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MP-14.03 During the Learning Curve, Does the Robot-Assisted Partial Nephrectomy Have Equal Outcomes to the Open Partial Nephrectomy?
MODERATED POSTER SESSIONS
Moderated Poster Session 14: Minimally Invasive Surgery Wednesday, October 19 13:15-14:45 MP-14.01 An Alternative Method for Veress Needle Access to Avoid Insertion Complications Komesli G1, Yesilli C2, Erkul A2, Ozgok Y3 1 Dept. of Urology, Military Hospital, Eskisehir, Turkey, 2Dept. of Urology, Yunus Emre State Hospital, Eskisehir, Turkey; 3Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey Introduction and Objective: Laparoscopic renal surgery can be performed effectively by either retroperitoneal or transperitoneal approach. Relative contraindications for transperitoneal laparoscopic procedures include previous intraabdominal procedures with severe adhesions, a history of peritonitis, and diaphragmatic hernia. Every kind of intraabdominal injuries and vascular injuries have been reported due to insertion of veress needle in the literature. To avoid insertion complications of veress needle alternative methods can be tested. Material and Methods: In traditional transperitoneal approach the patient is positioned in a standard complete flank position or 45 to the operating table and veress needle access is achieved via umblical region. The reported incidence of bowel injuries due to veress needle and trocar insertion is 0.03% to 0.3%. Different renal procedures were performed for thirteen patients by transperitoneal approach. Five of them had known previous abdominal surgery. We applied veress needle midpoint between xifoid and umbilicus on lateral edge of rectus muscle by utilising Palmer’s point. Our access point is a safe place for insertion for veress needle due to replacement of bowel content to the downside. Results: There was no complication due to veress needle access in our cases. Conversion to open surgery was required for two patients due to severe intraabdominal adhesion. There were no severe postoperative complications for all patients. Conclusions: Our experience suggests that this access is a good alternative and safe for insertion of the veress needle in
patients especially with previous abdominal surgery.
techniques result in equivalent local oncologic control post-operatively.
MP-14.02 Open vs Robot-Assisted Laparoscopic Nephron-Sparing Techniques: Are the Tumor-free Margins Equivalent? Andreoiu M, Muruve N Dept. of Urology, Cleveland Clinic Florida, Weston, USA
MP-14.03 During the Learning Curve, Does the Robot-Assisted Partial Nephrectomy Have Equal Outcomes to the Open Partial Nephrectomy? Jankowski T, Siemer S, Kamradt J, Bütow Z, Stöckle M Dept. of Urology, University of Saarland, Homburg, Germany
Introduction and Objective: Limited published data exists regarding whether robot-assisted laparoscopic nephron-sparing surgery impacts a surgeon’s ability to assess margin depth, thereby potentially leading to inferior tumor-free margins on final pathology. Some have argued that the magnified intra-operative visualization offered by the robot-assisted laparoscopic approach can lead to overestimation of the distance between tumor edge and line of resection. We reviewed data on tumorfree margin distance at our institution from both open and robotic-assisted laparoscopic partial nephrectomies to determine whether the laparoscopic approach resulted in decreased tumor-free margins compared to those obtained through the traditional open surgical approach. Materials and Methods: A retrospective comparison review of 51 consecutive open vs 31 robotic-assisted laparoscopic nephron-sparing renal neoplasm resection over the past 2 years (January 2009 to December 2010) was undertaken. The defining clinical and pathologic characteristics of each tumor were recorded and the pathology report for each case examined for the specified distance between the tumor and resection margins. Each group’s data were then compared using a Student’s t-test to assess for a significant difference in the average tumor-free margin distance of the two groups. Results: Clinical and pathologic tumor characteristics were equivalent between the two groups. There were no intra-operative complications in either group. No robotic cases had to be converted to the open approach. There was no significant difference in the average tumor-free margin distance of the two groups, with average distances of 2.89 mm and 2.73 mm in the open surgical and robotic-assisted cases, respectively. Conclusions: The operative field magnification available with robot-assisted laparoscopic partial nephrectomy does not appear to impair the surgeon’s ability to assess proper margin depth during renal tumor resection. This indicates that both
UROLOGY 78 (Supplement 3A), September 2011
Introduction and Objective: The aim of this work was to examine if there are therapeutically relevant differences between a robot-assisted laparoscopic nephrectomy (RPN) and an open partial nephrectomy (OPN) during the learning curve. Materials and Method: A total of 100 patients after OPN/RPN were compared with each other. A matched pair analysis with regards to age (mean 65 years), sex, grading, the tumour size (mean 3 cm) and tumour entity was performed. Results: The mean ischemic time was 21.4 min in the RPN group and 19 min in the OPN group. The mean operating time was 210 min. in the RPN group and 106 min in the OPN group. The perioperative hemoglobin drop was 2.1 g / dl and 1,7 g/l, respectively. Positive surgical margins were detected in 4% of the patients where a RPN was performed and in 2% where an OPN was performed. There was 22% of the patients after RPN and 30% after OPN suffered complications. In only 6% of both patient groups a further invasive therapy was necessary. A conversion to open surgery occurred in 30% of patients in the RPN group. The mean postoperative hospital stay was 7.4 days after RPN, 11.2 days after OPN. Conclusion: The data above indicates that robotic-assisted surgery, despite the learning curve, which should not be underestimated, has equivalent oncological and functional results when compared to the open partial nephrectomy. The choice as to which operating technique should be used remains a personal and patient guided one.
MP-14.04 Accuracy of Predictive Scoring Systems in Laparoscopic Nephrectomy Jundi O1, Khafagy R2, Rogawski K1 1 Calderdale Huddersfield NHS Trust, Huddersfield, UK; 2Leeds Teaching Hospitals Trust, Leeds, UK Introduction and Objective: The Physiological and Operative Severity Score for
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Moderated Poster Session 14: Minimally Invasive Surgery Wednesday, October 19 13:15-14:45 MP-14.01 An Alternative Method for Veress Needle Access to Avoid Insertion Complications Komesli G1, Yesilli C2, Erkul A2, Ozgok Y3 1 Dept. of Urology, Military Hospital, Eskisehir, Turkey, 2Dept. of Urology, Yunus Emre State Hospital, Eskisehir, Turkey; 3Dept. of Urology, Gulhane Military Medical Academy, Ankara, Turkey Introduction and Objective: Laparoscopic renal surgery can be performed effectively by either retroperitoneal or transperitoneal approach. Relative contraindications for transperitoneal laparoscopic procedures include previous intraabdominal procedures with severe adhesions, a history of peritonitis, and diaphragmatic hernia. Every kind of intraabdominal injuries and vascular injuries have been reported due to insertion of veress needle in the literature. To avoid insertion complications of veress needle alternative methods can be tested. Material and Methods: In traditional transperitoneal approach the patient is positioned in a standard complete flank position or 45 to the operating table and veress needle access is achieved via umblical region. The reported incidence of bowel injuries due to veress needle and trocar insertion is 0.03% to 0.3%. Different renal procedures were performed for thirteen patients by transperitoneal approach. Five of them had known previous abdominal surgery. We applied veress needle midpoint between xifoid and umbilicus on lateral edge of rectus muscle by utilising Palmer’s point. Our access point is a safe place for insertion for veress needle due to replacement of bowel content to the downside. Results: There was no complication due to veress needle access in our cases. Conversion to open surgery was required for two patients due to severe intraabdominal adhesion. There were no severe postoperative complications for all patients. Conclusions: Our experience suggests that this access is a good alternative and safe for insertion of the veress needle in
patients especially with previous abdominal surgery.
techniques result in equivalent local oncologic control post-operatively.
MP-14.02 Open vs Robot-Assisted Laparoscopic Nephron-Sparing Techniques: Are the Tumor-free Margins Equivalent? Andreoiu M, Muruve N Dept. of Urology, Cleveland Clinic Florida, Weston, USA
MP-14.03 During the Learning Curve, Does the Robot-Assisted Partial Nephrectomy Have Equal Outcomes to the Open Partial Nephrectomy? Jankowski T, Siemer S, Kamradt J, Bütow Z, Stöckle M Dept. of Urology, University of Saarland, Homburg, Germany
Introduction and Objective: Limited published data exists regarding whether robot-assisted laparoscopic nephron-sparing surgery impacts a surgeon’s ability to assess margin depth, thereby potentially leading to inferior tumor-free margins on final pathology. Some have argued that the magnified intra-operative visualization offered by the robot-assisted laparoscopic approach can lead to overestimation of the distance between tumor edge and line of resection. We reviewed data on tumorfree margin distance at our institution from both open and robotic-assisted laparoscopic partial nephrectomies to determine whether the laparoscopic approach resulted in decreased tumor-free margins compared to those obtained through the traditional open surgical approach. Materials and Methods: A retrospective comparison review of 51 consecutive open vs 31 robotic-assisted laparoscopic nephron-sparing renal neoplasm resection over the past 2 years (January 2009 to December 2010) was undertaken. The defining clinical and pathologic characteristics of each tumor were recorded and the pathology report for each case examined for the specified distance between the tumor and resection margins. Each group’s data were then compared using a Student’s t-test to assess for a significant difference in the average tumor-free margin distance of the two groups. Results: Clinical and pathologic tumor characteristics were equivalent between the two groups. There were no intra-operative complications in either group. No robotic cases had to be converted to the open approach. There was no significant difference in the average tumor-free margin distance of the two groups, with average distances of 2.89 mm and 2.73 mm in the open surgical and robotic-assisted cases, respectively. Conclusions: The operative field magnification available with robot-assisted laparoscopic partial nephrectomy does not appear to impair the surgeon’s ability to assess proper margin depth during renal tumor resection. This indicates that both
UROLOGY 78 (Supplement 3A), September 2011
Introduction and Objective: The aim of this work was to examine if there are therapeutically relevant differences between a robot-assisted laparoscopic nephrectomy (RPN) and an open partial nephrectomy (OPN) during the learning curve. Materials and Method: A total of 100 patients after OPN/RPN were compared with each other. A matched pair analysis with regards to age (mean 65 years), sex, grading, the tumour size (mean 3 cm) and tumour entity was performed. Results: The mean ischemic time was 21.4 min in the RPN group and 19 min in the OPN group. The mean operating time was 210 min. in the RPN group and 106 min in the OPN group. The perioperative hemoglobin drop was 2.1 g / dl and 1,7 g/l, respectively. Positive surgical margins were detected in 4% of the patients where a RPN was performed and in 2% where an OPN was performed. There was 22% of the patients after RPN and 30% after OPN suffered complications. In only 6% of both patient groups a further invasive therapy was necessary. A conversion to open surgery occurred in 30% of patients in the RPN group. The mean postoperative hospital stay was 7.4 days after RPN, 11.2 days after OPN. Conclusion: The data above indicates that robotic-assisted surgery, despite the learning curve, which should not be underestimated, has equivalent oncological and functional results when compared to the open partial nephrectomy. The choice as to which operating technique should be used remains a personal and patient guided one.
MP-14.04 Accuracy of Predictive Scoring Systems in Laparoscopic Nephrectomy Jundi O1, Khafagy R2, Rogawski K1 1 Calderdale Huddersfield NHS Trust, Huddersfield, UK; 2Leeds Teaching Hospitals Trust, Leeds, UK Introduction and Objective: The Physiological and Operative Severity Score for
S133