Robot-assisted Laparoscopic Partial Nephrectomy Via the Extraperitoneal Approach in the Prone Position Versus the Lateral Position

The First Affiliated Hospital with Nanjing Medical University200 enrolled

Overview

The goal of this clinical trial is to investigate whether robot-assisted laparoscopic partial nephrectomy by extraperitoneal approach in the prone position had any advantages over the traditional lateral position. The main questions it aims to answer are: Is prone surgery safe and feasible, and what are the advantages over the traditional lateral position? Does surgery in the prone position have an impact on the patients\' prognosis? Researchers will compare prone position to lateral position to see if robot-assisted laparoscopic partial nephrectomy by extraperitoneal approach in the prone position has any advantages over the traditional lateral position and whether it has any significant effect on the prognosis of the patients. Participants will be randomly allocated 1:1 to two groups: prone position group and lateral position group. The enrolled patients will be underwent robotic-assisted laparoscopic partial nephrectomy via extraperitoneal approach according to the corresponding positions of their groups. Demographic indicators and perioperative-related indicators will be counted and recorded. CT or MRI and related biochemical examinations will be reviewed at 1 month, 3 months, 6 months and 1 year after surgery, and every 1 year thereafter. The similarities and differences of the indicators in different positions will be analysed, and subgroup analyses will be performed according to the corresponding results.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

200

Conditions

Renal Tumor

Interventions

Robot-assisted laparoscopic partial nephrectomy via extraperitoneal approach in the prone positionPROCEDURE

This group of patients underwent robotic-assisted laparoscopic partial nephrectomy via extraperitoneal approach in the prone position

Robot-assisted laparoscopic partial nephrectomy via extraperitoneal approach in the lateral positionPROCEDURE

This group of patients underwent robotic-assisted laparoscopic partial nephrectomy via extraperitoneal approach in the lateral position

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. . Patients with preoperative imaging suggestive of renal occupancy; 2. . Sex is not limited; 3. . Age ≥18 years; 4. . Clinical staging consistent with indications for partial nephrectomy; 5. . Suitable for robotic-assisted laparoscopic partial nephrectomy via extraperitoneal approach as judged by relevant preoperative clinical data; 6. . Agree to provide basic clinical information and pathological and imaging data for scientific research and sign an informed consent form; 7. . Agree to provide monitoring results during the follow-up recurrence monitoring process. Exclusion Criteria: 1. . Patients who did not meet the indications for partial nephrectomy and did not undergo robotic-assisted laparoscopic partial nephrectomy via extraperitoneal approach; 2. . Patients who refuse to undergo or cannot tolerate surgery in the appropriate position; 3. . Patients with incomplete documentation of relevant data to provide accurate demographic, perioperative, and prognostic data; 4. . Any condition which, in the opinion of the investigator, may be detrimental to the subject or result in the inability of the subject to meet or perform the requirements of the study; 5. . Patients who are unable to provide written informed consent;

Outcomes

Primary Outcomes

Tumour characteristics checklist

We will record tumor size (cm), location, position, laterality through preoperative imaging.

Time frame: Baseline ( before surgery)

Tumour characteristics assessed by RENAL nephrometry score

The R.E.N.A.L. Nephrometry Score consists of (R)adius (tumor size as maximal diameter), (E)xophytic/endophytic properties of the tumor, (N)earness of tumor deepest portion to the collecting system or sinus, (A)nterior (a)/posterior (p) descriptor and the (L)ocation relative to the polar line. The suffix h (hilar) is assigned to tumors that abut the main renal artery or vein. Of the 5 components 4 are scored on a 1, 2 or 3-point scale with the 5th indicating the anterior or posterior location of the mass relative to the coronal plane of the kidney. Higher scores indicate more complex tumour.

Time frame: Baseline ( before surgery)

Demographics of patients

age (year)

Time frame: Baseline ( before surgery)

Demographics of patients

gender

Time frame: Baseline ( before surgery)

Demographics of patients

BMI (kg/m2)

Time frame: Baseline ( before surgery)

Demographics of patients

American Society of Anesthesiology score

Time frame: Baseline ( before surgery)

Demographics of patients

age-adjusted charlson comorbidity index

Time frame: Baseline ( before surgery)

Demographics of patients

preoperative estimated glomerular filtration rate(ml/min/1.73m2).

Time frame: Baseline ( before surgery)

Perioperative data

intraoperative average PaCO2(mmHg).