Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento / Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up

Introducción: Presentamos los resultados oncológicos y funcionales de una serie de 43 pacientes afectos de un tumor renal, tratados en forma consecutiva mediante nefrectomía parcial robótica (NPR). Material y método: Entre los años 2010 y 2014 efectuamos 95 NPR. Para la evaluación de los resultados se incluyeron solo a los pacientes (n = 43) que tuvieran un seguimiento mínimo de 2 años. Se realizó un análisis descriptivo de las características demográficas y variables perioperatorias. Se utilizaron curvas de Kaplan-Meier para evaluar la supervivencia global, supervivencia cáncer-específica y supervivencia libre de recurrencia. Resultados: La edad media fue 53,1 ± 13,5 años. El tamaño tumoral preoperatorio fue 3,7 ± 2,3 cm. El tiempo quirúrgico fue 102,2 ± 37,1 min. El tiempo de isquemia fue de 21,27 ± 7,74 min con una mediana de sangrado intraoperatorio de 150 ml (RIC = 87,5-425). Hubo un 7% de complicaciones postoperatorias Clavien ≥ III. No hubo mortalidad. El grado de Fürhman promedio fue 2,5 ± 0,56. No hubo márgenes quirúrgicos positivos ni recurrencia local. La mediana de seguimiento fue 38 ± 8 meses, con una supervivencia global, una supervivencia libre de recurrencia y una supervivencia cáncer específica del 100% a 3 años de seguimiento. La supervivencia libre de recurrencia fue del 92,3% a 48 meses de seguimiento. La media de filtración glomerular preoperatoria fue 91,04 ± 28,17 y la postoperatoria 89,9 ± 27,69 ml/min por 1,73 m2, con una disminución no significativa (p = 0,74). Conclusiones: Los resultados funcionales y oncológicos de nuestra serie de NPR, confirman su seguridad y eficacia. La NPR ofrece una óptima preservación de la función renal y control oncológico a mediano plazo

Background: We present the oncological and functional results from a series of 43 patients with renal tumours, treated consecutively with robot-assisted partial nephrectomy (RPN). Materials and method: Between 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n = 43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan-Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. Results: The patients’ mean age was 53.1 ± 13.5 years. The mean preoperative tumour size was 3.7 ± 2.3 cm. The mean surgical time was 102.2 ± 37.1 min. The mean ischemia time was 21.27 ± 7.74 minutes, with a median intraoperative bleeding volume of 150 mL (IQR, 87.5-425). There was a 7% rate of postoperative complications (Clavien ≥ III). There was no mortality. The average Fürhman grade was 2.5 ± 0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38 ± 8 months, with an overal survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04 ± 28.17 mL/min/1.73 m2, and the postoperative rate was 89.9 ± 27.69 mL/min/1.73 m2, with a nonsignificant reduction (P = .74). Conclusions: The functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term

Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up. / Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento.

BACKGROUND: We present the oncological and functional results from a series of 43 patients with renal tumours, treated consecutively with robot-assisted partial nephrectomy (RPN). MATERIALS AND METHOD: Between 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n=43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan-Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. RESULTS: The patients' mean age was 53.1±13.5 years. The mean preoperative tumour size was 3.7±2.3cm. The mean surgical time was 102.2±37.1min. The mean ischemia time was 21.27±7.74minutes, with a median intraoperative bleeding volume of 150mL (IQR, 87.5-425). There was a 7% rate of postoperative complications (Clavien≥III). There was no mortality. The average Fürhman grade was 2.5±0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38±8 months, with an overal survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04±28.17mL/min/1.73m(2), and the postoperative rate was 89.9±27.69mL/min/1.73m(2), with a nonsignificant reduction (P=.74). CONCLUSIONS: The functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term.

Descripción y evaluación estandarizada de complicaciones asociadas a adrenalectomía laparoscópica / Complications associated with laparoscopic adrenalectomy: Description and standardized assessment

Objetivo: La adrenalectomía laparoscópica (AL) es el procedimiento de elección para el manejo quirúrgico de las masas adrenales. Nuestro objetivo es presentar una evaluación estandarizada de las complicaciones perioperatorias en una serie de AL. Material y métodos: Entre los meses de junio de 1993 a septiembre de 2012 se realizaron 344 AL en pacientes con diagnóstico de tumor suprarrenal, de forma consecutiva. Los datos fueron recolectados de forma prospectiva y analizados retrospectivamente para evaluar las complicaciones perioperatorias. Las complicaciones intraoperatorias se definieron utilizando la clasificación de Satava y las complicaciones postoperatorias según la clasificación de Clavien-Dindo. Resultados: Veinticinco AL presentaron complicaciones perioperatorias (7,3%), 11 fueron intraoperatorias (3,2%), siendo en su mayoría lesiones vasculares y del diafragma (Satava grado 2) y 14 postoperatorias (4,1%). Seis pacientes presentaron complicaciones que precisaron intervención quirúrgica (Clavien IIIa/IIIb) y/o soporte en la unidad de cuidados intensivos (Clavien IV). Hubo una conversión a cirugía abierta (0,3%). A pesar de que se tomaron todas las medidas endocrinológicas preoperatorias adecuadas, un paciente portador de un feocromocitoma desarrolló en el intraoperatorio una crisis hipertensiva incontrolable y paro cardiorrespiratorio recuperado, falleciendo a los 5 días por un infarto cerebral masivo (Clavien V). Conclusiones: Las complicaciones quirúrgicas necesitan de un criterio común de estandarización mediante la aplicación combinada de 2 herramientas. Creemos que este concepto de evaluación de la morbilidad de la cirugía debe ser aplicado de forma sistemática, y de esta manera permitir a los cirujanos lograr un nuevo estándar de informes de eventos adversos perioperatorios refinado, conciso y comparativo

Objective: Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of the adrenal masses. Our objective is to show a standardized assessment of perioperative complications in one LA series. Materials and methods: 322 LA were performed consecutively between June of 1993 and September of 2012 in patients diagnosed with suprarenal tumor. In order to evaluate perioperative complications, data were collected prospectively and analyzed retrospectively. Intraoperative complications were defined using Satava classification and Clavien-Dindo classification of postoperative complications. Results: Twenty five LA showed perioperative complications (7.3%); 11 (3.2%) were intraoperative complications, most of them vascular diaphragmatic lesions (Satava Grade 2); and 14 (4.1%) were postoperative complications. Six patients showed complications requiring surgery (Clavien IIIa/IIIb) and/or support in Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in one case (0.3%). Despite all appropriate preoperative endocrine measures were taken, an uncontrolled hypertensive crisis and cardio-respiratory arrest recovered were developed during surgery in one patient carrier of pheochromocytoma who died from massive cerebral infarction at 5 days (Clavien V). Conclusions: Standardized criteria of surgical complications are necessary. Standardization is possible by combined application of two tools. We believe that this evaluation concept of the surgery morbidity must be used systematically in order to achieve a new standard refined, concise and comparative for reports of adverse perioperative events

Complications associated with laparoscopic adrenalectomy: Description and standardized assessment.

OBJECTIVE: Laparoscopic adrenalectomy (LA) is the procedure of choice for surgical management of the adrenal masses. Our objective is to show a standardized assessment of perioperative complications in one LA series. MATERIAL AND METHODS: 322 LA were performed consecutively between June of 1993 and September of 2012 in patients diagnosed with suprarenal tumour. In order to evaluate perioperative complications, data were collected prospectively and analysed retrospectively. Intraoperative complications were defined using Satava classification and Clavien-Dindo classification of postoperative complications. RESULTS: Twenty five LA showed perioperative complications (7.3%); 11 (3.2%) were intraoperative complications, most of them vascular diaphragmatic lesions (Satava Grade 2); and 14 (4.1%) were postoperative complications. Six patients showed complications requiring surgery (Clavien IIIa/IIIb) and/or support in Intensive Care Unit (Clavien IV). Conversion to open surgery was necessary in one case (.3%). Despite all appropriate preoperative endocrine measures were taken, an uncontrolled hypertensive crisis and cardio-respiratory arrest recovered were developed during surgery in one patient carrier of pheochromocytoma who died from massive cerebral infarction at 5 days (Clavien V). CONCLUSIONS: Standardized criteria of surgical complications are necessary. Standardization is possible by combined application of two tools. We believe that this evaluation concept of the surgery morbidity must be used systematically in order to achieve a new standard refined, concise and comparative for reports of adverse perioperative events.

Nefrectomía parcial robótica con compresión selectiva del parénquima (pinza de Simon) / Robotic Partial Nephrectomy With Selective Parenchymal Compression (Simon Clamp)

Objetivo: Presentar nuestra experiencia inicial en nefrectomía parcial robótica (NPR) realizando compresión selectiva del parénquima renal, sin pinzamiento del hilio renal. Material y métodos: Se realizó NPR utilizando el sistema robótico da Vinci S HD con abordaje transperitoneal y compresión selectiva del parénquima renal a 4 pacientes con masa tumoral exofítica de localización polar. Se utilizó la pinza de Simon laparoscópica (Simon's clamp Aesculap®) sin control vascular del hilio renal. La reconstrucción renal fue la utilizada regularmente. Resultados: La edad promedio fue de 49,6 años (42-59) con una relación hombre/mujer 3:1. El tiempo operatorio promedio fue de 71,6 min (40-120). El sangrado estimado promedio fue de 250 ml (50-400). El tamaño tumoral promedio fue de 3,25 cm (1,5-5,3). No hubo complicaciones perioperatorias ni postoperatorias. La estancia media hospitalaria fue de 3,5 días (1-7). No hubo complicaciones hemorrágicas intra ni postoperatorias. El examen patológico de las lesiones reveló carcinoma renal en 3 casos y quiste hemorrágico en un caso. No hubo márgenes quirúrgicos positivos. Conclusiones: Nuestros resultados preliminares muestran que la NPR con compresión regional del parénquima renal es una alternativa quirúrgica factible en pacientes seleccionados y tumores de localización polar, proporcionando un campo quirúrgico adecuado para la resección tumoral (AU)

Objective: To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. Material and methods: In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap®). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. Results: The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. Conclusion: Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors (AU)

Robotic partial nephrectomy with selective parenchymal compression (Simon clamp).

OBJECTIVE: To present our initial experience using selective renal parenchymal ischemia, without hilar clamping, in robotic-assisted partial nephrectomy. MATERIAL AND METHODS: In four patients with T1a renal tumor we performed robotic-assisted partial nephrectomy, using the Simon's clamp (Aesculap). It provides selective parenchymal compression without the need of vascular clamping. All patients had exofitic renal tumors in polar location. Renal parenchymal reconstruction was done as the standard technique. RESULTS: The median age was 49.6 years (42-59), 3 male and 1 female patient. Median operative time was 71,6 minutes (40-120). Mean stimated bleeding was 250 ml (50-400). Average tumor size was 3,25 cm (1,5-5,3). There were no complications and the average hospital stay was 3,5 days (1-7). The pathology was informed as renal cell carcinoma in three patients and one hemorrhagic cyst. The surgical margins were negative. CONCLUSION: Our preliminary results shows that selective renal parenchymal compression, with the Simon's clamp, provides an alternative to vascular control in selected patients with polar renal tumors.

Nefrectomía parcial robótica: experiencia inicial en 25 casos consecutivos / Robotic Partial nephrectomy: An initial experience in 25 consecutive cases

Objetivo: Presentar nuestra experiencia inicial en nefrectomía parcial robótica (NPR) en una serie de 25 pacientes operados de forma consecutiva. Material y métodos: Se trata de una serie de 25 pacientes consecutivos sometidos a NPR desde abril de 2010 a febrero de 2011. Se utilizó el sistema robótico da Vinci S HD, con abordaje transperitoneal. En 22 casos se utilizó control vascular total del hilio renal y en tres casos se realizó compresión selectiva del parénquima renal con un dispositivo ad hoc. Resultados: La edad promedio fue de 55,8 años (26-77), con una relación hombre/mujer 2:1. El tiempo operatorio promedio fue de 117,6 minutos (54-205) y el tiempo de isquemia caliente fue de 20,2 minutos (9-34). El sangrado estimado promedio fue de 440 ml (20-2.000). El tamaño tumoral promedio fue de 3,25 cm (1-5,3). Cinco pacientes (20%) presentaron complicaciones, siendo la hemorragia intraoperatoria la más frecuente (Clavien II). No hubo conversión a cirugía abierta o laparoscópica. La estancia media hospitalaria fue de 3,5 días (1-7). El examen patológico de las lesiones reveló carcinoma renal en 19 casos y lesiones benignas en 6 pacientes. No hubo márgenes quirúrgicos positivos ni mortalidad. Conclusiones: Nuestros resultados preliminares muestran que la NPR es una alternativa quirúrgica factible de realizar en pacientes con tumores renales de pequeño tamaño (AU)

Objective: To report our initial experience with robotic partial nephrectomy (RPN) in a series of 25 consecutively-operated patients. Material and methods: A series of 25 consecutive patients who underwent RPN from April 2010 to February 2011 were studied. We used the da Vinci S HD robotic system with transperitoneal approach. Total renal hilum control was used 22 cases and 3 patients underwent selective renal parenchymal compression with an adhoc device. Results: Mean age was 55.8 years (26-77) with a male/female ratio of 2:1. Mean operative time was 117.6 minutes (54-205) and the warm ischemia time was 20.2 minutes (9-34). Mean estimated blood loss was 440 ml (20-2000) and the mean tumor size was 3.25 cm (1-5.3). Five patients (20%) had complications, the most frequent being intraoperative bleeding (Clavien II). There was no conversion to open or laparoscopic surgery. Mean hospital stay was 3.5 days (1-7). The pathological study revealed renal cell carcinoma in 19 cases and benign lesions in6 patients. There were no positive surgical margins and no mortality. Conclusions: Our preliminary results show that RPN is a feasible surgical approach in small-size drenal tumors (AU)

[Robotic partial nephrectomy: an initial experience in 25 consecutive cases]. / Nefrectomía parcial robótica: experiencia inicial en 25 casos consecutivos.

OBJECTIVE: To report our initial experience with robotic partial nephrectomy (RPN) in a series of 25 consecutively-operated patients. MATERIAL AND METHODS: A series of 25 consecutive patients who underwent RPN from April 2010 to February 2011 were studied. We used the da Vinci S HD robotic system with transperitoneal approach. Total renal hilum control was used 22 cases and 3 patients underwent selective renal parenchymal compression with an ad-hoc device. RESULTS: Mean age was 55.8 years (26-77) with a male/female ratio of 2:1. Mean operative time was 117.6 minutes (54-205) and the warm ischemia time was 20.2 minutes (9-34). Mean estimated blood loss was 440 ml (20-2000) and the mean tumor size was 3.25 cm (1-5.3). Five patients (20%) had complications, the most frequent being intraoperative bleeding (Clavien II). There was no conversion to open or laparoscopic surgery. Mean hospital stay was 3.5 days (1-7). The pathological study revealed renal cell carcinoma in 19 cases and benign lesions in 6 patients. There were no positive surgical margins and no mortality. CONCLUSIONS: Our preliminary results show that RPN is a feasible surgical approach in small-sized renal tumors.

Nefrectomía laparoscópica en niños / Laparoscopic nephrectomy in children

Introducción: la nefrectomía laparoscópica en niños, a diferencia de la población adulta, ha tenido una evolución más lenta debido al erróneo concepto de que los niños requieren incisiones pequeñas y se recuperan con mayor rapidez. El objetivo de este artículo es presentar nuestra experiencia en cirugía renal laparoscópica en una población pediátrica. Material y métodos: se revisaron las historias clínicas de los niños que fueron sometidos a cirugía renal laparoscópica en nuestra institución entre mayo de 1993 y septiembre de 2010. Los datos fueron registrados prospectivamente y analizados de forma retrospectiva. Las variables analizadas fueron la indicación quirúrgica, edad, sexo, procedimiento y abordaje, tiempo de quirófano, estancia hospitalaria, sangrado intraoperatorio, complicaciones perioperatorias, conversión a cirugía abierta, reintervención y tasas de transfusión de sangre. Resultados: entre mayo de 1993 y septiembre de 2010 un total de 72 pacientes fueron operados; se practicaron 45 nefrectomías (62,5%), 13 nefroureterectomías (18%) y 14 heminefrectomías(19,4%). La edad media fue de 68 meses (rango: 3-168). El tiempo medio operatorio (OR) fue de 80,4 minutos (rango: 25-270 min) con una pérdida estimada sanguínea promedio de 37,5 ml (rango: 0 -1.000 ml). Hubo tres (4,1%) conversiones a cirugía abierta. Una fue debido a un sangrado intraoperatorio y las otras dos secundarias a una difícil disección debido a presentar cirugías renales previas. La estancia media hospitalaria fue de 3,17 días (rango: 1-30 días) y hubo 7 (9,72%) complicaciones postoperatorias. No hubo mortalidad. Conclusiones: consideramos que el abordaje laparoscópico para la cirugía renal en pacientes pediátricos es un procedimiento factible, seguro y eficaz que debe ser considerado como la primera opción para el tratamiento de la patología benigna en este grupo de población (AU)

Introduction: Laparoscopic nephrectomy in children, not as in the adult population, has evolved more slowly due to the misleading concept that children require small incisions and recover faster. The aim of this article is to present our experience in laparoscopic renal surgery in a paediatric population. Material and methods: We checked the clinical records of children that were subjected to laparoscopic renal surgery at our institution between May 1993 and September 2010. We recorded the data prospectively and analysed it retrospectively. The variables we studied were surgical indication, age, sex, procedure and approach, surgery time, hospital stay, intraoperative bleeding, perioperative complications, conversion to open surgery, reintervention and blood transfusion rates. Results: Between May 1993 and September 2010, we operated a total of 72 patients, 45 nephrectomies (62.5%), 13 nephroureterectomies (18%) and 14 heminephrectomies (19.4%). The mean age was 68 months (range 3-168). The mean surgery time was 80.4 min. (range: 25-270 min.) with a estimated mean blood loss of 37.5 ml (range: 0 -1.000 ml). There were 3 (4.1%) conversions to open surgery. One was due to intraoperative bleeding and the other two were secondary to a difficult dissection due to a history of prior renal surgical interventions. The mean hospital stay was 3.17 days (range: 1-30 days) and there were 7 (9.72%) postoperative complications. There were no deaths. Conclusions: We consider the laparoscopic approach for renal surgery in paediatric patients to be a feasible, safe and effective procedure that must be considered as the first option for the treatment of benign pathology in this population group (AU)

[Laparoscopic nephrectomy in children]. / Nefrectomía laparoscópica en niños.

INTRODUCTION: Laparoscopic nephrectomy in children, not as in the adult population, has evolved more slowly due to the misleading concept that children require small incisions and recover faster. The aim of this article is to present our experience in laparoscopic renal surgery in a paediatric population. MATERIAL AND METHODS: We checked the clinical records of children that were subjected to laparoscopic renal surgery at our institution between May 1993 and September 2010. We recorded the data prospectively and analysed it retrospectively. The variables we studied were surgical indication, age, sex, procedure and approach, surgery time, hospital stay, intraoperative bleeding, perioperative complications, conversion to open surgery, reintervention and blood transfusion rates. RESULTS: Between May 1993 and September 2010, we operated a total of 72 patients, 45 nephrectomies (62.5%), 13 nephroureterectomies (18%) and 14 heminephrectomies (19.4%). The mean age was 68 months (range 3-168). The mean surgery time was 80.4 min. (range: 25-270 min.) with a estimated mean blood loss of 37.5 ml (range: 0 -1.000 ml). There were 3 (4.1%) conversions to open surgery. One was due to intraoperative bleeding and the other two were secondary to a difficult dissection due to a history of prior renal surgical interventions. The mean hospital stay was 3.17 days (range: 1-30 days) and there were 7 (9.72%) postoperative complications. There were no deaths. CONCLUSIONS: We consider the laparoscopic approach for renal surgery in paediatric patients to be a feasible, safe and effective procedure that must be considered as the first option for the treatment of benign pathology in this population group.