Vladislav Gorbatiy

Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio‐embolization and nephron‐sparing surgery

Study Type – Therapy (case series)

Cost comparison of nephron-sparing treatments for cT1a renal masses

OBJECTIVES Treatment options for small renal tumors have evolved from radical nephrectomy (RN) to partial nephrectomy (PN), thermal ablation, or active surveillance. With the advancement of techniques, costs differences are unclear. The objective of this study is to compare the 6-month costs associated with nephron-sparing procedures for cT1a renal tumors. MATERIALS AND METHODS We performed a review of patients diagnosed with a solitary cT1a renal mass who underwent surgical treatment from June 2008 to May 2011. Open partial nephrectomy (OPN), robot-assisted partial nephrectomy (RLPN), laparoscopic radio-frequency ablation (LRFA), or computed tomography guided radio frequency ablation (CTRFA) was performed on 173 patients. Cost data were collected for surgical costs, associated hospital stay, and the 6-month postoperative period. RESULTS Patients underwent surgery, including 52 OPN, 48 RLPN, 44 LRFA, and 29 CTRFA. Median total costs associated were

Comparison of Safety, Renal Function Outcomes and Efficacy of Laparoscopic and Percutaneous Radio Frequency Ablation of Renal Masses

17,018,

Laparoscopic and Image-guided Radiofrequency Ablation of Renal Tumors: Patient Selection and Outcomes

20,314,

Laparoendoscopic single site nephrectomy with the SPIDER surgical system: Engineering advancements tested in a porcine model

13,965, and

Initial experience with laparoendoscopic single-site simple nephrectomy using the TransEnterix SPIDER surgical system: assessing feasibility and safety.

6,475, for OPN, RLPN, LRFA, and CTRFA, respectively. When stratified by approach differences were noted for total cost (P < 0.001), operating room (OR) time (P < 0.001), surgical supply (P < 0.001), and room and board (P < 0.001) in univariable analysis. Multivariable linear regression (R(2) = 0.966) showed surgical approach (P = 0.007), length of stay (P < 0.001), and OR time (P < 0.001) to be significant predictors of total cost. However, tumor size (P = 0.175), and Charlson comorbidity index (P = 0.078) were not statistically significant. CONCLUSIONS Six-month cost of nephron-sparing surgery is lowest with radio frequency ablation (RFA) by either laparoscopic or computed tomography (CT)-guided approach compared to RLPN and OPN. As oncologic and safety outcomes improve and become comparable in all nephron-sparing surgery (NSS) approaches, cost of each procedure will start to play a stronger role in the clinical and healthcare policy setting.

Intravesical Methylene Blue Facilitates Precise Identification of the Diverticular Neck During Robot-Assisted Laparoscopic Bladder Diverticulectomy

PURPOSE With the increased incidence of low stage renal cancers, thermal ablation technology has emerged as a viable treatment option. Current AUA (American Urological Association) guidelines include thermal ablation as a treatment modality for select individuals. We compared the laparoscopic and percutaneous approach for the radio frequency ablation of renal tumors under the guidance of urological surgeons. MATERIALS AND METHODS We reviewed our radio frequency ablation database of patients with renal masses undergoing laparoscopic or computerized tomography guided percutaneous radio frequency ablation with simultaneous peripheral fiberoptic thermometry from November 2001 to January 2011 at a single tertiary care center. Data were collected on patient demographics, and surgical and clinicopathological outcomes stratified by approach. RESULTS A total of 298 patients with 316 renal tumors underwent laparoscopic (122 tumors) or computerized tomography guided (194 tumors) radio frequency ablation. There were no statistically significant differences between the laparoscopic and computerized tomography guided radio frequency ablation groups with respect to patient demographics, complication rates and renal functional outcomes (p>0.05). The 3-year Kaplan-Meier estimation of radiographic recurrence-free probability was 95% for computerized tomography guided radio frequency ablation and 94% for laparoscopic radio frequency ablation (p=0.84). Subanalysis of the 212 (67%) renal cell carcinoma tumors showed a 3-year Kaplan-Meier estimation of oncologic recurrence-free probability (post-ablation biopsy proven viable tumor) of 94% for computerized tomography guided radio frequency ablation and 100% for laparoscopic radio frequency ablation (p=0.16). Median followup was 21 months for laparoscopic radio frequency ablation) and 19 months for computerized tomography guided radio frequency ablation. CONCLUSIONS Laparoscopic and computerized tomography guided radio frequency ablation appear safe and effective with statistically equivalent rates of complications and recurrence.

Oncologic Outcomes Using Real-Time Peripheral Thermometry-Guided Radiofrequency Ablation of Small Renal Masses

Multiple modalities exist for the management of small renal tumors, including active surveillance, extirpation (radical nephrectomy and partial nephrectomy), and ablative therapies. Radiofrequency ablation (RFA) is an alternative to extirpative surgery for renal tumors. This article presents the current literature on RFA for renal tumors. We reviewed 28 RFA series in the English literature from 2003 to 2010 to assess patient selection, biopsy, renal outcomes, and oncologic outcomes.

Development and Evaluation of a Novel Cadaveric Model for Performance of Image-Guided Percutaneous Renal Tumor Ablation

UNLABELLED Abstract Background and Purpose: The Single Port Instrument Delivery Extended Reach (SPIDER) surgical system was developed for true continuous instrument triangulation during laparoendoscopic single site (LESS) surgery. We present our initial preclinical experience with the SPIDER surgical system during renal surgery. MATERIAL AND METHODS Bilateral laparoscopic nephrectomies were performed in a live adult porcine animal model using the SPIDER device. A standard surgical approach was used via direct video guidance. RESULTS The procedure was successfully performed without surgical error or complication. The SPIDER system proved easy to use with only a minimal learning curve. Intracorporeal surgical knots were tied without difficulty using this single site system. CONCLUSIONS Our initial experience with the SPIDER surgical system during renal surgery is promising. SPIDER allows for true single port instrument triangulation offering a superior operative experience to currently available LESS surgical systems.

Salvage robot-assisted partial nephrectomy for the management of renal cell carcinoma following failed stereotactic radiotherapy

PURPOSE The goal of this report is to describe our initial clinical experience performing a simple nephrectomy with the SPIDER (Single Port Instrument Delivery Extended Reach) laparoendoscopic single-site (LESS) surgical system. PATIENT AND METHODS One patient with a nonfunctioning kidney secondary to a ureteropelvic junction obstruction underwent a simple nephrectomy through a single incision performed using the SPIDER surgical system. We assessed the technical feasibility, efficiency, and perioperative outcomes. RESULTS The SPIDER-LESS nephrectomy was performed successfully without additional skin incisions for laparoscopic ports, instrument clashing, or open conversion. Total operative time was 210 minutes with blood loss of 50  mL. The patient experienced no intraoperative or postoperative complications. Pathologic evaluation confirmed atrophic renal parenchyma. CONCLUSIONS The SPIDER surgical system LESS nephrectomy is feasible and safe. Future refinements of the technology and prospective studies are needed to further optimize its application in urology.