title: Robotic assisted laparoscopic partial nephrectomy using contrast-enhanced ultrasound scan to map renal blood flow.
abstract: OBJECTIVE
  The paper describes novel real-time 'in situ mapping' and 'sequential occlusion angiography' to facilitate selective ischaemia robotic partial nephrectomy (RPN) using intraoperative contrast enhanced ultrasound scan (CEUS).
  
  
  METHODS
  Data were collected and assessed for 60 patients (61 tumours) between 2009 and 2013. 31 (50.8%) tumours underwent 'Global Ischaemia', 27 (44.3%) underwent 'Selective Ischaemia' and 3 (4.9%) were removed 'Off Clamp Zero Ischaemia'. Demographics, operative variables, complications, renal pathology and outcomes were assessed.
  
  
  RESULTS
  Median PADUA score was 9 (range 7-10). The mean warm ischaemia time in selective ischaemia was less and statistically significant than in global ischaemia (17.1 and 21.4, respectively). Mean operative time was 163 min. Postoperative complications (n = 10) included three (5%) Clavien grade 3 or above. Malignancy was demonstrated in 47 (77%) with negative margin in 43 (91.5%) and positive margin in four (8.5%). Long-term decrease in eGFR post selective ischaemia robotic partial nephrectomy was less compared with global ischaemia (four and eight, respectively) but not statistically significant.
  
  
  CONCLUSIONS
  This technique is safe, feasible and cost-effective with comparable perioperative outcomes. The technical aspects elucidate the role of intraoperative CEUS to facilitate and ascertain selective ischaemia. Further work is required to demonstrate long-term oncological outcomes. © 2016 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons, Ltd.
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Alenezi
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Aamir
authors.initials: A
authors.lastname: Motiwala
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Susannah
authors.initials: S
authors.lastname: Eves
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Gray
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Asha
authors.initials: A
authors.lastname: Thomas
authors.affiliation: HCA Laboratories, 43a Wimpole Street, London, W1G 8AQ, UK.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Meiers
authors.affiliation: Department of Pathology, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Haytham
authors.initials: H
authors.lastname: Sharif
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Hanif
authors.initials: H
authors.lastname: Motiwala
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Laniado
authors.affiliation: Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, Slough, Berkshire, SL2 4HL, UK.
authors.forename: Omer
authors.initials: O
authors.lastname: Karim
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D003250:Constriction; D003287:Contrast Media / Q000737:chemistry; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia; D007668:Kidney / Q000000981:diagnostic imaging / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D012079:Renal Circulation; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: SonoVue; contrast enhanced ultrasounds scan (CEUS); global ischaemia; microbubbles; robot assisted laparoscopic partial nephrectomy; selective ischaemia