Laparoscopic Partial Nephrectomy: A Single-center Evolving Experience
Objectives To review our laparoscopic partial nephrectomy (LPN) experience, examine the evolution of technique, and compare the outcomes between the early and recent experience. The indications and surgical technique of LPN continuously evolve. Methods Data for 184 patients who underwent LPN for a t...
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| Veröffentlicht in: | Urology (Ridgewood, N.J.) N.J.), 2010-02, Vol.75 (2), p.282-287 |
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| creator | Lifshitz, David A Shikanov, Sergey A Deklaj, Tom Katz, Mark H Zorn, Kevin C Eggener, Scott E Shalhav, Arieh L |
| description | Objectives To review our laparoscopic partial nephrectomy (LPN) experience, examine the evolution of technique, and compare the outcomes between the early and recent experience. The indications and surgical technique of LPN continuously evolve. Methods Data for 184 patients who underwent LPN for a tumor between October 2002 and August 2008 was retrieved from a prospective database. Surgical and functional outcomes for the entire cohort were analyzed and the first 50 (group 1) and most recent 50 (group 2) cases were compared. Results The groups were similar in terms of baseline renal function, body mass index, and comorbidities. The mean tumor size and the proportion of central tumors in groups 1 and 2 were 2.4 vs 3 cm and 12% vs 52%, respectively ( P 4 cm had more complications ( P = .042). In group 2 the estimated blood loss and hospital stay decreased (243 vs 140 mL, P = .01, 1.4 vs 2.5 days, P |
| doi_str_mv | 10.1016/j.urology.2009.07.1351 |
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The indications and surgical technique of LPN continuously evolve. Methods Data for 184 patients who underwent LPN for a tumor between October 2002 and August 2008 was retrieved from a prospective database. Surgical and functional outcomes for the entire cohort were analyzed and the first 50 (group 1) and most recent 50 (group 2) cases were compared. Results The groups were similar in terms of baseline renal function, body mass index, and comorbidities. The mean tumor size and the proportion of central tumors in groups 1 and 2 were 2.4 vs 3 cm and 12% vs 52%, respectively ( P <.003). In group 2 we stopped the use of ureteral catheters and bolster renorrhaphy, and routinely clamped the renal hilum. Mean warm ischemia time in groups 1 and 2 (30 and 27 minute, respectively, P = .3) and the complication rate were similar. Overall, patients with tumors >4 cm had more complications ( P = .042). In group 2 the estimated blood loss and hospital stay decreased (243 vs 140 mL, P = .01, 1.4 vs 2.5 days, P <.001). Overall 78% of the tumors were malignant and the positive margin rate was 3%. With a median follow-up of 18 months, no local or distant tumor recurrences were observed. Conclusions With growing experience and technical modifications, LPN is now performed for patients with larger and more central tumors. Longer follow-up is necessary to evaluate oncologic outcomes.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2009.07.1351</identifier><identifier>PMID: 19962732</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Nephrectomy - methods ; Nephrectomy - trends ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Urology ; Young Adult</subject><ispartof>Urology (Ridgewood, N.J.), 2010-02, Vol.75 (2), p.282-287</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-934e1eb41c71d0754939954975b9641becb5335848ce9fc864cf0c6e848f1a023</citedby><cites>FETCH-LOGICAL-c422t-934e1eb41c71d0754939954975b9641becb5335848ce9fc864cf0c6e848f1a023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urology.2009.07.1351$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19962732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lifshitz, David A</creatorcontrib><creatorcontrib>Shikanov, Sergey A</creatorcontrib><creatorcontrib>Deklaj, Tom</creatorcontrib><creatorcontrib>Katz, Mark H</creatorcontrib><creatorcontrib>Zorn, Kevin C</creatorcontrib><creatorcontrib>Eggener, Scott E</creatorcontrib><creatorcontrib>Shalhav, Arieh L</creatorcontrib><title>Laparoscopic Partial Nephrectomy: A Single-center Evolving Experience</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>Objectives To review our laparoscopic partial nephrectomy (LPN) experience, examine the evolution of technique, and compare the outcomes between the early and recent experience. The indications and surgical technique of LPN continuously evolve. Methods Data for 184 patients who underwent LPN for a tumor between October 2002 and August 2008 was retrieved from a prospective database. Surgical and functional outcomes for the entire cohort were analyzed and the first 50 (group 1) and most recent 50 (group 2) cases were compared. Results The groups were similar in terms of baseline renal function, body mass index, and comorbidities. The mean tumor size and the proportion of central tumors in groups 1 and 2 were 2.4 vs 3 cm and 12% vs 52%, respectively ( P <.003). In group 2 we stopped the use of ureteral catheters and bolster renorrhaphy, and routinely clamped the renal hilum. Mean warm ischemia time in groups 1 and 2 (30 and 27 minute, respectively, P = .3) and the complication rate were similar. Overall, patients with tumors >4 cm had more complications ( P = .042). In group 2 the estimated blood loss and hospital stay decreased (243 vs 140 mL, P = .01, 1.4 vs 2.5 days, P <.001). Overall 78% of the tumors were malignant and the positive margin rate was 3%. With a median follow-up of 18 months, no local or distant tumor recurrences were observed. Conclusions With growing experience and technical modifications, LPN is now performed for patients with larger and more central tumors. Longer follow-up is necessary to evaluate oncologic outcomes.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Female</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephrectomy - methods</subject><subject>Nephrectomy - trends</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Urology</subject><subject>Young Adult</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU2P0zAQhi0EYsvCX1jlxinBX7FrDojVqnxIFSAtnC1nOllc3DjYSUX_PQ6thMSF00jvvPP1DCE3jDaMMvVq38wphvhwajilpqG6YaJlj8iKtVzXxpj2MVmVDK0lN-0VeZbznlKqlNJPyRUzRnEt-Ipstm50KWaIo4fqi0uTd6H6hOP3hDDFw-l1dVvd--EhYA04TJiqzTGGY1Gqza8Rk8cB8Dl50ruQ8cUlXpNv7zZf7z7U28_vP97dbmuQnE-1ERIZdpKBZjuqW2lEWVQa3XZGSdYhdK0Q7VquAU0PayWhp6CwCD1zlItr8vLcd0zx54x5sgefAUNwA8Y5Wy2ENkwLXZzq7IRyXE7Y2zH5g0sny6hdCNq9vRC0C0FLtV0IlsKby4i5O-Dub9kFWTG8PRuwHHr0mGyGPxB2fkFmd9H_f8abf1pA8IMHF37gCfM-zmkoGC2zmVtq75c_Lm8sgSvK1-I3pRaZYw</recordid><startdate>20100201</startdate><enddate>20100201</enddate><creator>Lifshitz, David A</creator><creator>Shikanov, Sergey A</creator><creator>Deklaj, Tom</creator><creator>Katz, Mark H</creator><creator>Zorn, Kevin C</creator><creator>Eggener, Scott E</creator><creator>Shalhav, Arieh L</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100201</creationdate><title>Laparoscopic Partial Nephrectomy: A Single-center Evolving Experience</title><author>Lifshitz, David A ; Shikanov, Sergey A ; Deklaj, Tom ; Katz, Mark H ; Zorn, Kevin C ; Eggener, Scott E ; Shalhav, Arieh L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-934e1eb41c71d0754939954975b9641becb5335848ce9fc864cf0c6e848f1a023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Female</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nephrectomy - methods</topic><topic>Nephrectomy - trends</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Urology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lifshitz, David A</creatorcontrib><creatorcontrib>Shikanov, Sergey A</creatorcontrib><creatorcontrib>Deklaj, Tom</creatorcontrib><creatorcontrib>Katz, Mark H</creatorcontrib><creatorcontrib>Zorn, Kevin C</creatorcontrib><creatorcontrib>Eggener, Scott E</creatorcontrib><creatorcontrib>Shalhav, Arieh L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lifshitz, David A</au><au>Shikanov, Sergey A</au><au>Deklaj, Tom</au><au>Katz, Mark H</au><au>Zorn, Kevin C</au><au>Eggener, Scott E</au><au>Shalhav, Arieh L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Laparoscopic Partial Nephrectomy: A Single-center Evolving Experience</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2010-02-01</date><risdate>2010</risdate><volume>75</volume><issue>2</issue><spage>282</spage><epage>287</epage><pages>282-287</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><abstract>Objectives To review our laparoscopic partial nephrectomy (LPN) experience, examine the evolution of technique, and compare the outcomes between the early and recent experience. The indications and surgical technique of LPN continuously evolve. Methods Data for 184 patients who underwent LPN for a tumor between October 2002 and August 2008 was retrieved from a prospective database. Surgical and functional outcomes for the entire cohort were analyzed and the first 50 (group 1) and most recent 50 (group 2) cases were compared. Results The groups were similar in terms of baseline renal function, body mass index, and comorbidities. The mean tumor size and the proportion of central tumors in groups 1 and 2 were 2.4 vs 3 cm and 12% vs 52%, respectively ( P <.003). In group 2 we stopped the use of ureteral catheters and bolster renorrhaphy, and routinely clamped the renal hilum. Mean warm ischemia time in groups 1 and 2 (30 and 27 minute, respectively, P = .3) and the complication rate were similar. Overall, patients with tumors >4 cm had more complications ( P = .042). In group 2 the estimated blood loss and hospital stay decreased (243 vs 140 mL, P = .01, 1.4 vs 2.5 days, P <.001). Overall 78% of the tumors were malignant and the positive margin rate was 3%. With a median follow-up of 18 months, no local or distant tumor recurrences were observed. Conclusions With growing experience and technical modifications, LPN is now performed for patients with larger and more central tumors. Longer follow-up is necessary to evaluate oncologic outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>19962732</pmid><doi>10.1016/j.urology.2009.07.1351</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Female Humans Laparoscopy Male Middle Aged Nephrectomy - methods Nephrectomy - trends Retrospective Studies Time Factors Treatment Outcome Urology Young Adult |
| title | Laparoscopic Partial Nephrectomy: A Single-center Evolving Experience |
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