|
1
|
Mohsin MS, Jess R, Abdulrasheed H, Almedej H, Osman B, Gaballa N, Chandrasekharan S. Exploring the Role of Intracorporeal Ultrasound in Partial Nephrectomies: A Systematic Review. Cureus 2024; 16:e73293. [PMID: 39524170 PMCID: PMC11549963 DOI: 10.7759/cureus.73293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2024] [Indexed: 11/16/2024] Open
Abstract
Renal cell carcinoma accounts for the sixth most common cancer in the United Kingdom. With the increasing application of cross-sectional imaging, the frequency of incidental renal masses has increased over time. Laparoscopic and robot-assisted partial nephrectomy has become the standard of care in the management of size and stage-appropriate renal masses. The objective of this systematic review was to analyse the surgical outcomes when intracorporeal ultrasound was utilised as an adjunct in partial nephrectomy. A comprehensive search in PubMed and Google Scholar was performed in July 2024 for publications in the English language. The primary endpoint was to evaluate the role of intracorporeal ultrasound as an adjunct in robotic partial nephrectomies and its impact on tumour clearance. After identifying 609 records, 52 records were screened and 44 records were sought for retrieval. Eight publications were included in this systematic review comprising 765 patients. Seven of the eight studies reported outcomes from single centres. The mean percentage of negative surgical margins was 97.6% (range = 92.1-100%). The use of intracorporeal ultrasound as an adjunct in partial nephrectomy for T1 renal cell cancer has proven to improve the rates of negative surgical margins thereby reducing the incidence of local recurrence and distant metastasis.
Collapse
Affiliation(s)
- Mohamed S Mohsin
- Department of Urology, University Hospitals Birmingham, Birmingham, GBR
| | - Rebecca Jess
- Department of Urology, University Hospitals Birmingham, Birmingham, GBR
| | | | - Humood Almedej
- Department of Urology, University Hospitals Birmingham, Birmingham, GBR
| | - Banan Osman
- Department of Urology, University Hospitals Birmingham, Birmingham, GBR
| | - Nader Gaballa
- Department of Urology, University Hospitals Birmingham, Birmingham, GBR
| | | |
Collapse
|
|
2
|
Mihai I, Dura H, Teodoru CA, Todor SB, Ichim C, Grigore N, Mohor CI, Mihetiu A, Oprinca G, Bacalbasa N, Tanasescu D, Bratu DG, Boicean A, Oros B, Hasegan A. Intraoperative Ultrasound: Bridging the Gap between Laparoscopy and Surgical Precision during 3D Laparoscopic Partial Nephrectomies. Diagnostics (Basel) 2024; 14:942. [PMID: 38732356 PMCID: PMC11083918 DOI: 10.3390/diagnostics14090942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The use of 3D laparoscopic partial nephrectomy has emerged as a cornerstone in the surgical arsenal for addressing renal tumors, particularly in managing challenging cases characterized by deeply seated tumors embedded within the renal parenchyma. In these intricate scenarios, the utilization of intraoperative ultrasound (IOUS) acquires paramount importance, serving as an indispensable tool for guiding and meticulously monitoring the surgical process in real time. To further explore the efficacy of IOUS-guided techniques, we conducted a retrospective study comparing outcomes in patients who underwent partial nephrectomy with IOUS guidance (n = 60) between 2020 and 2022 with a cohort from 2018 to 2019 without IOUS guidance (n = 25). Our comprehensive analysis encompassed various post-operative parameters, including the duration until food resumption, analgesia requirements, and length of the hospital stay. While these parameters exhibited comparable outcomes between the two groups, notable distinctions emerged in the intraoperative metrics. The IOUS-guided cohort demonstrated significantly reduced blood loss, a shorter median operative duration, and diminished ischemia time (p = 0.001). These compelling findings underscore the undeniable benefits of IOUS-guided techniques in not only facilitating the attainment of negative surgical margins but also in enhancing procedural safety and precision, thereby contributing to improved patient outcomes in the management of renal tumors.
Collapse
Affiliation(s)
- Ionela Mihai
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Horatiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Cosmin Adrian Teodoru
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Nicolae Grigore
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Alin Mihetiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - George Oprinca
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Nicolae Bacalbasa
- Surgery Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
| | - Denisa Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| | - Bogdan Oros
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Adrian Hasegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (I.M.); (C.A.T.); (S.B.T.); (C.I.); (N.G.); (C.I.M.); (A.M.); (G.O.); (D.T.); (D.G.B.); (A.B.); (A.H.)
| |
Collapse
|
|
3
|
Liu W, Zhang E, Zhang M. Current Application of Navigation Systems in Robotic-Assisted and Laparoscopic Partial Nephrectomy: Focus on the Improvement of Surgical Performance and Outcomes. Ann Surg Oncol 2024; 31:2163-2172. [PMID: 38063985 DOI: 10.1245/s10434-023-14716-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024]
Abstract
Kidney cancer represents the third most prevalent malignancy among all types of genitourinary cancer worldwide. Currently, there is a growing trend of employing partial nephrectomy for the management of large and complex tumors. Surgical outcomes are associated with some amendable surgical factors, including warm ischemic time, pedicle clamping, preserved volume of renal parenchyma, appropriate surgical strategy, and precise resection of the tumor. Improving surgical performance is pivotal for achieving favorable surgical outcomes. Due to advancements in imaging visualization technology and the shift of the medical paradigm toward precision medicine, an increasing number of navigation systems have been implemented in partial nephrectomy procedures. The navigation system can assist surgeons in formulating optimal surgical strategies and enhance the safety, precision, and feasibility of resecting complex renal tumors. In this review, we provide an overview of currently available navigation systems and their feasible applications, with a focus on how they contribute to the improvement of surgical performance and outcomes during robotic-assisted and laparoscopic partial nephrectomy.
Collapse
Affiliation(s)
- Wangmin Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Enchong Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Mo Zhang
- Department of Urology, The First Hospital of China Medical University, Shenyang, China.
| |
Collapse
|
|
4
|
Batista LT, Oliveira JGRD, Gouvea VP, Souza LAD, Tourinho-Barbosa R. Alternative use of endocavitary probe to guide minimally invasive partial nephrectomy: is it reasonable? Acta Cir Bras 2022; 37:e370607. [PMID: 36134853 PMCID: PMC9488510 DOI: 10.1590/acb370607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To describe the use of endocavitary ultrasound probe as an auxiliary tool when performing partial nephrectomy in cases of endophytic renal tumors, to standardize the method, and to report the preliminary results achieved with this technique. Methods: Fifteen patients diagnosed with completely endophytic underwent partial nephrectomy with the use of an endocavitary ultrasound probe. This article describes the technique involved in partial nephrectomy and details the preparation of the endocavitary ultrasound probe to ensure its safe use. Results: All the patients had a RENAL score between 8 and 11. The median time of warm ischemia was 26 and 18 minutes for laparoscopic or robot-assisted surgery, respectively. The median duration of surgery was 150 minutes, and the median console time was 145 minutes for the laparoscopic and robot-assisted surgery groups, respectively. The median estimate of blood loss was 200 mL. Only three patients in the laparoscopic group had focal positive surgical margins. There were no cases of infection at the site of probe entry. Conclusions: Intraoperative use of an endocavitary ultrasound probe for partial nephrectomy is possible and a safe alternative to the excision of endophytic tumors when neither robotic probes nor laparoscopic probes are available.
Collapse
Affiliation(s)
- Lucas Teixeira Batista
- PhD. Universidade Federal da Bahia - Department of Urology - Salvador (BA), Brazil.,PhD. Hospital Cardiopulmonar - Department of Urology - Salvador (BA), Brazil
| | | | - Vitor Parente Gouvea
- Graduate student. Escola Bahiana de Medicina e Saúde Pública - Salvador (BA), Brazil
| | | | - Rafael Tourinho-Barbosa
- PhD. Hospital Cardiopulmonar - Department of Urology - Salvador (BA), Brazil.,PhD. Faculdade de Medicina do ABC - Department of Urology - Santo André (SP), Brazil
| |
Collapse
|
|
5
|
Li L, Wu H, Hu S, Yu Y, Chen Z, Wang P, Zhou L, Li R, Yao L, Yue S. Clear cell renal cell carcinoma detection by multimodal photoacoustic tomography. PHOTOACOUSTICS 2021; 21:100221. [PMID: 33251109 PMCID: PMC7683266 DOI: 10.1016/j.pacs.2020.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/22/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
There is a need for accurate and rapid detection of renal cancer in clinic. Here, we integrated photoacoustic tomography (PAT) with ultrasound imaging in a single system, which achieved tissue imaging depth about 3 mm and imaging speed about 3.5 cm2/min. We used the wavelength at 1197 nm to map lipid distribution in normal renal tissues and clear cell renal cell carcinoma (ccRCC) tissues collected from 19 patients undergone nephrectomy. Our results indicated that the photoacoustic signal from lipids was significantly higher in ccRCC tissues than that in normal tissues. Moreover, based on the quantification of lipid area ratio, we were able to differentiate normal and ccRCC with 100 % sensitivity, 80 % specificity, and area under receiver operating characteristic curve of 0.95. Our findings demonstrate that multimodal PAT can differentiate normal and ccRCC by integrating the morphologic information from ultrasound and lipid amount information from vibrational PAT.
Collapse
Affiliation(s)
- Lin Li
- Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Hanbo Wu
- Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Shuai Hu
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Yanfei Yu
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Zhicong Chen
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Pu Wang
- Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
- Vibronix Inc., West Lafayette, IN, USA
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Rui Li
- Vibronix Inc., West Lafayette, IN, USA
| | - Lin Yao
- Department of Urology, Peking University First Hospital, Beijing 100034, China
| | - Shuhua Yue
- Institute of Medical Photonics, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| |
Collapse
|
|
6
|
Sun Y, Wang W, Zhang Q, Zhao X, Xu L, Guo H. Intraoperative ultrasound: technique and clinical experience in robotic-assisted renal partial nephrectomy for endophytic renal tumors. Int Urol Nephrol 2020; 53:455-463. [PMID: 33006090 DOI: 10.1007/s11255-020-02664-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/21/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Surgical removal of completely endophytic renal tumors has presented great technical difficulties for surgeons. In this study, we aim to introduce the role and use of intraoperative ultrasound (IOUS) performed in robotic-assisted renal partial nephrectomy (RAPN) for endophytic renal tumors. METHODS We retrospectively assessed the demographics data and surgical outcomes of 58 consecutive endophytic renal tumor patients who were all attributed 3 points for the 'E' domain of the RENAL nephrometry score or 3 points for the exophytic rate of the PADUA score between October 2016 and September 2018. 38 patients who had undergone RAPN with IOUS were grouped. RAPN was carried out in another 20 patients without IOUS and these 20 patients were also grouped. RESULTS Patients in IOUS-guided group had significantly lower estimated blood loss (P < 0.001), shorter warm ischemia time (P = 0.010) and improved MIC (Margin, ischemia, and complications) rate (P = 0.026) and Pentafecta achievement (P = 0.016) compared to non IOUS-guided group. In multivariate logistic regression analysis, RAPN with IOUS was an independent predictor of MIC achievement (odds ratio 3.595; confidence interval 1.023-12.633; P = 0.046). Surface-intermediate-base (SIB) margin score was lower for IOUS-guided group vs non IOUS-guided group (P = 0.029). CONCLUSION RAPN for completely endophytic renal tumors is a feasible procedure in terms of complication rates, oncologic and functional outcomes. A robotic ultrasound probe operated by console surgeon generates a favorable perioperative outcomes and surgical margin rates after RAPN.
Collapse
Affiliation(s)
- Yifan Sun
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Wei Wang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Linfeng Xu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China.
| |
Collapse
|
|
7
|
Stewart S, Darr M, Gomer H, Smith A, Samiei A, Post JC, Miller RJ, Lyne J, Cohen J, Treado PJ. Visible near infrared reflectance molecular chemical imaging of human ex vivo carcinomas and murine in vivo carcinomas. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:1-18. [PMID: 32096369 PMCID: PMC7039338 DOI: 10.1117/1.jbo.25.2.026003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/27/2020] [Indexed: 05/23/2023]
Abstract
SIGNIFICANCE A key risk faced by oncological surgeons continues to be complete removal of tumor. Currently, there is no intraoperative imaging device to detect kidney tumors during excision. AIM We are evaluating molecular chemical imaging (MCI) as a technology for real-time tumor detection and margin assessment during tumor removal surgeries. APPROACH In exploratory studies, we evaluate visible near infrared (Vis-NIR) MCI for differentiating tumor from adjacent tissue in ex vivo human kidney specimens, and in anaesthetized mice with breast or lung tumor xenografts. Differentiation of tumor from nontumor tissues is made possible with diffuse reflectance spectroscopic signatures and hyperspectral imaging technology. Tumor detection is achieved by score image generation to localize the tumor, followed by application of computer vision algorithms to define tumor border. RESULTS Performance of a partial least squares discriminant analysis (PLS-DA) model for kidney tumor in a 22-patient study is 0.96 for area under the receiver operating characteristic curve. A PLS-DA model for in vivo breast and lung tumor xenografts performs with 100% sensitivity, 83% specificity, and 89% accuracy. CONCLUSION Detection of cancer in surgically resected human kidney tissues is demonstrated ex vivo with Vis-NIR MCI, and in vivo on mice with breast or lung xenografts.
Collapse
Affiliation(s)
- Shona Stewart
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Marlena Darr
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Heather Gomer
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Aaron Smith
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Arash Samiei
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | | | - Ralph J. Miller
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - John Lyne
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Jeffrey Cohen
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | | |
Collapse
|
|
8
|
Joeres F, Schindele D, Luz M, Blaschke S, Russwinkel N, Schostak M, Hansen C. How well do software assistants for minimally invasive partial nephrectomy meet surgeon information needs? A cognitive task analysis and literature review study. PLoS One 2019; 14:e0219920. [PMID: 31318919 PMCID: PMC6638947 DOI: 10.1371/journal.pone.0219920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/04/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Intraoperative software assistance is gaining increasing importance in laparoscopic and robot-assisted surgery. Within the user-centred development process of such systems, the first question to be asked is: What information does the surgeon need and when does he or she need it? In this article, we present an approach to investigate these surgeon information needs for minimally invasive partial nephrectomy and compare these needs to the relevant surgical computer assistance literature. MATERIALS AND METHODS First, we conducted a literature-based hierarchical task analysis of the surgical procedure. This task analysis was taken as a basis for a qualitative in-depth interview study with nine experienced surgical urologists. The study employed a cognitive task analysis method to elicit surgeons' information needs during minimally invasive partial nephrectomy. Finally, a systematic literature search was conducted to review proposed software assistance solutions for minimally invasive partial nephrectomy. The review focused on what information the solutions present to the surgeon and what phase of the surgery they aim to support. RESULTS The task analysis yielded a workflow description for minimally invasive partial nephrectomy. During the subsequent interview study, we identified three challenging phases of the procedure, which may particularly benefit from software assistance. These phases are I. Hilar and vascular management, II. Tumour excision, and III. Repair of the renal defects. Between these phases, 25 individual challenges were found which define the surgeon information needs. The literature review identified 34 relevant publications, all of which aim to support the surgeon in hilar and vascular management (phase I) or tumour excision (phase II). CONCLUSION The work presented in this article identified unmet surgeon information needs in minimally invasive partial nephrectomy. Namely, our results suggest that future solutions should address the repair of renal defects (phase III) or put more focus on the renal collecting system as a critical anatomical structure.
Collapse
Affiliation(s)
- Fabian Joeres
- Department of Simulation and Graphics, Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Daniel Schindele
- Clinic of Urology and Paediatric Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Maria Luz
- Department of Simulation and Graphics, Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Simon Blaschke
- Clinic of Urology and Paediatric Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Nele Russwinkel
- Department of Cognitive Modelling in Dynamic Human-Machine Systems, Technische Universität Berlin, Berlin, Germany
| | - Martin Schostak
- Clinic of Urology and Paediatric Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Christian Hansen
- Department of Simulation and Graphics, Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany
| |
Collapse
|
|
9
|
Yang F, Liu S, Mou L, Wu L, Li X, Xing N. Application of intraoperative ultrasonography in retroperitoneal laparoscopic partial nephrectomy: A single-center experience of recent 199 cases. Endosc Ultrasound 2019; 8:118-124. [PMID: 31006707 PMCID: PMC6482610 DOI: 10.4103/eus.eus_15_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objectives: To summarize the value and application experiences of intraoperative laparoscopic ultrasonography (ILUS) in retroperitoneal laparoscopic partial nephrectomy (RLPN). Materials and Methods: From January 2013 to December 2018, RLPN with ILUS was performed on the recent 199 patients in our center (two patients received bilateral RLPN due to suspected malignancy of both right and left sides), and the relevant clinical and follow-up data were retrospectively reviewed. Among them, 119 patients were male and 80 were female; the age of patients was 53.4 ± 12.3 years. Of all the renal tumors, 105 were located on the left side and 96 on the right side with a RENAL score of 6.6 ± 1.7. All the patients were diagnosed as or suspected of having a renal tumor by preoperative imaging examination. The ILUS was applied in all the operations to help locate the tumor, delineate the boundary, clarify the diagnosis, observe the blood supply, and so on. Results: RLPN with ILUS in these 199 patients was successfully performed without conversion to open surgery. All surgeries were completed in 90.2 ± 21.7 min, with 73.6 ± 89.2 mL for estimated blood loss, and 19.3 ± 5.6 min for warm ischemia time. The tumor size was 3.6 ± 1.5 cm, and all the surgical margins were negative. The drainage days and postoperative hospital days were 4.7 ± 2.3 and 6.1 ± 2.3, respectively. The preoperative creatinine was 69.7 ± 19.4 μmol/L compared with 61.6 ± 12.7 μmol/L measured 1 month postoperatively. There were 17 cases of renal cell carcinoma no more than 1 cm, and they were resected without artery clamp or a large amount of blood loss. Satellite tumors were confirmed in 12 cases, of which 8 were not detected by preoperative examinations and finally found by ILUS during surgeries. Conclusion: ILUS can alleviate the difficulty of preoperative diagnosis, facilitate surgical dissection, and improve the effect of nephron-sparing surgeries. Due to its great advantage, ILUS should further be promoted and applied.
Collapse
Affiliation(s)
- Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sai Liu
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lianjie Mou
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liyuan Wu
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xuesong Li
- Department of Urology, National Urological Cancer Center, Institute of Urology, Peking University First Hospital, Peking University, Beijing, China
| | - Nianzeng Xing
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
10
|
Intraoperative Imaging Techniques to Support Complete Tumor Resection in Partial Nephrectomy. Eur Urol Focus 2018; 4:960-968. [DOI: 10.1016/j.euf.2017.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/29/2017] [Indexed: 12/22/2022]
|
|
11
|
Aldrink JH, Cost NG, McLeod DJ, Bates DG, Stanek JR, Smith EA, Ehrlich PF. Technical Considerations for Nephron-Sparing Surgery in Children: What Is Needed to Preserve Renal Units? J Surg Res 2018; 232:614-620. [PMID: 30463781 DOI: 10.1016/j.jss.2018.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy is used preoperatively for children with bilateral Wilms tumor (BWT) or unilateral high-risk Wilms tumor (UHRWT) to promote tumor regression to facilitate renal preservation with nephron-sparing surgery (NSS). In adults, various surgical techniques have been described to preserve renal tissue. Few studies have examined the use of surgical adjuncts in NSS in children with renal tumors. METHODS We performed a multi-institutional retrospective review of patients with BWT or UHRWT. Patient demographics, tumor size at diagnosis, following neoadjuvant chemotherapy, utilization of surgical adjuncts including intraoperative ultrasound (IOUS), margin status, complications, renal function, and follow-up were recorded. RESULTS The cohort comprised 23 patients: 18 BWT, 3 UHRWT, and 2 patients with solitary kidney. Twenty-two of the 23 patients had successful NSS. IOUS was used 19 times, and seven had positive margins after surgery. Cooling/vascular isolation was used six times. At a median follow-up of 18 mo, median estimated glomerular filtration rate Schwartz was 126 mL/min/1.73 m2 and median serum creatinine 0.39 mg/dL in the 22 patients who had successful NSS. There have been no tumor recurrences. CONCLUSIONS In patients with BWT and UHRWT, surgical adjuncts such as cooling/vascular isolation are uncommonly performed. IOUS may be helpful but does not guarantee negative microscopic margins. LEVEL OF EVIDENCE Level 4, Case series with no comparison group.
Collapse
Affiliation(s)
- Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Nicholas G Cost
- Division of Pediatric Urology, Department of Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Daryl J McLeod
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - David Gregory Bates
- Division of Pediatric Radiology, Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph R Stanek
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Biostatistics, Nationwide Children's Hospital, Columbus, Ohio
| | - Ethan A Smith
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
|
12
|
Liu B, Zhan Y, Chen X, Xie Q, Wu B. Laparoscopic ultrasonography: The wave of the future in renal cell carcinoma? Endosc Ultrasound 2018; 7:161-167. [PMID: 29941724 PMCID: PMC6032702 DOI: 10.4103/eus.eus_27_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic or robotic surgery is the main method of treating renal cell carcinoma (RCC). Laparoscopic surgery can accurately target lesions and shorten patient recovery time. Renal endogenous tumors or inferior vena cava tumor thrombi are very difficult to remove using the laparoscopic approach. The emergence of laparoscopic ultrasonography (LUS) has solved this problem. LUS can assist in the detection of tumor boundaries and the extent of tumor thrombi. The lack of tactile feedback may hinder the development of laparoscopic surgery for the treatment of renal cancer. LUS has become an important tool that has improved the rates of successful surgery. LUS is applied in not only early and locally advanced RCC treatment but also in monitoring ablation therapy, testing renal blood perfusion, and exposing renal pedicles. Sonographic techniques used for LUS include initial B-mode, Doppler, and contrast-enhanced ultrasound (CEUS). Contrast agents applied for CEUS do not induce nephrotoxicity and can display renal perfusion more accurately than the regular color Doppler ultrasound. According to current literature, LUS is a promising technique for the treatment of RCC, especially for endogenous RCC or RCC with thrombosis, and for monitoring the effectiveness of radiofrequency ablation, although further well-designed studies are warranted.
Collapse
Affiliation(s)
- Bitian Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yunhong Zhan
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qingpeng Xie
- Department of Urology, Cancer Hospital of China Medial University, Liaoning Cancer Hospital, Shenyang, Liaoning Province, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
|
13
|
Urman B, Boza A, Ata B, Aksu S, Arslan T, Taskiran C. Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas. J OBSTET GYNAECOL 2017; 38:85-89. [PMID: 28764594 DOI: 10.1080/01443615.2017.1327515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the feasibility of intraoperative endoscopic ultrasound guidance for excision of symptomatic deep intramural myomas that are not otherwise visible at laparoscopy. Seventeen patients with symptomatic deep intramural myomas who underwent laparoscopic myomectomy with intraoperative endoscopic ultrasound guidance were followed up and reported. All myomas were removed successfully. The endometrium was breached in one patient. All patients were relieved of their symptoms and three patients presenting with infertility conceived. There were no short- or long-term complications associated with the procedure. One patient who had multiple myomas necessitated intravenous iron treatment prior to discharge. Laparoscopic removal of small symptomatic deep intramural myomas is facilitated by the use of intraoperative endoscopic ultrasound that enables exact localisation and correct placement of the serosal incision. Impact statement What is already known on this subject: When the myoma is symptomatic, compressing the endometrium, does not show serosal protrusion and is not amenable to hysteroscopic resection, laparoscopic surgery may become challenging. What do the results of this study add: The use of intraoperative endoscopic ultrasound under these circumstances may facilitate the procedure by accurate identification of the myoma and correct placement of the serosal incision. What are the implications of these findings for clinical practice and/or further research: Intraoperative ultrasound should be more oftenly used to accurately locate deep intramural myomas to the end of making laparoscopy feasible and possibly decreasing recurrence by facilitating removal of otherwise unidentifiable disease.
Collapse
Affiliation(s)
- Bulent Urman
- a Department of Obstetrics and Gynecology , Koc University School of Medicine, Rumelifeneri Yolu , Istanbul , Turkey.,b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Aysen Boza
- b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Baris Ata
- a Department of Obstetrics and Gynecology , Koc University School of Medicine, Rumelifeneri Yolu , Istanbul , Turkey
| | - Sertan Aksu
- b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Tonguc Arslan
- b Women's Health Centre , American Hospital , Istanbul , Turkey
| | - Cagatay Taskiran
- a Department of Obstetrics and Gynecology , Koc University School of Medicine, Rumelifeneri Yolu , Istanbul , Turkey.,b Women's Health Centre , American Hospital , Istanbul , Turkey
| |
Collapse
|
|
14
|
Roy S, Evans C. Overview of robotic colorectal surgery: Current and future practical developments. World J Gastrointest Surg 2016; 8:143-150. [PMID: 26981188 PMCID: PMC4770168 DOI: 10.4240/wjgs.v8.i2.143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/19/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete.
Collapse
|
|
15
|
Alharbi FM, Chahwan CK, Le Gal SG, Guleryuz KM, Tillou XP, Doerfler AP. Intraoperative ultrasound control of surgical margins during partial nephrectomy. Urol Ann 2016; 8:430-433. [PMID: 28057986 PMCID: PMC5100147 DOI: 10.4103/0974-7796.192107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aims: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. Subjects and Methods: This study was conducted for patients undergoing partial nephrectomy (PN) with T1–T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. Results: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.
Collapse
Affiliation(s)
- Feras M Alharbi
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - Charles K Chahwan
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - Sophie G Le Gal
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - Kerem M Guleryuz
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - Xavier P Tillou
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| | - Arnaud P Doerfler
- Department of Urology and Transplantation, Caen University Hospital, Caen, France
| |
Collapse
|
|
16
|
Intraoperative and surgical specimen (ex vivo) ultrasound in the assessment of margins at partial nephrectomy. Int Urol Nephrol 2015; 47:1665-9. [PMID: 26267670 DOI: 10.1007/s11255-015-1083-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/05/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To correlate the accuracy of intraoperative and surgical specimen (ex vivo) ultrasound (US) with pathological margin status at partial nephrectomy. MATERIALS AND METHODS Patients undergoing partial nephrectomy for T1 renal tumours in the period May 2010-January 2014 at a single institution who had intraoperative specimen US were included. PN was performed by standardised technique with intraoperative tumour localisation. Following excision, surgical specimen (ex vivo) US was performed and the margin status was compared to the final histopathological analysis. The specificity of US to identify margin status was calculated as was the correlation between the ultrasonographic and final pathological margin. RESULTS Forty-five patients were included (median age 61 years). Mean tumour size was 28.1 ± 10 mm, and 89 % were renal cell carcinomas with the remainder being oncocytomas. Forty-four cases had negative surgical margins on pathological analysis, and US had a specificity of 100 %. There was a strong correlation between the margin as measured on US and final analysis (Pearson's r = 0.86, p < 0.001). CONCLUSION Results show that intraoperative, surgical specimen (ex vivo) US control of resection margins in patients undergoing PN is feasible and efficient. It represents a promising tool to ensure margin negativity during PN.
Collapse
|