Feasibility of adopting retroperitoneal robotic partial nephrectomy after extensive transperitoneal experience

AbstractPurposeAdoption of robotic retroperitoneal surgery has lagged behind robotic surgery adoption in general due to unique challenges of access and anatomy. We evaluated our initial results with robotic retroperitoneal robotic partial nephrectomy (RRPN) after transitioning from exclusively transperitoneal robotic partial nephrectomy (TRPN) to evaluate safety and any identifiable learning curve.MethodsWe evaluated our single-surgeon (RA) prospective partial nephrectomy database since adopting RRPN routinely for posterior tumors in 2017. The surgeon had previously performed 410 partial nephrectomies by this time. Outcomes were compared after the initial 30 RRPN.ResultsOf 137 patients since adopting RRPN, two attempted RRPN were converted to TRPN without complications due to morbid obesity affecting access, and 30 RRPN were completed (107 TRPN). There were no statistically significant differences in demographics, mean tumor size, or RENAL score between groups. Mean blood loss was lower in RRPN (53  mL vs 99 mL,P  
Source: World Journal of Urology - Category: Urology & Nephrology Source Type: research

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Authors: Taylor CR, Dominguez JE, Habib AS Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population...
Source: Local and Regional Anesthesia - Category: Anesthesiology Tags: Local Reg Anesth Source Type: research
Authors: Tonlorenzi D, Brunelli M, Conti M, Covani U, Traina G Abstract Increasing occlusal vertical dimension (OVD) by means of oral splints is a practice widely used in the treatment of temporomandibular disorders (TMD), specifically myofascial pain, although the results are still uncertain. Oral splints with a vertical height that significantly exceeds the clinical rest position are considered by some researchers to be a better therapeutic solution in alleviating TMD symptoms than are "low" splints.In our observational study, 21 patients suffering from myofascial pain were examined for the effects of w...
Source: Archives Italiennes de Biologie - Category: Neuroscience Tags: Arch Ital Biol Source Type: research
Conclusion: This case report highlights how pubalgia may be misdiagnosed as a lumbar disc herniation and may inadvertently lead to unnecessary lumbar surgery. PMID: 31819818 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Conclusion: Two holocervical cord intramedullary ependymomas were safely and effectively surgically resected without incurring significant perioperative morbidity. PMID: 31819817 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Authors: Sangrador M, Olvera JG, Ortiz VM Abstract A 25-year-old woman presented with a 4 months history of progressive pain and tumefaction in the right parietal region. Deformity of the scalp was evident, and a biopsy was taken, reporting a high- grade dermatofibrosarcoma. She underwent surgical management, achieving a gross total resection. Dermatofibrosarcoma protuberans is a rare tumor arising from the dermis. It tends to have an indolent course and local recurrence after excision. PMID: 31819815 [PubMed]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Quadratus lumborum block (QLB) is a new abdominal wall block which has been used successfully for the post operative pain management of patients undergoing abdominal surgeries [1,2]. Classically QLB can be given in four different approaches using ultrasound [3]. In many developing countries like India ultrasound is still not available at all centers. Many times in patients with central obesity it is difficult to perform this block using ultrasound [4]. So we present a new ‘Gaurav-Aditi’ technique of performing the QLB, wherein post-operative pain of six patients who were undergoing open radical nephrectomy was ...
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
Quadratus lumborum block (QLB) is a new abdominal wall block which has shown promising results in the post-operative pain management of patients undergoing abdominal surgeries [1]. Using ultrasound it can be given in four different ways [2]. QLB is a deep muscle plane block making it difficult even for an experienced anesthesiologist to perform it accurately using ultrasound. Presence of excess fat in obese patients adds to this challenge [3]. We would thus like to present a unique technique wherein, laparoscopic guided continuous type 1 QLB was successfully performed to manage the post-operative pain in a series of five p...
Source: Journal of Clinical Anesthesia - Category: Anesthesiology Authors: Tags: Correspondence Source Type: research
CONCLUSIONS At our hospital, obese donors had short-term results comparable to those of non-obese donors in laparoscopic living nephrectomy. While longer operative time and length of stay were found, there were no significant complications observed. Long-term outcomes should be evaluated to justify use of obese donors. PMID: 27160737 [PubMed - in process]
Source: Annals of Transplantation - Category: Transplant Surgery Authors: Tags: Ann Transplant Source Type: research
Conclusion: there is no increased risk of doing the lymph node dissection early on.   Dr. Eggener-CON   Basics Lymph node dissections rarely done, even for large tumors, because there is no proven therapeutic or staging benefit for low risk patients.  A Mayo study revealed no data showing therapeutic benefit in high risk patients.  For clinically node negative high risk patients, there is staging value but no proven therapeutic benefit. Rate of positive nodes is associated with stage and grade; the higher the stage and grade, the more likely there will be positive nod...
Source: Kidney Cancer Association - Category: Urology & Nephrology Source Type: news
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