgical strategies for partial nephrectomy. Eur Urol. 2015;68(6):980–92.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lane BR, Babineau DC, Poggio ED, Weight CJ, Larson BT, Gill IS, Novick AC. Factors predicting renal functional outcome after partial nephrectomy. J Urol. 2008;180(6):2363–8. discussion 2368–9.

    Article  PubMed  Google Scholar 

  8. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41–6.

    Article  PubMed  Google Scholar 

  9. Porpiglia F, Renard J, Billia M, Musso F, Volpe A, Burruni R, Terrone C, Colla L, Piccoli G, Podio V, Scarpa RM. Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? One-year results of a prospective study. Eur Urol. 2007;52(4):1170–8.

    Article  PubMed  Google Scholar 

  10. Thompson RH, Frank I, Lohse CM, Saad IR, Fergany A, Zincke H, Leibovich BC, Blute ML, Novick AC. The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol. 2007;177(2):471–6.

    Article  PubMed  Google Scholar 

  11. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Blute ML, Campbell SC. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010;58(3):340–5.

    Article  PubMed  Google Scholar 

  12. Simone G, Gill IS, Mottrie A, Kutikov A, Patard JJ, Alcaraz A, Rogers CG. Indications, techniques, outcomes, and limitations for minimally ischemic and off-clamp partial nephrectomy: a systematic review of the literature. Eur Urol. 2015;68(4):632–40.

    Article  PubMed  Google Scholar 

  13. Alenezi A, Novara G, Mottrie A, Al-Buheissi S, Karim O. Zero ischaemia partial nephrectomy: a call for standardized nomenclature and functional outcomes. Nat Rev Urol. 2016;13(11):674–83.

    Article  PubMed  Google Scholar 

  14. Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol. 2015;67(5):891–901.

    Article  PubMed  Google Scholar 

  15. Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, Cindolo L, Han KR, De La Taille A, Tostain J, Artibani W, Abbou CC, Lobel B, Chopin DK, Figlin RA, Mulders PF, Belldegrun AS. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171(6 Pt 1):2181–5. quiz 2435.

    Article  PubMed  Google Scholar 

  16. Volpe A, Blute ML, Ficarra V, Gill IS, Kutikov A, Porpiglia F, Rogers C, Touijer KA, Van Poppel H, Thompson RH. Renal ischemia and function after partial nephrectomy: a collaborative review of the literature. Eur Urol. 2015;68(1):61–74.

    Article  PubMed  Google Scholar 

  17. Zargar H, Akca O, Ramirez D, Brandao LF, Laydner H, Krishnan J, Stein RJ, Kaouk JH. The impact of extended warm ischemia time on late renal function after robotic partial nephrectomy. J Endourol. 2015;29(4):444–8.

    Article  PubMed  Google Scholar 

  18. Wiener S, Kiziloz H, Dorin RP, Finnegan K, Shichman SS, Meraney A. Predictors of postoperative decline in estimated glomerular filtration rate in patients undergoing robotic partial nephrectomy. J Endourol. 2014;28(7):807–13.

    Article  PubMed  Google Scholar 

  19. Porpiglia F, Bertolo R, Amparore D, Podio V, Angusti T, Veltri A, Fiori C. Evaluation of functional outcomes after laparoscopic partial nephrectomy using renal scintigraphy: clamped vs clampless technique. BJU Int. 2015;115(4):606–12.

    Article  PubMed  Google Scholar 

  20. Hung AJ, Tsai S, Gill IS. Does eliminating global renal ischemia during partial nephrectomy improve functional outcomes? Curr Opin Urol. 2013;23(2):112–7.

    Article  PubMed  Google Scholar 

  21. Baumert H, Ballaro A, Shah N, Mansouri D, Zafar N, Molinié V, Neal D. Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques. Eur Urol. 2007;52(4):1164–9.

    Article  PubMed  Google Scholar 

  22. Aron M, Koenig P, Kaouk JH, Nguyen MM, Desai MM, Gill IS. Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre. BJU Int. 2008;102(1):86–92.

    Article  PubMed  Google Scholar 

  23. San Francisco IF, Sweeney MC, Wagner AA. Robot-assisted partial nephrectomy: early unclamping technique. J Endourol. 2011;25(2):305–8.

    Article  PubMed  Google Scholar 

  24. Peyronnet B, Baumert H, Mathieu R, Masson-Lecomte A, Grassano Y, Roumiguié M, Massoud W, AbdElFattah V, Bruyère F, Droupy S, de la Taille A, Doumerc N, Bernhard JC, Vaessen C, Rouprêt M, Bensalah K. Early unclamping technique during robot-assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity. BJU Int. 2014;114(5):741–7.

    Article  PubMed  Google Scholar 

  25. Simone G, Papalia R, Guaglianone S, Gallucci M. ‘Zero ischaemia’, sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score. BJU Int. 2012;110(1):124–30.

    Article  PubMed  Google Scholar 

  26. Peña JA, Oliveira M, Ochoa DC, Santillana JM, Skrobot SA, Castellarnau S, Breda A, Palou J, Villavicencio H. The road to real zero ischemia for partial nephrectomy. J Endourol. 2013;27(7):936–42.

    Article  PubMed  Google Scholar 

  27. Kaczmarek BF, Tanagho YS, Hillyer SP, Mullins JK, Diaz M, Trinh QD, Bhayani SB, Allaf ME, Stifelman MD, Kaouk JH, Rogers CG. Off-clamp robot-assisted partial nephrectomy preserves renal function: a multi-institutional propensity score analysis. Eur Urol. 2013;64(6):988–93.

    Article  PubMed  Google Scholar 

  28. Satkunasivam R, Tsai S, Syan S, Bernhard JC, de Castro Abreu AL, Chopra S, Berger AK, Lee D, Hung AJ, Cai J, Desai MM, Gill IS. Robotic unclamped“minimal-margin” partial nephrectomy: ongoing refinement of the anatomic zero-ischemia concept. Eur Urol. 2015;68(4):705–12.

    Article  PubMed  Google Scholar 

  29. Antonelli A, Cindolo L, Sandri M, Furlan M, Veccia A, Palumbo C, Simeone C,Sessa F, Facchiano D, Serni S, Carini M, De Concilio B, Zeccolini G, Celia A, Ingrosso M, Giommoni V, Annino F, Pizzuti V, Nucciotti R, Dandrea M, Porreca A, Minervini A. Perioperative morbidity of clamp vs off-clamp robotic partial nephrectomy: preliminary results from a multicentre randomized clinical trial (the CLOCK study). 2017;197(4):e646–e647.

    Google Scholar 

  30. Imbeault A, Pouliot F, Finley DS, Shuch B, Dujardin T. Prospective study comparing two techniques of renal clamping in laparoscopic partial nephrectomy: impact on perioperative parameters. J Endourol. 2012;26(5):509–14.

    Article  PubMed  Google Scholar 

  31. Viprakasit DP, Derweesh I, Wong C, Su LM, Stroup SP, Bazzi W, Strom KH, Herrell SD. Selective renal parenchymal clamping in robot-assisted laparoscopic partial nephrectomy: a multi-institutional experience. J Endourol. 2011;25(9):1487–91.

    Article  PubMed  Google Scholar 

  32. Martin GL, Warner JN, Nateras RN, Andrews PE, Humphreys MR, Castle EP. Comparison of total, selective, and non arterial clamping techniques during laparoscopic and robot-assisted partial nephrectomy. J Endourol. 2012;26(2):152–6.

    Article  PubMed  Google Scholar 

  33. McClintock TR, Bjurlin MA, Wysock JS, Borofsky MS, Marien TP, Okoro C, Stifelman MD. Can selective arterial clamping with fluorescence imaging preserve kidney function during robotic partial nephrectomy? Urology. 2014;84(2):327–32.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gill IS, Eisenberg MS, Aron M, Berger A, Ukimura O, Patil MB, Campese V, Thangathurai D, Desai MM. “zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol. 2011;59(1):128–34.

    Article  PubMed  Google Scholar 

  35. Abreu AL, Gill IS, Desai MM. Zero-ischaemia robotic partial nephrectomy (RPN) for hilar tumours. BJU Int. 2011;108(6 Pt 2):948–54.

    Article  PubMed  Google Scholar 

  36. Gill IS, Patil MB, Abreu AL, Ng C, Cai J, Berger A, Eisenberg MS, Nakamoto M, Ukimura O, Goh AC, Thangathurai D, Aron M, Desai MM. Zero ischemia anatomical partial nephrectomy: a novel approach. J Urol. 2012;187(3):807–14.

    Article  PubMed  Google Scholar 

  37. Desai MM, de Castro Abreu AL, Leslie S, Cai J, Huang EY, Lewandowski PM, Lee D, Dharmaraja A, Berger AK, Goh A, Ukimura O, Aron M, Gill IS. Robotic partial nephrectomy with superselective versus main artery clamping: a retrospective comparison. Eur Urol. 2014;66(4):713–9.

    Article  PubMed  Google Scholar 

  38. Shin TY, Choi KH, Lim SK, Kim KH, Lee DH, Lee JY, Oh YT, Jung DC, Han WK, Rha KH. Simplified zero ischemia in robot assisted partial nephrectomy: initial yonsei experience. Korean J Urol. 2013;54(2):78–84.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ng CK, Gill IS, Patil MB, Hung AJ, Berger AK, de Castro Abreu AL, Nakamoto M, Eisenberg MS, Ukimura O, Thangathurai D, Aron M, Desai MM. Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur Urol. 2012;61(1):67–74.

    Article  PubMed  Google Scholar 

  40. Borofsky MS, Gill IS, Hemal AK, Marien TP, Jayaratna I, Krane LS, Stifelman MD. Near-infrared fluorescence imaging to facilitate super-selective arterial clamping during zero-ischaemia robotic partial nephrectomy. BJU Int. 2013;111(4):604–10.

    Article  PubMed  Google Scholar 

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Correspondence to Francesco Porpiglia .

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Porpiglia, F., Amparore, D., Bertolo, R. (2018). Warm Ischemia During Robotic Partial Nephrectomy. In: John, H., Wiklund, P. (eds) Robotic Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-65864-3_7

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  • DOI: https://doi.org/10.1007/978-3-319-65864-3_7

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