RODRIGO FROTA TiSBU Cirurgia Robotica Urologica ndash Hospital SamaritanoRJ

Fellow Laparoscopia e Cirurgia Robotica ndash Cleveland Clinic

NEFRECTOMIA RADICAL PARA TUMORES T2-T3

NEFRECTOMIA PARCIAL TNM

NEFRECTOMIA PARCIAL TNM

NEFRECTOMIA PARCIAL T3

- 4 a 10 dos RCC diagnosticados jaacute com trombo venoso - cirurgia - tratamento mais eficaz - 45 a 70 dos pacientes curaacuteveis com a nefrectomia + trombectomia

NEFRECTOMIA PARCIAL TNM

pT2 (95cm) pT3b

NEFRECTOMIA PARCIAL ABERTA X LAPAROSCOPICA Robotic

Lap

Open

ADVANTAGES -Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

- Enhanced visibility of vital structures (ie NVB) - Superior ergonomics for the primary surgeon - Shorter learning curve compared to LRP

-Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

-Enhanced visibility of vital structures (ie NVB)

- Lower cost compared to RALP

- Proven oncological Outcomes -Tactile feedback

- No additional training

DISADVANTAGES -No long-term oncological data

- High initial and procedural cost -

-No long-term oncological data

- Steep learning curve-

-Increased blood loss

- Increased length of catheterization

Frota et al Int Brz J Urol June 2008 Vol 84

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL TNM

NEFRECTOMIA PARCIAL TNM

NEFRECTOMIA PARCIAL T3

- 4 a 10 dos RCC diagnosticados jaacute com trombo venoso - cirurgia - tratamento mais eficaz - 45 a 70 dos pacientes curaacuteveis com a nefrectomia + trombectomia

NEFRECTOMIA PARCIAL TNM

pT2 (95cm) pT3b

NEFRECTOMIA PARCIAL ABERTA X LAPAROSCOPICA Robotic

Lap

Open

ADVANTAGES -Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

- Enhanced visibility of vital structures (ie NVB) - Superior ergonomics for the primary surgeon - Shorter learning curve compared to LRP

-Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

-Enhanced visibility of vital structures (ie NVB)

- Lower cost compared to RALP

- Proven oncological Outcomes -Tactile feedback

- No additional training

DISADVANTAGES -No long-term oncological data

- High initial and procedural cost -

-No long-term oncological data

- Steep learning curve-

-Increased blood loss

- Increased length of catheterization

Frota et al Int Brz J Urol June 2008 Vol 84

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL TNM

NEFRECTOMIA PARCIAL T3

- 4 a 10 dos RCC diagnosticados jaacute com trombo venoso - cirurgia - tratamento mais eficaz - 45 a 70 dos pacientes curaacuteveis com a nefrectomia + trombectomia

NEFRECTOMIA PARCIAL TNM

pT2 (95cm) pT3b

NEFRECTOMIA PARCIAL ABERTA X LAPAROSCOPICA Robotic

Lap

Open

ADVANTAGES -Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

- Enhanced visibility of vital structures (ie NVB) - Superior ergonomics for the primary surgeon - Shorter learning curve compared to LRP

-Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

-Enhanced visibility of vital structures (ie NVB)

- Lower cost compared to RALP

- Proven oncological Outcomes -Tactile feedback

- No additional training

DISADVANTAGES -No long-term oncological data

- High initial and procedural cost -

-No long-term oncological data

- Steep learning curve-

-Increased blood loss

- Increased length of catheterization

Frota et al Int Brz J Urol June 2008 Vol 84

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL T3

- 4 a 10 dos RCC diagnosticados jaacute com trombo venoso - cirurgia - tratamento mais eficaz - 45 a 70 dos pacientes curaacuteveis com a nefrectomia + trombectomia

NEFRECTOMIA PARCIAL TNM

pT2 (95cm) pT3b

NEFRECTOMIA PARCIAL ABERTA X LAPAROSCOPICA Robotic

Lap

Open

ADVANTAGES -Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

- Enhanced visibility of vital structures (ie NVB) - Superior ergonomics for the primary surgeon - Shorter learning curve compared to LRP

-Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

-Enhanced visibility of vital structures (ie NVB)

- Lower cost compared to RALP

- Proven oncological Outcomes -Tactile feedback

- No additional training

DISADVANTAGES -No long-term oncological data

- High initial and procedural cost -

-No long-term oncological data

- Steep learning curve-

-Increased blood loss

- Increased length of catheterization

Frota et al Int Brz J Urol June 2008 Vol 84

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL TNM

pT2 (95cm) pT3b

NEFRECTOMIA PARCIAL ABERTA X LAPAROSCOPICA Robotic

Lap

Open

ADVANTAGES -Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

- Enhanced visibility of vital structures (ie NVB) - Superior ergonomics for the primary surgeon - Shorter learning curve compared to LRP

-Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

-Enhanced visibility of vital structures (ie NVB)

- Lower cost compared to RALP

- Proven oncological Outcomes -Tactile feedback

- No additional training

DISADVANTAGES -No long-term oncological data

- High initial and procedural cost -

-No long-term oncological data

- Steep learning curve-

-Increased blood loss

- Increased length of catheterization

Frota et al Int Brz J Urol June 2008 Vol 84

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL ABERTA X LAPAROSCOPICA Robotic

Lap

Open

ADVANTAGES -Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

- Enhanced visibility of vital structures (ie NVB) - Superior ergonomics for the primary surgeon - Shorter learning curve compared to LRP

-Decreased blood loss

-Faster recovery

-Better cosmetic results

-Decreased hospital stay

-Enhanced visibility of vital structures (ie NVB)

- Lower cost compared to RALP

- Proven oncological Outcomes -Tactile feedback

- No additional training

DISADVANTAGES -No long-term oncological data

- High initial and procedural cost -

-No long-term oncological data

- Steep learning curve-

-Increased blood loss

- Increased length of catheterization

Frota et al Int Brz J Urol June 2008 Vol 84

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses

Berger AD Kanofsky JA OMalley RL Hyams ES Chang C Taneja SS Stifelman MD

Department of Urology New York University School of Medicine New York Urology 2008 Mar71(3)421-4

- Total 164 pact - 124 lt 7-cm e 40 (322) gt=7 cm - Tamanho 42 cm (18 - 69) x 92 cm (7 ndash 14) - Resultados cirurgicos e oncologicos semelhantes

NEFRECTOMIA PARCIAL Laparoscopic radical nephrectomy for very large renal tumors (gt or =10 cm) is there a size limit

Conley SP Humphreys MR Desai PJ Castle EP Dueck AC Ferrigni RG Andrews PE

Department of Urology Mayo Clinic Phoenix Arizona J Endourol 2009 Jan23(1)57-61

- 11 ( 3 n = 360) 2000 - 2007 - 170 min (80-240 min) - Perda sanguinea 150 mL (50-300 mL) - 2 complicaccedilotildees (IRA e Ileo) - Tamanho 12 cm (10-21 cm) - 5 (455) pT2 3 (273) pT3a 2 ( 181)p T3b1 (91)pT4

NEFRECTOMIA PARCIAL

bull T2 aberto (n=72) x T2 laparoscoacutepico (n=41) bull demograacuteficos comparaacuteveis bull Laparoscoacutepico lt perda sanguiacutenea lt analgesia

lt internaccedilatildeo tempo ciruacutergico 15min gt bull seguimento meacutedio 45 anos resultados

oncologicos semelhantes

NEFRECTOMIA PARCIAL

bull laparoscopia pura transperitoneal bull usg peroperatoacuterio bull 5 pacientes 119 minutos 150ml bull Grampeador

NEFRECTOMIA PARCIAL Laparoscopic radical nephrectomy for renal cell carcinoma oncological outcomes at 10 years or more

Berger A Brandina R Atalla MA Herati AS Kamoi K Aron M Haber GP Stein RJ Desai MM Kavoussi LR Gill IS USC Institute of Urology Keck School of Medicine University of Southern California Los Angeles California

J Urol 2009 Nov182(5)2172-6

- 73 NRL (Fev 1994 Marc 1999) - Follow up 112 anos ( 10-15) - Tu 5 cm (17 to 13) - pT1a ( 41) pT1b (30) - pT2(15) pT3a(10) pT3b (3) pT4 (1) - Sobrevida Ca especifica 92

NEFRECTOMIA PARCIAL

bull laparoscopia pura transperitoneal bull usg peroperatoacuterio bull 5 pacientes 119 minutos 150ml bull Grampeador

NEFRECTOMIA PARCIAL Laparoscopic radical nephrectomy for renal cell carcinoma oncological outcomes at 10 years or more

Berger A Brandina R Atalla MA Herati AS Kamoi K Aron M Haber GP Stein RJ Desai MM Kavoussi LR Gill IS USC Institute of Urology Keck School of Medicine University of Southern California Los Angeles California

J Urol 2009 Nov182(5)2172-6

- 73 NRL (Fev 1994 Marc 1999) - Follow up 112 anos ( 10-15) - Tu 5 cm (17 to 13) - pT1a ( 41) pT1b (30) - pT2(15) pT3a(10) pT3b (3) pT4 (1) - Sobrevida Ca especifica 92

NEFRECTOMIA PARCIAL Laparoscopic radical nephrectomy for renal cell carcinoma oncological outcomes at 10 years or more

Berger A Brandina R Atalla MA Herati AS Kamoi K Aron M Haber GP Stein RJ Desai MM Kavoussi LR Gill IS USC Institute of Urology Keck School of Medicine University of Southern California Los Angeles California

J Urol 2009 Nov182(5)2172-6

- 73 NRL (Fev 1994 Marc 1999) - Follow up 112 anos ( 10-15) - Tu 5 cm (17 to 13) - pT1a ( 41) pT1b (30) - pT2(15) pT3a(10) pT3b (3) pT4 (1) - Sobrevida Ca especifica 92

NEFRECTOMIA PARCIAL Outcomes of laparoscopic radical nephrectomy in the setting of vena caval and renal vein thrombus seven-year experience

Martin GL Castle EP Martin AD Desai PJ Lallas CD Ferrigni RG Andrews PE Department of Urology Mayo Clinic Phoenix Arizona USA

J Endourol 2008 Aug22(8)1681-5

- Total 14 pact (pT3b) em 7 anos ( 2000-2007) - 10 (VR) 4 (VCI) - 1 conversatildeo ( margem + VR) - Uso pinca vascular e Hand Assisted - Seguro e Factivel =gt experiecircncia laparoscoacutepica

NEFRECTOMIA PARCIAL T3b

NEFRECTOMIA PARCIAL T3b

bull 5 pacientes bull ateacute 5cm de trombo em

cava bull cavotomia em todos bull 170ml 327min

NEFRECTOMIA PARCIAL

Urology 2013 in press

- 2002 a 2010 5 centros italianos 222 nx lap T2 - 85cm 180min 280ml - transfusatildeo 19 - conversatildeo 54 - complicaccedilotildees Clavien 3 ou 4 27

NEFRECTOMIA PARCIAL Experiencia Pessoal

NEFRECTOMIA PARCIAL T2 T 4

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL T3b

bull 5 pacientes bull ateacute 5cm de trombo em

cava bull cavotomia em todos bull 170ml 327min

NEFRECTOMIA PARCIAL

Urology 2013 in press

- 2002 a 2010 5 centros italianos 222 nx lap T2 - 85cm 180min 280ml - transfusatildeo 19 - conversatildeo 54 - complicaccedilotildees Clavien 3 ou 4 27

NEFRECTOMIA PARCIAL Experiencia Pessoal

NEFRECTOMIA PARCIAL T2 T 4

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

bull 5 pacientes bull ateacute 5cm de trombo em

cava bull cavotomia em todos bull 170ml 327min

NEFRECTOMIA PARCIAL

Urology 2013 in press

- 2002 a 2010 5 centros italianos 222 nx lap T2 - 85cm 180min 280ml - transfusatildeo 19 - conversatildeo 54 - complicaccedilotildees Clavien 3 ou 4 27

NEFRECTOMIA PARCIAL Experiencia Pessoal

NEFRECTOMIA PARCIAL T2 T 4

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL

Urology 2013 in press

- 2002 a 2010 5 centros italianos 222 nx lap T2 - 85cm 180min 280ml - transfusatildeo 19 - conversatildeo 54 - complicaccedilotildees Clavien 3 ou 4 27

NEFRECTOMIA PARCIAL Experiencia Pessoal

NEFRECTOMIA PARCIAL T2 T 4

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL Experiencia Pessoal

NEFRECTOMIA PARCIAL T2 T 4

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL T2 T 4

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL Experiencia Pessoal

Tamanho Tumoral 12 cm Tempo Operatoacuterio 3 hr 20 min Tempo Internaccedilatildeo 3 dias

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL MENSAGEM

NEFRECTOMIA PARCIAL OBRIGADO

rodrigofrotafgmailcom wwwrodrigofrotanet

• NEFRECTOMIA RADICAL PARA TUMORES T2-T3
• TNM
• TNM
• T3
• TNM
• ABERTA X LAPAROSCOPICA
• Transperitoneal laparoscopic radical nephrectomy for large (more than 7 cm) renal masses
• Laparoscopic radical nephrectomy for very large renal tumors (gt or =10 cm) is there a size limit
• Laparoscopic radical nephrectomy for renal cell carcinoma oncological outcomes at 10 years or more
• Outcomes of laparoscopic radical nephrectomy in the setting of vena caval and renal vein thrombus seven-year experience
• T3b
• T3b
• Slide Number 15
• Slide Number 16
• Experiencia Pessoal
• T2 T 4
• Experiencia Pessoal
• MENSAGEM
• OBRIGADO