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Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow

OBJECTIVE: The paper describes novel real‐time ‘in situ mapping’ and ‘sequential occlusion angiography’ to facilitate selective ischaemia robotic partial nephrectomy (RPN) using intraoperative contrast enhanced ultrasound scan (CEUS). MATERIALS AND METHODS: Data were collected and assessed for 60 pa...

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Autores principales: Alenezi, Ahmad, Motiwala, Aamir, Eves, Susannah, Gray, Rob, Thomas, Asha, Meiers, Isabelle, Sharif, Haytham, Motiwala, Hanif, Laniado, Marc, Karim, Omer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347890/
https://www.ncbi.nlm.nih.gov/pubmed/26948671
http://dx.doi.org/10.1002/rcs.1738
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author Alenezi, Ahmad
Motiwala, Aamir
Eves, Susannah
Gray, Rob
Thomas, Asha
Meiers, Isabelle
Sharif, Haytham
Motiwala, Hanif
Laniado, Marc
Karim, Omer
author_facet Alenezi, Ahmad
Motiwala, Aamir
Eves, Susannah
Gray, Rob
Thomas, Asha
Meiers, Isabelle
Sharif, Haytham
Motiwala, Hanif
Laniado, Marc
Karim, Omer
author_sort Alenezi, Ahmad
collection PubMed
description OBJECTIVE: The paper describes novel real‐time ‘in situ mapping’ and ‘sequential occlusion angiography’ to facilitate selective ischaemia robotic partial nephrectomy (RPN) using intraoperative contrast enhanced ultrasound scan (CEUS). MATERIALS AND METHODS: Data were collected and assessed for 60 patients (61 tumours) between 2009 and 2013. 31 (50.8%) tumours underwent ‘Global Ischaemia’, 27 (44.3%) underwent ‘Selective Ischaemia’ and 3 (4.9%) were removed ‘Off Clamp Zero Ischaemia’. Demographics, operative variables, complications, renal pathology and outcomes were assessed. RESULTS: Median PADUA score was 9 (range 7–10). The mean warm ischaemia time in selective ischaemia was less and statistically significant than in global ischaemia (17.1 and 21.4, respectively). Mean operative time was 163 min. Postoperative complications (n = 10) included three (5%) Clavien grade 3 or above. Malignancy was demonstrated in 47 (77%) with negative margin in 43 (91.5%) and positive margin in four (8.5%). Long‐term decrease in eGFR post selective ischaemia robotic partial nephrectomy was less compared with global ischaemia (four and eight, respectively) but not statistically significant. CONCLUSIONS: This technique is safe, feasible and cost‐effective with comparable perioperative outcomes. The technical aspects elucidate the role of intraoperative CEUS to facilitate and ascertain selective ischaemia. Further work is required to demonstrate long‐term oncological outcomes. © 2016 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons, Ltd.
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spelling pubmed-53478902017-03-23 Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow Alenezi, Ahmad Motiwala, Aamir Eves, Susannah Gray, Rob Thomas, Asha Meiers, Isabelle Sharif, Haytham Motiwala, Hanif Laniado, Marc Karim, Omer Int J Med Robot Original Articles OBJECTIVE: The paper describes novel real‐time ‘in situ mapping’ and ‘sequential occlusion angiography’ to facilitate selective ischaemia robotic partial nephrectomy (RPN) using intraoperative contrast enhanced ultrasound scan (CEUS). MATERIALS AND METHODS: Data were collected and assessed for 60 patients (61 tumours) between 2009 and 2013. 31 (50.8%) tumours underwent ‘Global Ischaemia’, 27 (44.3%) underwent ‘Selective Ischaemia’ and 3 (4.9%) were removed ‘Off Clamp Zero Ischaemia’. Demographics, operative variables, complications, renal pathology and outcomes were assessed. RESULTS: Median PADUA score was 9 (range 7–10). The mean warm ischaemia time in selective ischaemia was less and statistically significant than in global ischaemia (17.1 and 21.4, respectively). Mean operative time was 163 min. Postoperative complications (n = 10) included three (5%) Clavien grade 3 or above. Malignancy was demonstrated in 47 (77%) with negative margin in 43 (91.5%) and positive margin in four (8.5%). Long‐term decrease in eGFR post selective ischaemia robotic partial nephrectomy was less compared with global ischaemia (four and eight, respectively) but not statistically significant. CONCLUSIONS: This technique is safe, feasible and cost‐effective with comparable perioperative outcomes. The technical aspects elucidate the role of intraoperative CEUS to facilitate and ascertain selective ischaemia. Further work is required to demonstrate long‐term oncological outcomes. © 2016 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons, Ltd. John Wiley and Sons Inc. 2016-03-07 2017-03 /pmc/articles/PMC5347890/ /pubmed/26948671 http://dx.doi.org/10.1002/rcs.1738 Text en © 2016 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons, Ltd. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Alenezi, Ahmad
Motiwala, Aamir
Eves, Susannah
Gray, Rob
Thomas, Asha
Meiers, Isabelle
Sharif, Haytham
Motiwala, Hanif
Laniado, Marc
Karim, Omer
Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
title Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
title_full Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
title_fullStr Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
title_full_unstemmed Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
title_short Robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
title_sort robotic assisted laparoscopic partial nephrectomy using contrast‐enhanced ultrasound scan to map renal blood flow
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347890/
https://www.ncbi.nlm.nih.gov/pubmed/26948671
http://dx.doi.org/10.1002/rcs.1738
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