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Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy |
Yoichiro Tohia,*(),Shiori Murataa,Noriyuki Makitaa,Issei Suzukia,Masashi Kubotaa,Yoshio Suginoa,Koji Inouea,Hiroyuki Uedab,Mutsushi Kawakitaa
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a Department of Urology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan b Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-cho, Chuo-ku, Kobe City, Japan |
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Abstract Objective: To assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm (RAP) on contrast-enhanced computed tomography (CE-CT) after robot-assisted partial nephrectomy (RAPN) without parenchymal renorrhaphy. Methods: From May 2016 to December 2017, 78 patients underwent RAPN for renal tumors. Inner suture was performed in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft coagulation system was used, and absorbable hemostats were placed on the resection bed. CE-CT was carried out within 7 days after surgery. Data on these patients were prospectively collected. A single radiologist determined the diagnosis of RAP. Results: Median (range) data were as follows: Patient age, 65 (19-82) years; radiographic tumor size, 30 (12-95) mm; operating time, 166 (102-294) min; warm ischemic time, 16 (7-67) min; and blood loss, 15 (0-4450) mL. One patient (1.6%) required a perioperative blood transfusion. No patient required conversion to open surgery or nephrectomy. CE-CT was carried out at median 6 (3-7) days after surgery. CE-CT showed no RAP development in all 61 patients. Urinary leakage was not observed. One patient had acute cholecystitis, a postoperative complication classified as Clavien-Dindo grade higher than 3, which was treated with cholecystectomy. Positive surgical margin was identified in four patients (6.6%). Conclusion: RAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe. Our technique could eliminate the risk of RAP.
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Received: 19 June 2018
Available online: 08 October 2019
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Corresponding Authors:
Yoichiro Tohi
E-mail: yoto716yotoyoto@gmail.com
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Characteristics | Data | Patients, n | 61 | Age, mean (range), year | 65 (19-82) | BMI, mean (range), kg/m2 | 24.6 (19.0-41.6) | Charlson comorbidity index, mean (range) | 2 (2-10) | Tumor side, n | Left | 35 | Right | 26 | Tumor size, mean (range), mm | 30 (12-95) | R.E.N.A.L. score, n (%) | Low (4-6) | 23 (37.7) | Moderate (7-9) | 26 (42.6) | High (10-12) | 12 (19.7) |
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Patients' characteristics.
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Variables | Data | Approach, n | Transperitoneal | 28 | Retroperitoneal | 33 | Operating time, mean (range), min | 166 (97-294) | Consol time, mean (range), min | 98 (27-227) | Blood loss, mean (range), mL | 15 (0-4450) | Warm ischemic time, mean (range), min | 16 (7-67) | Renal artery clamp, n | Total | 47 | Selective | 7 | Unclamp | 7 | Inner suture, n (%) | 38 (62.2) | Conversions, n | 0 | Transfusions, n (%) | 1 (1.6) | CE-CT follow-up time, mean (range), day | 6 (3-7) | Postoperative hospital stay, mean (range), day | 7 (3-11) |
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Perioperative outcomes.
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Variables | Data | Malignant, n (%) | 58 (95) | Pathological stage, n | T1a | 49 | T1b | 6 | T2a | 1 | T3a | 2 | Fuhrman grade, n | 1 | 16 | 2 | 37 | 3 | 3 | 4 | 2 | Histology, n | Clear cell RCC | 53 | Chromophobe RCC | 2 | Papillary RCC | 3 | Angiomyolipoma | 1 | Oncocytoma | 1 | Others | 1 | Positive surgical margin, n (%) | 4 (6.6) |
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Pathological reports.
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Complications | Clavien-Dindo Grade 1-2, n | Clavien-Dindo Grade 3-5, n | Fever after 3 days postoperative | 3 | 0 | Superficial incisional SSI | 1 | 0 | Upper arm pain | 1 | 0 | Respiratory failure | 1 | 0 | Cholecystitis | 0 | 1 | Urinary leakage | 0 | 0 | RAP | 0 | 0 |
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Details of 30 days postoperative complications by events.
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[1] |
Huang WC, Elkin EB, Levery AS, Jang TL, Russo P . Partial nephrectomy versus radical nephrectomy in patients with small renal tumorsdis there a difference in mortality and cardiovascular outcomes? J Urol 2009; 181:55-62.
|
[2] |
Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC , et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol 2008; 179:468-73.
|
[3] |
Gill IS, Martin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E , et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 2003; 170:64-8.
|
[4] |
Albani JM, Novick AC . Renal artery pseudoaneurysm after partial nephrectomy:three case reports and a literature review. Urology 2003; 62:227-31.
|
[5] |
Negoro H, Kawakita M, Koda Y . Renal artery pseudoaneurysm after laparoscopic partial nephrectomy for renal cell carcinoma in a solitary kidney. Int J Urol 2005; 12:683-5.
|
[6] |
Takagi T, Kondo T, Tajima T, Campbell SC, Tanabe K . Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm. Int J Urol 2014; 21:880-5.
|
[7] |
Omae K, Kondo T, Takagi T, Morita S, Hashimoto T, Kobayashi H . Renal sinus exposure as an independent factor predicting asymptomatic unruptured pseudoaneurysm formation detected in the early postoperative period after minimally invasive partial nephrectomy. Int J Urol 2015; 22:356-61.
|
[8] |
Dindo D, Demartines N, Clavien PA . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205-13.
|
[9] |
Jain S, Nyirenda T, Yates J, Munver R . Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy:a systematic review and comparative analysis. J Urol 2013; 189:1643-8.
|
[10] |
Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JB , et al. Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178:41-6.
|
[11] |
Singh D, Gill IS . Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. J Urol 2005; 174:2256-9.
|
[12] |
Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P . Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol 2011; 185:2061-5.
|
[13] |
Shapiro EY, Hakimi AA, Hyams ES, Cynamon J, Stifelman M, Ghavamian R . Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. Urology 2009; 74:819-23.
|
[14] |
Cohenpour M, Strauss S, Gottlieb P, Peer A, Rimon U, Stav K , et al. Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 2007; 62:1104-9.
|
[15] |
Ota T, Komori H, Rii J, Ochi A, Suzuki K, Shiga N , et al. Soft coagulation in partial nephrectomy without renorrhaphy: feasibility of a new technique and early outcomes. Int J Urol 2014; 21:244-7.
|
[16] |
Tanagho YS, Kaouk JH, Allaf ME, Rogers CG, Stifelman MD, Kaczmarek BF , et al. Perioperative complications of robotassisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology 2013; 81:573-9.
|
[17] |
Scoll BJ, Uzzo RG, Chen DYT, Boorjian SA, Kutikov A, Manley BJ , et al. Robot-assisted partial nephrectomy: a large single-institutional experience. Urology 2010; 75:1328-34.
|
[18] |
Tanaka K, Teishima J, Takenaka A, Shiroki R, Kobayashi Y, Hattori K , et al. Prospective study of robotic partial nephrectomy for renal cancer in Japan: comparison with a historical control undergoing laparoscopic partial nephrectomy. Int J Urol 2018; 25:472-8.
|
[19] |
Zargar H, Allaf ME, Bhayani S, Stifelman M, Rogers C, Ball MV , et al. Trifecta and optimal perioperative outcomes of robotic and laparoscopic partial nephrectomy in surgical treatment of small renal masses: a multi-institutional study. BJU Int 2015; 116:407-14.
|
[20] |
Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R , et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009; 169:2078-86.
|
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