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      Laparoscopic renal surgery is here to stay

      review-article
      * , ,
      Arab Journal of Urology
      Elsevier
      BMI, body mass index, (L)(LESS-)DN, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy, eGFR, estimated GFR, LOS, length of hospital stay, NOTES, natural orifice transluminal endoscopic surgery, (L)(O)(RA)PN, (laparoscopic) (open) (robot-assisted) partial nephrectomy, PUJO, PUJ obstruction, (L)(O)(RA)PY, (laparoscopic) (open) (robot-assisted) pyeloplasty, RCT, randomised controlled trial, (L)(O)(RA)RN, (laparoscopic) (open) (robot-assisted) radical nephrectomy, WIT, warm ischaemia time, Laparoscopic/open/robotic renal surgery, Radical nephrectomy, Donor nephrectomy, Partial nephrectomy, Pyeloplasty

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          Abstract

          Objectives

          To review the current literature comparing the outcomes of renal surgery via open, laparoscopic and robotic approaches.

          Materials and methods

          A comprehensive literature search was performed on PubMed, MEDLINE and Ovid, to look for studies comparing outcomes of renal surgery via open, laparoscopic, and robotic approaches.

          Results

          Limited good-quality evidence suggests that all three approaches result in largely comparable functional and oncological outcomes. Both laparoscopic and robotic approaches result in less blood loss, analgesia requirement, with a shorter hospital stay and recovery time, with similar complication rates when compared with the open approach. Robotic renal surgeries have not shown any significant clinical benefit over a laparoscopic approach, whilst the associated cost is significantly higher.

          Conclusion

          With the high cost and lack of overt clinical benefit of the robotic approach, laparoscopic renal surgery will likely continue to remain relevant in treating various urological pathologies.

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          Most cited references54

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          Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors.

          Laparoscopic partial nephrectomy is an increasingly performed, minimally invasive alternative to open partial nephrectomy. We compared early postoperative outcomes in 1,800 patients undergoing open partial nephrectomy by experienced surgeons with the initial experience with laparoscopic partial nephrectomy in patients with a single renal tumor 7 cm or less. Data on 1,800 consecutive open or laparoscopic partial nephrectomies were collected prospectively or retrospectively in tumor registries at 3 large referral centers. Demographic, intraoperative, postoperative and followup data were compared between the 2 groups. Compared to the laparoscopic partial nephrectomy group of 771 patients the 1,028 undergoing open partial nephrectomy were a higher risk group with a greater percent presenting symptomatically with decreased performance status, impaired renal function and tumor in a solitary functioning kidney (p<0.0001). More tumors in the open partial nephrectomy group were more than 4 cm and centrally located and more proved to be malignant (p<0.0001 and 0.0003, respectively). Based on multivariate analysis laparoscopic partial nephrectomy was associated with shorter operative time (p<0.0001), decreased operative blood loss (p<0.0001) and shorter hospital stay (p<0.0001). The chance of intraoperative complications was comparable in the 2 groups. However, laparoscopic partial nephrectomy was associated with longer ischemia time (p<0.0001), more postoperative complications, particularly urological (p<0.0001), and an increased number of subsequent procedures (p<0.0001). Renal functional outcomes were similar 3 months after laparoscopic and open partial nephrectomy with 97.9% and 99.6% of renal units retaining function, respectively. Three-year cancer specific survival for patients with a single cT1N0M0 renal cell carcinoma was 99.3% and 99.2% after laparoscopic and open partial nephrectomy, respectively. Early experience with laparoscopic partial nephrectomy is promising. Laparoscopic partial nephrectomy offered the advantages of less operative time, decreased operative blood loss and a shorter hospital stay. When applied to patients with a single renal tumor 7 cm or less, laparoscopic partial nephrectomy was associated with additional postoperative morbidity compared to open partial nephrectomy. However, equivalent functional and early oncological outcomes were achieved.
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            Laparoscopic dismembered pyeloplasty.

            As laparoscopic nephrectomy has become a viable ablative procedure for kidney removal, additional areas of reconstructive laparoscopic urological procedures are being investigated. We describe our early experience with laparoscopic pyeloplasty for the management of ureteropelvic junction obstruction. Technical highlights include initial placement of an internal ureteral stent, lateral insufflation, placement of 5, 10 mm. trocars, pyelotomy (or reduction pyeloplasty performed with articulating laparoscopic scissors, reapproximation of the ureteropelvic junction with a running 4-zero polyglactin suture, placement of a 7 mm. suction drain in the retroperitoneal space and reapproximation of the colon to the body wall with a hernia stapler. We have performed laparoscopic dismembered pyeloplasty in 5 patients with symptomatic ureteropelvic junction obstruction. Operating time ranged from 3 to 7 hours, with the majority of time devoted to laparoscopic suturing (1 to 3 hours). Hospital stay averaged 3 days and all patients returned to normal activity within 1 week. Followup averaged 12 months (range 9 to 17 months) with complete resolution of symptoms in all patients. We believe that this innovative reconstructive laparoscopic procedure can be used for treatment of complicated ureteropelvic junction obstruction as in patients with a large, redundant renal pelvis or crossing lower pole vessels.
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              Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis.

              Robotic partial nephrectomy (RPN) is rapidly increasing; however, the benefit of RPN over laparoscopic partial nephrectomy (LPN) is controversial.
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                Author and article information

                Contributors
                Journal
                Arab J Urol
                Arab J Urol
                Arab Journal of Urology
                Elsevier
                2090-598X
                2090-5998
                06 March 2018
                September 2018
                06 March 2018
                : 16
                : 3
                : 314-320
                Affiliations
                Department of Urology, Freeman Hospital, High Heaton, Newcastle upon Tyne, UK
                Author notes
                [* ]Corresponding author at: Department of Urology, Level 3, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK. angus.luk@ 123456nuth.nhs.uk
                Article
                S2090-598X(18)30008-1
                10.1016/j.aju.2018.01.003
                6104665
                4baef770-5a90-467a-ab69-bbfca27b910a
                © 2018 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 11 October 2017
                : 23 January 2018
                Categories
                Upper Tract Surgery

                bmi, body mass index,(l)(less-)dn, (laparoscopic) (laparoendoscopic single-site-) donor nephrectomy,egfr, estimated gfr,los, length of hospital stay,notes, natural orifice transluminal endoscopic surgery,(l)(o)(ra)pn, (laparoscopic) (open) (robot-assisted) partial nephrectomy,pujo, puj obstruction,(l)(o)(ra)py, (laparoscopic) (open) (robot-assisted) pyeloplasty,rct, randomised controlled trial,(l)(o)(ra)rn, (laparoscopic) (open) (robot-assisted) radical nephrectomy,wit, warm ischaemia time,laparoscopic/open/robotic renal surgery,radical nephrectomy,donor nephrectomy,partial nephrectomy,pyeloplasty

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