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la técnica quirúrgica Robusteza-asistida demuestra promesa

por Lauren Dubinsky, Senior Reporter | July 09, 2014
Dr. Jim Hu
A novel robotic-assisted surgical technique used to remove small kidney cancer tumors leads to a low rate of complications and cancer recurrence, according to a recent study published online in European Urology.

It's the largest multicenter study to date using robot-assisted retroperitoneoscopic partial nephrectomy (RARPN).

Researchers from UCLA's Jonsson Comprehensive Cancer Center analyzed data from 227 patients from UCLA, the University of Michigan and the Swedish Medical Center in Seattle who underwent RARPN from 2006 to 2013.

After almost three years of follow-up, they found that there were only two cases of cancer recurrence and only a 12.3 percent rate of complications. Additionally, they've shown that it's effective at removing small kidney cancer tumors that are less accessible with conventional minimally invasive approaches and for patients who had previous abdominal surgery.

RARPN is a kind of laparoscopic surgery and the procedure is conducted using robotic arms and magnified, high-definition 3-D cameras that are controlled by the surgeon.

Thermal ablation is most commonly used for removing small kidney tumors but it's associated with an eight times higher need for CT scanning in order to ensure that the tumor didn't return.

"With thermal ablation you don't know if you used heat to kill the entire tumor - that's determined by additional X-ray testing, like CT scans or MR, that have to be conducted over time," Dr. Jim Hu, the study's author, told DOTmed News.

However, with RARPN, surgeons get the final pathology so there's no need for a CT scan. Hu thinks that because of this, RARPN will eventually become the standard of care over thermal ablation.

"I think by taking it all out entirely, by getting confirmation from the pathologist that we got it all adds a great deal of easing patient anxiety about the cancer, and has been shown to decrease the need for X-rays in the future," said Hu.

A note of interest for researchers was that there was up to a five minute difference between surgeons in the time that the main blood supply to the kidney was blocked during surgery, which is called the warm ischemia time (WIT). A longer WIT can lead to increased chances of complications such as acute kidney failure and long-term chronic kidney disease.

But the researchers found that with experience, the WIT is shorter. "It just shows you that the more experience the better the outcomes," said Hu.

"I think there's a perception that newer technology always equates to better outcomes but I think that amongst surgeons that do this a lot there's a realization that there's still a difference in outcomes by surgeon experience and also by individual surgeon heterogeneity," he added.

Even though the complication rate was low, there was a 3.5 difference in complications between surgeons – meaning one surgeon had 3.5 times more complications than another.

The next step is demonstrating this technique to other surgeons - a video was uploaded to various social media to provide video feedback and coaching to them.

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