Saad A. Mir

Cost Comparison of Robotic, Laparoscopic, and Open Partial Nephrectomy

PURPOSE To compare direct costs associated with open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted LPN (RALPN). METHODS A meta-analysis of nonoverlapping studies was performed to determine operating room (OR) time, equipment use, and length of stay (LOS) for OPN, LPN, and RALPN. Cost models using cost data obtained from our institution were created, and robotic cost and maintenance were amortized over 7 years. One- and two-way sensitivity analyses were performed to evaluate the effect of changing variables on the cost effectiveness of each approach. RESULTS Seven RALPN, 18 LPN, and 8 OPN data series were identified, comprising a total of 477, 2220, and 2745 procedures, respectively. Weighted mean OR time was 188, 200, 193 minutes; weighted mean LOS was 2.6, 3.2, and 5.9 days for RALPN, LPN, and OPN, respectively. LPN was the most cost-effective approach at a mean direct cost of

Patient-reported body image and cosmesis outcomes following kidney surgery: Comparison of laparoendoscopic single-site, laparoscopic, and open surgery

10,311, with a cost advantage of

Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery

1116 and

Complications during the initial experience with laparoendoscopic single-site pyeloplasty

1652 over OPN (

Minimal arterial in-flow protects renal oxygenation and function during porcine partial nephrectomy: Confirmation by hyperspectral imaging

11,427) and RALPN (

Minimally Invasive Nephrectomy: The Influence of Laparoendoscopic Single-site Surgery on Patient Selection, Outcomes, and Morbidity

11,962), respectively. Sensitivity analyses demonstrate that significant decreases in robotic costs are required for RALPN to be cost effective. CONCLUSION Despite similar OR times, LPN is more cost effective than OPN because of shorter LOS. Because of lower instrumentation costs, LPN is the most cost effective despite a longer LOS than RALPN. RALPN has high cost of maintenance and instrumentation, which is partially compensated by the shorter LOS. Evidence of oncological and functional equivalence to OPN is warranted to determine the future role of RALPN.

Novel Iron Oxide Microparticles Used to Render Stone Fragments Paramagnetic: Assessment of Toxicity in a Murine Model

BACKGROUND Laparoendoscopic single-site surgery (LESS) is reported to result in superior cosmesis versus alternative surgical approaches, based solely on surgeon assessment or anecdotal evidence. OBJECTIVE Evaluate patient-reported body image and cosmesis outcomes following kidney surgery. DESIGN, SETTING, AND PARTICIPANTS We conducted a prospective and retrospective observational cohort study involving patients who underwent kidney surgery (n=114) via LESS (n=35), laparoscopic (n=52), or open (n=27) approaches. Cosmesis was evaluated using a comprehensive survey administered ≥3 mo postoperatively. MEASUREMENTS Survey components were a body image questionnaire (BIQ) consisting of body image and cosmesis subscales, a photo-series questionnaire (PSQ) assessing scar preferences after knowledge of scar outcomes for alternative surgical approaches, and query of preference for future surgical approach using a trade-off method. Body image, cosmesis, and PSQ scales ranged from 5 to 20, 3 to 24, and 1 to 10, respectively. RESULTS AND LIMITATIONS Median BIQ component scores did not significantly differ across surgical approaches. Median ratings for the LESS, laparoscopy, and open scar photographs were 8, 5, and 5, respectively (p=0.0001). Before viewing photographs, median self-scar ratings for LESS, laparoscopy, and open approaches were 9, 5, and 6.5, respectively (p=0.02); after photographs, ratings were 9, 7, and 7, respectively (p=0.008). Assuming equivalent surgical risk among the approaches, overall preference for future LESS, laparoscopy, or open surgery was 39%, 33%, or 4%, respectively. As theoretical risk of LESS was raised, preference for LESS decreased, whereas preference for laparoscopy and open surgery increased. Study limitations are a nonrandomized design and the use of a nonvalidated scale. CONCLUSIONS Urologic patients favor LESS cosmesis outcomes over those for laparoscopy or open surgery. Considering the superior scar satisfaction among LESS patients, who were younger and more likely to be undergoing surgery for benign disease, we infer that this demographic most values the cosmetic advantages of LESS.

Novel stone-magnetizing microparticles: in vitro toxicity and biologic functionality analysis.

Study Type – Therapy (case series)

Intermediate term outcomes associated with the surveillance of ureteropelvic junction obstruction in adults.

Study Type – Therapy (case series)

Intra-operative erythropoietin during laparoscopic partial nephrectomy is not renoprotective

OBJECTIVES To examine the potential for renal protection through incomplete renal artery (RA) occlusion with both assessments of creatinine changes and the use of hyperspectral imaging to monitor tissue oxygenation. Renal ischemia during partial nephrectomy can have adverse consequences on renal function. METHODS Fourteen pigs with a solitary kidney underwent open partial nephrectomy with warm ischemia. The RA flow was measured and reduced to 25%, 10%, and 0% of baseline for 60 minutes. Hyperspectral imaging was used to assess the percentage of oxyhemoglobin (%HbO(2)) at baseline, during ischemia, and during reperfusion. The %HbO(2) and change in the serum creatinine level from baseline were compared. RESULTS The baseline RA flow and %HbO(2) were similar in all groups, and, as expected, RA occlusion resulted in decreasing %HbO(2). The reduction of RA flow to 25% and 10% improved the nadir tissue oxygenation compared with 0% flow (P = .01 and P = .04, respectively) and 25% flow also appeared to prolong the interval to reach the nadir %HbO(2). Reperfusion resulted in a swift return to the baseline %HbO(2) in all 3 groups. The change in the serum creatinine from baseline to postoperative day 7 showed significantly improved renal preservation in the 25% RA flow group. CONCLUSIONS Incomplete RA occlusion during porcine partial nephrectomy resulted in favorable renal oxygenation profiles with as little as 10% blood flow and appeared to be renoprotective when 25% of the baseline RA flow is preserved. Hyperspectral imaging is a sensitive, noninvasive tool for real-time monitoring of renal oxygenation and, thereby, blood flow, which could facilitate intraoperative decision-making to protect kidney function.