bs_bs_banner
Evolving renorrhaphy technique
11 Nogueira L, Katz D, Pinochet R et al. Critical evaluation of perioperative complications in laparoscopic partial nephrectomy. Urology 2010; 75: 288–94. 12 Ma YC, Zuo L, Chen JH et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J. Am. Soc. Nephrol. 2006; 17: 2937–44. 13 Lifshitz DA, Shikanov SA, Deklaj T et al. Laparoscopic partial nephrectomy: a single-center evolving experience. Urology 2010; 75: 282–7. 14 Kaouk JH, Hillyer SP, Autorino R et al. 252 robotic partial nephrectomies: evolving renorrhaphy technique and surgical outcomes at a single institution. Urology 2011; 78: 1338–44. 15 Kaouk JH, Khalifeh A, Hillyer S, Haber GP, Stein RJ, Autorino R. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur. Urol. 2012; 62: 553–61. 16 Gill IS, Eisenberg MS, Aron M et al. “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur. Urol. 2011; 59: 128–34. 17 Shao P, Qin C, Yin C et al. Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes. Eur. Urol. 2011; 59: 849–55. 18 Ng CK, Gill IS, Patil MB et al. Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur. Urol. 2012; 61: 67–74. 19 Link RE, Bhayani SB, Allaf ME et al. Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. J. Urol. 2005; 173: 1690–4. 20 Simmons MN, Chung BI, Gill IS. Perioperative efficacy of laparoscopic partial nephrectomy for tumors larger than 4 cm. Eur. Urol. 2009; 55: 199–207. 21 Permpongkosol S, Link RE, Su LM et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J. Urol. 2007; 177: 580–5. 22 Simmons MN, Gill IS. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J. Urol. 2007; 177: 2067–73; discussion 2073.
23 Nguyen MM, Gill IS. Halving ischemia time during laparoscopic partial nephrectomy. J. Urol. 2008; 179: 627–32; discussion 632. 24 Turna B, Frota R, Kamoi K et al. Risk factor analysis of postoperative complications in laparoscopic partial nephrectomy. J. Urol. 2008; 179: 1289–94; discussion 1294–5. 25 Rais-Bahrami S, Romero FR, Lima GC et al. Elective laparoscopic partial nephrectomy in patients with tumors >4 cm. Urology 2008; 72: 580–3. 26 Van Poppel H, Da PL, Albrecht W et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur. Urol. 2007; 51: 1606–15. 27 Colombo JR Jr, Haber GP, Aron M, Xu M, Gill IS. Laparoscopic partial nephrectomy in obese patients. Urology 2007; 69: 44–8. 28 Romero FR, Rais-Bahrami S, Muntener M, Brito FA, Jarrett TW, Kavoussi LR. Laparoscopic partial nephrectomy in obese and non-obese patients: comparison with open surgery. Urology 2008; 71: 806–9. 29 Eaton SH, Thirumavalaven N, Katz MH, Babayan RK, Wang DS. Effect of body mass index on perioperative outcomes for laparoscopic partial nephrectomy. J. Endourol. 2011; 25: 1447–50. 30 Aboumarzouk OM, Stein RJ, Haber GP, Kaouk J, Chlosta PL, Somani BK. Laparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis. BJU Int. 2012; 110: 1244–50. 31 Lane BR, Russo P, Uzzo RG et al. Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function. J. Urol. 2011; 185: 421–7. 32 Yossepowitch O, Eggener SE, Serio A et al. Temporary renal ischemia during nephron sparing surgery is associated with short-term but not long-term impairment in renal function. J. Urol. 2006; 176 (4 Pt 1): 1339–43; discussion 1343. 33 Jeldres C, Bensalah K, Capitanio U et al. Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy. BJU Int. 2009; 103: 1632–5.
Editorial Comment Editorial Comment to Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: Single-surgeon series This is an impressive and large series of laparoscopic retroperitoneal partial nephrectomies carried out by a single surgeon from Beijing.1 The authors were initially carrying out a one-layer, interrupted, figure-of-eight suture for the first 228 patients, and then changed the technique to a two-layer, continuous running repair for the last 298 patients. The benefits of the continuous two-layer repair included a shorter warm ischemia time and a decreased hospital stay. It is clear from this series and others that at present there is no indication for knot tying during laparoscopic or robotic partial nephrectomies. Whether the surgeon uses Weck clips, Lapra-Ty clips or V-lock sutures, the days of tying knots during the renorrhapy are gone. The closure of the partial nephrectomy defect site is tighter and more secure, with less urine leak and/or postoperative bleed. Indeed, even some of my colleagues who carry out open nephron-sparing surgery are using some of these techniques during open partial nephrectomy. The authors of this series are obviously experienced, as overall the average operative time was less than 90 min. In addition, the warm ischemia time was just 15–17 min. In the USA, more partial nephrectomies are being carried out with robotic assistance, although the benefit of robotic versus standard laparoscopic partial nephrectomy is unclear. One purported advantage of robotic versus laparoscopic partial nephrectomy is decreased warm ischemia time; however, it seems that those © 2014 The Japanese Urological Association
surgeons with extensive experience with laparoscopic partial nephrectomy have very low warm ischemia time. I would be surprised if adding the robot would further decrease the operative time and/or warm ischemia time in this single-surgeon series. Furthermore, unlike in the USA, the da Vinci robot is not as widely available in other countries. Again, the authors are to be congratulated on a large series of laparoscopic retroperitoneal laparoscopic partial nephrectomies. It is my hope that other groups can have a similar experience and improve outcomes for patients that undergo partial nephrectomy. David S Wang M.D. Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA [email protected] DOI: 10.1111/iju.12487
Conflict of interest None declared.
Reference 1 Wahafu W, Ma X, Li HZ et al. Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: Single-surgeon series. Int. J. Urol. 2014; 21: 865–73.
873
Evolving renorrhaphy technique
11 Nogueira L, Katz D, Pinochet R et al. Critical evaluation of perioperative complications in laparoscopic partial nephrectomy. Urology 2010; 75: 288–94. 12 Ma YC, Zuo L, Chen JH et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease. J. Am. Soc. Nephrol. 2006; 17: 2937–44. 13 Lifshitz DA, Shikanov SA, Deklaj T et al. Laparoscopic partial nephrectomy: a single-center evolving experience. Urology 2010; 75: 282–7. 14 Kaouk JH, Hillyer SP, Autorino R et al. 252 robotic partial nephrectomies: evolving renorrhaphy technique and surgical outcomes at a single institution. Urology 2011; 78: 1338–44. 15 Kaouk JH, Khalifeh A, Hillyer S, Haber GP, Stein RJ, Autorino R. Robot-assisted laparoscopic partial nephrectomy: step-by-step contemporary technique and surgical outcomes at a single high-volume institution. Eur. Urol. 2012; 62: 553–61. 16 Gill IS, Eisenberg MS, Aron M et al. “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur. Urol. 2011; 59: 128–34. 17 Shao P, Qin C, Yin C et al. Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes. Eur. Urol. 2011; 59: 849–55. 18 Ng CK, Gill IS, Patil MB et al. Anatomic renal artery branch microdissection to facilitate zero-ischemia partial nephrectomy. Eur. Urol. 2012; 61: 67–74. 19 Link RE, Bhayani SB, Allaf ME et al. Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. J. Urol. 2005; 173: 1690–4. 20 Simmons MN, Chung BI, Gill IS. Perioperative efficacy of laparoscopic partial nephrectomy for tumors larger than 4 cm. Eur. Urol. 2009; 55: 199–207. 21 Permpongkosol S, Link RE, Su LM et al. Complications of 2,775 urological laparoscopic procedures: 1993 to 2005. J. Urol. 2007; 177: 580–5. 22 Simmons MN, Gill IS. Decreased complications of contemporary laparoscopic partial nephrectomy: use of a standardized reporting system. J. Urol. 2007; 177: 2067–73; discussion 2073.
23 Nguyen MM, Gill IS. Halving ischemia time during laparoscopic partial nephrectomy. J. Urol. 2008; 179: 627–32; discussion 632. 24 Turna B, Frota R, Kamoi K et al. Risk factor analysis of postoperative complications in laparoscopic partial nephrectomy. J. Urol. 2008; 179: 1289–94; discussion 1294–5. 25 Rais-Bahrami S, Romero FR, Lima GC et al. Elective laparoscopic partial nephrectomy in patients with tumors >4 cm. Urology 2008; 72: 580–3. 26 Van Poppel H, Da PL, Albrecht W et al. A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur. Urol. 2007; 51: 1606–15. 27 Colombo JR Jr, Haber GP, Aron M, Xu M, Gill IS. Laparoscopic partial nephrectomy in obese patients. Urology 2007; 69: 44–8. 28 Romero FR, Rais-Bahrami S, Muntener M, Brito FA, Jarrett TW, Kavoussi LR. Laparoscopic partial nephrectomy in obese and non-obese patients: comparison with open surgery. Urology 2008; 71: 806–9. 29 Eaton SH, Thirumavalaven N, Katz MH, Babayan RK, Wang DS. Effect of body mass index on perioperative outcomes for laparoscopic partial nephrectomy. J. Endourol. 2011; 25: 1447–50. 30 Aboumarzouk OM, Stein RJ, Haber GP, Kaouk J, Chlosta PL, Somani BK. Laparoscopic partial nephrectomy in obese patients: a systematic review and meta-analysis. BJU Int. 2012; 110: 1244–50. 31 Lane BR, Russo P, Uzzo RG et al. Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function. J. Urol. 2011; 185: 421–7. 32 Yossepowitch O, Eggener SE, Serio A et al. Temporary renal ischemia during nephron sparing surgery is associated with short-term but not long-term impairment in renal function. J. Urol. 2006; 176 (4 Pt 1): 1339–43; discussion 1343. 33 Jeldres C, Bensalah K, Capitanio U et al. Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy. BJU Int. 2009; 103: 1632–5.
Editorial Comment Editorial Comment to Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: Single-surgeon series This is an impressive and large series of laparoscopic retroperitoneal partial nephrectomies carried out by a single surgeon from Beijing.1 The authors were initially carrying out a one-layer, interrupted, figure-of-eight suture for the first 228 patients, and then changed the technique to a two-layer, continuous running repair for the last 298 patients. The benefits of the continuous two-layer repair included a shorter warm ischemia time and a decreased hospital stay. It is clear from this series and others that at present there is no indication for knot tying during laparoscopic or robotic partial nephrectomies. Whether the surgeon uses Weck clips, Lapra-Ty clips or V-lock sutures, the days of tying knots during the renorrhapy are gone. The closure of the partial nephrectomy defect site is tighter and more secure, with less urine leak and/or postoperative bleed. Indeed, even some of my colleagues who carry out open nephron-sparing surgery are using some of these techniques during open partial nephrectomy. The authors of this series are obviously experienced, as overall the average operative time was less than 90 min. In addition, the warm ischemia time was just 15–17 min. In the USA, more partial nephrectomies are being carried out with robotic assistance, although the benefit of robotic versus standard laparoscopic partial nephrectomy is unclear. One purported advantage of robotic versus laparoscopic partial nephrectomy is decreased warm ischemia time; however, it seems that those © 2014 The Japanese Urological Association
surgeons with extensive experience with laparoscopic partial nephrectomy have very low warm ischemia time. I would be surprised if adding the robot would further decrease the operative time and/or warm ischemia time in this single-surgeon series. Furthermore, unlike in the USA, the da Vinci robot is not as widely available in other countries. Again, the authors are to be congratulated on a large series of laparoscopic retroperitoneal laparoscopic partial nephrectomies. It is my hope that other groups can have a similar experience and improve outcomes for patients that undergo partial nephrectomy. David S Wang M.D. Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA [email protected] DOI: 10.1111/iju.12487
Conflict of interest None declared.
Reference 1 Wahafu W, Ma X, Li HZ et al. Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: Single-surgeon series. Int. J. Urol. 2014; 21: 865–73.
873
