A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Objectives. The robotic-assisted laparoscopic retroperitoneal lymph node dissection (R-RPLND) represents a new frontier in the surgical management of testicular cancer in the realm of minimally invasive urologic oncology. We aimed to review the early outcomes as compared to the laparoscopic and open approaches as well as describe the operative technique for the R-RPLND. Materials and Methods. We reviewed all the literature related to the R-RPLND based on an electronic PubMed search up until July 2017. Results and Discussion. Encouraged by favorable early oncologic and safety outcomes for treatment of clinical stage (CS) I nonseminomatous germ cell tumor (NSGCT), the R-RPLND affords the same recovery advantages as the laparoscopic retroperitoneal lymph node dissection (L-RPLND) while offering greater dexterity, superior visualization, and a theoretically shorter learning curve for the surgeon. While R-RPLND has a promising future in the management of patients with primary and postchemotherapy NSGCT, larger and more vigorous prospective studies are needed before supplanting the open RPLND as the gold standard approach for primary low-stage NSGCT or becoming an equivalent surgical modality in the postchemotherapy setting

Distant Metastases From a Small Renal Cell Carcinoma: A Case Report

AbstractRenal cell carcinoma (RCC) less than 3 cm in diameter rarely metastasizes. In this report, we present the case of a metastatic RCC in which the primary tumor was 1.6 cm. We further review the relevant literature to highlight this rare but important clinical presentation

Extracellular vesicle isolation from human renal cancer tissue

Renal cell carcinoma is a lethal disease that is often discovered incidentally. New non-invasive biomarkers are needed to aid diagnosis and treatment. Extracellular vesicles (EVs), membranous vesicles secreted by all cells, are a promising potential source for cancer biomarkers, but new methods are required that are both sensitive and specific for cancer identification. We have developed an EV isolation protocol optimized for kidney tumor and normal kidney tissue that yields a high vesicle concentration, confirmed by nanoparticle tracking analysis (NanoSight) and by nanoscale flow cytometry (NanoFCM). Using Western blot, we confirmed presence of EV markers CD81, CD63, flotillin-1, and absence of cellular debris, calnexin. Transmission electron microscopy images demonstrate intact membranous EVs. This new method improves existing protocols with additional steps to reduce contaminants in the EV product. Characterization of our isolation product confirms successful isolation of EVs with minimal contamination. The particle yields of our protocol are consistent and high as assessed by both standard and novel methods. This optimized protocol will contribute to biomarker discovery and biological studies of EVs in renal cancer

Perioperative outcomes of robotic partial nephrectomy for intrarenal tumors.

Intrarenal tumors pose a unique challenge to surgeons due to the lack of visual cues on the kidney surface. Intraoperative ultrasonography has facilitated the management of these tumors during minimally invasive partial nephrectomy. We sought to evaluate the safety, feasibility, and comparative effectiveness of robot-assisted partial nephrectomy (RPN) in the management of completely intrarenal tumors.Our institutional database was queried for patients undergoing RPN between 2007 and 2013. Patient demographics, tumor characteristics, and perioperative outcomes were compared for patients with intrarenal tumors and tumors with any exophytic component. Patients without available preoperative imaging were excluded from the study.A total of 297 patients were identified with 30 having completely intrarenal tumors and 267 having some exophytic component. Patient demographics were similar between the two groups. Median tumor size was smaller for the intrarenal group than the exophytic group (2.3 vs 2.7 cm, p=0.015) and nephrometry score was higher for the intrarenal group (9 vs 6, p<0.0001). Tumor characteristics were otherwise similar. Perioperative outcomes were similar between the intrarenal and exophytic groups: estimated blood loss (100 vs 100 mL, p=0.56), operative time (165 vs 162 minutes, p=0.86), warm ischemia time (17 vs 17 minutes, p=0.54), renal cell carcinoma positive surgical margin (0% vs 2.4%, p=0.74), intraoperative complications (0% vs 0.76%, p=0.81), and postoperative complications (6.7% vs 17.6% p=0.76).RPN is feasible, safe, and effective in the treatment of select intrarenal kidney tumors with outcomes similar to those of partially exophytic tumors. This is likely facilitated by intraoperative ultrasonography. Completely intrarenal kidney tumors should not be automatically relegated to radical nephrectomy or open surgery

Ureteral stents placed at the time of urinary diversion decreases postoperative morbidity

OBJECTIVE: To determine the impact of stenting ureteroenteric anastomoses on postoperative stricture rate and gastrointestinal recovery in continent and noncontinent urinary diversions (UDs). Patients and Methods: We retrospectively reviewed the clinical and pathologic data on 192 consecutive patients who underwent a radical cystectomy and UD. Patients received either a continent or noncontinent UD with or without stent placement through the ureteroenteric anastomoses. Stricture rate, gastrointestinal recovery, length of hospital stay, and stricture characteristics were analyzed. Study endpoints were compared between four groups – stented and nonstented continent and stented and nonstented noncontinent UDs. RESULTS: 36% of patients were stented and 64% were nonstented at the time of UD. Total ureteral stricture rate was 9.9%. There was no statistically significant difference in stricture rate (p = 0.11) or length of hospital stay (p = 0.081) in stented compared to nonstented patients. There was a significantly (p = 0.014) greater rate of ileus in patients who were nonstented in both continent and noncontinent UDs. CONCLUSION: Stenting of ureteroenteric anastomoses in both continent and noncontinent UD has no effect on postoperative stricture rate, but is associated with lower rates of postoperative ileus