Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up | Actas Urológicas Españolas (English Edition)

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Castillo, A. Rodríguez-Carlin, V. Borgna" "autores" => array:3 [ 0 => array:4 [ "nombre" => "O.A." "apellidos" => "Castillo" "email" => array:1 [ 0 => "octavio.castillo@indisa.cl" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Rodríguez-Carlin" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "V." "apellidos" => "Borgna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Urología y Centro de Cirugía Robótica, Clínica INDISA, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Andrés Bello, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1669 "Ancho" => 1651 "Tamanyo" => 101023 ] ] "descripcion" => array:1 [ "en" => "Survival free of recurrence of the disease was 92.3% CI (56.7–98.8) at 48 months of follow-up according to the Kaplan–Meier method. CI (confidence interval) is highlighted in orange." ] ] ] "textoCompleto" => "IntroductionThe incidence of renal cell carcinoma has increased significantly in recent years, largely due to an increased use of images in the study of non-specific abdominal symptoms. This has led to incidental diagnosis of smaller renal tumors and better nuclear differentiation susceptible to nephron sparing renal surgery.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> Currently, 70% of renal tumors diagnosed are <7cm (T1) and 45% are renal tumors ≤4cm (T1a).<a class="elsevierStyleCrossRef" href="#bib0160">2</a>Radical nephrectomy (RN) is associated with increased incidence of postoperative chronic kidney disease (CKD) and of an increased mortality from cardiovascular disease, liver, renal failure and sepsis.<a class="elsevierStyleCrossRefs" href="#bib0165">3,4</a> Partial nephrectomy (PN) is technically possible at least 50% of stage T1 renal tumors, with a cancer-specific survival equivalent to RN<a class="elsevierStyleCrossRefs" href="#bib0165">3,5</a> and a significantly greater preservation of renal function.<a class="elsevierStyleCrossRefs" href="#bib0165">3,4,6</a> For this reason, the PN is the treatment of choice for small renal masses (T1a) and eventually for tumors T1b.<a class="elsevierStyleCrossRefs" href="#bib0165">3–6</a>Open partial nephrectomy (OPN) continues to be the technique of choice in the treatment of stage T1 kidney damage. Laparoscopic partial nephrectomy (LPN) has shown comparable preoperative and oncologic results to the OPN, becoming a viable option for the treatment of small renal masses.<a class="elsevierStyleCrossRef" href="#bib0185">7</a> However, it is a complex surgical procedure with a long learning curve, therefore reserved for reference centers.<a class="elsevierStyleCrossRef" href="#bib0190">8</a>Robotic partial nephrectomy (RPN) was first described in 2004, using the Da Vinci® platform (Intuitive Surgical, Sunnyvale, CA, USA).<a class="elsevierStyleCrossRef" href="#bib0195">9</a> The potential benefits include a magnified stereoscopic display and fully articulated instruments under accurate control, which theoretically they could reduce the technical problems associated with the LPN during the dissection of the tumor and renal reconstruction.Our goal is to present the oncological and functional results in 43 patients followed for at least 2 years in a series of 95 patients treated consecutively by RPN.Materials and methodsBetween 2010 and 2014 we made 95 RPN consecutively to patients diagnosed with renal tumor. In all cases, the Da Vinci robotic system S-HD® (Intuitive Surgical Inc., Sunnyvale, CA, USA) was used.The data were collected prospectively and analyzed retrospectively. For the evaluation of oncological and functional results, we took as population study patients that had a minimum follow-up of 2 years. The preoperative evaluation included computerized tomography and/or magnetic resonance. In both cases the vascular phase reconstruction was performed to study the renal vasculature in relation to the tumor.Demographic characteristics were analyzed, as well as intraoperative and postoperative variables: location and tumor size, operative time, warm ischemia time (WIT), estimated blood loss, complications, length of hospitalization, surgical margins, pathological stage (TNM 2010)<a class="elsevierStyleCrossRef" href="#bib0200">10</a> and histological type of tumor.Surgical complexity of renal masses was classified as R.E.N.A.L.<a class="elsevierStyleCrossRef" href="#bib0210">12</a> nephrometry scoring system<a class="elsevierStyleCrossRef" href="#bib0205">11</a> in groups of low, moderate and high complexity. Intraoperative complications were defined using the classification of Satava<a class="elsevierStyleCrossRef" href="#bib0210">12</a> and postoperative complications according to Clavien classification modified by Dindo.<a class="elsevierStyleCrossRef" href="#bib0215">13</a>Preoperative and postoperative renal function was calculated by estimated glomerular filtration rate (GFR) in ml/min/1.73m2 with the Cockroft–Gault formula. Preoperative and postoperative renal function was classified according to the K/DOQI guidelines 2002<a class="elsevierStyleCrossRef" href="#bib0220">14</a> in CKD stage 1 (GFR≥90+kidney damage), stage 2 (GFR 60–89+kidney damage), stage 3 (GFR 30–59), stage 4 (15–30) and stage 5 (<15 or dialysis). For stages 1 and 2 of CKD, kidney damage was defined as the presence of one or more of the following factors: albuminuria, pathological radiological images (obstructive disease of the urinary tract and/or abnormalities of the renal parenchyma), urine sediment changes for more than 3 months (hematuria and/or leucocyturia) and histological alterations.Our follow-up protocol includes clinical examination, computerized tomography of the chest–abdomen and pelvis, and serum creatinine at 3 months after surgery, which is repeated at 6 months and then annually up to 5 years. The appearance of distant metastases and/or local recurrence was considered progression of the disease.Statistical analysisFor the descriptive analysis, continuous variables were recorded as mean±standard deviation or medians±interquartile range. The Kaplan–Meier method was used to calculate rates of overall survival, cancer-specific survival and recurrence-free survival. The differences between related samples by Student t-test were calculated.Surgical techniqueOur technique of RPN has been described previously.<a class="elsevierStyleCrossRef" href="#bib0225">15</a> The transperitoneal approach was used in all cases. In all procedures a technique with 3 or 4 arms was performed. When vascular control was required (artery and/or vein), we used laparoscopic bulldog clamps type (Aesculap®) or robotic (Scanlan®), Rummel tourniquet types and Satinski laparoscopic clamp (Storz®) at the discretion of the surgeon.In some cases, tumor resection was performed without clamping the renal hilum (“zero-ischemia”/“no-clamps”), either by using a laparoscopic clamp for selective compression of the renal parenchyma (Simon Clamp. Aesculap, Inc., Center Valley, PA, USA),<a class="elsevierStyleCrossRef" href="#bib0230">16</a> single-section monopolar coagulation, or by dissection and supraselective control of renal artery branches. The use of intraoperative ultrasound robotics was routinely in order to identify more precisely the tumor boundaries, especially in endophytic injury and/or renal hilum.ResultsOf the total group of patients with conservative robotic surgery (n=95), 43 who met the criterion of minimum follow-up of 2 years were analyzed. The demographic characteristics of these 43 patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean age was 53.1±13.5 years and BMI 27.2±3.89kg/m2. The most common clinical staging was T1a in 31 patients (72.1%) and there were 2 cases (4.65%) of tumor in solitary kidney.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The distribution between the right/left sides was 19/24 and the average tumor size by computerized tomography was 3.7±2.3cm. The R.E.N.A.L. average score was 6±1.75. Eleven patients (25.6%) had moderate renal masses and high surgical complexity, according to nephrometry score and there were 3 injuries with the renal hilum contact (7%), which were designated with the suffix “H”.The average operating time was 102.2±37.1min. Tumor resection was performed “without-pinch” of renal hilum in 9 patients: 6 by compression of the renal parenchyma (Simon Renal Pole Clamp), and in one case with supraselective control branches of the renal artery. A total control of the renal pedicle in 34 patients was performed, with an average WIT of 21.27±7.74min. The median intraoperative blood loss was 150ml (interquartile range=87.5–425).Perioperative complications are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. There were 2 intraoperative complications, one diaphragm injury and one spleen laceration which were repaired in the same surgical procedure (Satava grade 2). Seven patients (16%) had postoperative complications; the most frequent one was retroperitoneal hematoma that required transfusion of red blood cells (Clavien II) in 4 patients (9%). Two patients (4.6%) had arteriovenous fistula, which were treated by selective arterial embolization (Clavien IIIa). One patient had hemoperitoneum 12h after surgery and he required urgent exploratory laparotomy for hemostasis and renal repair. The patient evolved with an acute myocardial infarction that was resolved with medical treatment in intensive care unit (Clavien IVa). The median hospital stay was 3.6±2.2 days. None of the patients required conversion to open or laparoscopic surgical technique and there was no mortality.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The histopathological features of the damages are described in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. 74.4% of tumors were renal cell carcinoma with an average Führman grade of 2.5±0.56. There were 3 cases of tumors pT3a ≤4cm (clinical 2 T1a and 1 T1b) with perirenal fat and/or renal sinus involvement. There were no positive surgical margins and local recurrence.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The patients had a median follow-up of 38±8 months, with an overall survival, recurrence-free and cancer-specific of 100% at 3 years of follow-up. The recurrence-free survival was 92.3% at 48 months of follow-up according to the Kaplan–Meier method (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A patient with a pT3a lesion with renal sinus involvement developed lung metastases at 41 months after surgery, and is currently being treated with tyrosine kinase inhibitors.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Regarding functional outcomes (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>), the mean preoperative GFR was 91.04±28.17ml/min/1.73m2 and the average postoperative control at 1 year was 89.9±27.69ml/min/1.73m2, with an average decrease of −1.1±18.4ml/min/1.73m2 (p=0.74). There was a 3.3% increase in CKD stage and no patient required dialysis, either temporary or permanent.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionTraditionally PN was related to those patients with compelling indications such as solitary kidney (congenital or acquired), CKD and bilateral renal tumor.<a class="elsevierStyleCrossRef" href="#bib0235">17</a> Today the most common indication for PN is in patients with renal tumor <4cm with normal contralateral kidney. The PN has shown a cancer-specific survival equivalent to RN, with a significantly greater preservation of renal function in patients with tumors stage T1.<a class="elsevierStyleCrossRefs" href="#bib0165">3–6</a> In our series, only 13.9% of patients had mandatory indication of PN by CKD and/or solitary kidney, 72% were carriers of a renal tumor ≤4cm (T1a) and 95% <7cm (T1b).There is enough evidence to conclude that CKD secondary to RN is associated with increased risk of death from cardiovascular events, liver disease, renal failure and sepsis.<a class="elsevierStyleCrossRefs" href="#bib0165">3,4</a> It is in this context where we must raise the nephron-sparing renal surgery, not only taking into account the risk of progression and cancer-specific mortality, but also the risk of morbidity and mortality in the aftermath of surgery.New tools were recently introduced that could guide the surgical decision making in the conservative renal surgery nephron: nephrometry scoring system R.E.N.A.L., PADUA and C-Index. Preliminary data support that those systems can improve academic information, perioperative complication risk assessment and prediction of functional outcomes.<a class="elsevierStyleCrossRef" href="#bib0240">18</a>The R.E.N.A.L. system was described in 2009 by Kutikov and Uzzo. This system assigns points based on 5 tumor characteristics. The acronym “R.E.N.A.L.” refers to (R)adius (tumor size as maximal diameter), (E)xophytic/endophytic, (N)earness of tumor the collecting system or sinus, (A)nterior/posterior and the (L)ocation relative to the polar line. This system classifies renal tumors in 3 surgical complexity groups: mild (4–6 points), moderate (7–9 points) and high (10–12 points).<a class="elsevierStyleCrossRef" href="#bib0205">11</a> A higher rate of perioperative complications was associated to medium and high complexity renal tumors treated by RPN<a class="elsevierStyleCrossRefs" href="#bib0245">19,20</a> according to this nephrometry system and, for this reason, we use this tool to describe the characteristics of renal masses in our series. Although 25.6% of patients in our study were carriers of renal masses from moderate to high surgical complexity according to the R.E.N.A.L. system, only 3 patients (6.9%) had postoperative complications Clavien ≥III of which 2 were arteriovenous fistulas that were resolved by selective percutaneous angioembolization (Clavien IIIa) and hemoperitoneum 12h after surgery. This required urgent laparotomy for hemostasis and renal repair (Clavien IVa). It is important to highlight that 3 patients had R.E.N.A.L. nephrometry score ≥8, 2 being moderate and one of a high surgical complexity, 2 of them with imperative indication for being solitary.The open RN first described by Robson has been replaced over time by less radical alternatives, including nephron-sparing surgery and minimally invasive surgery in patients with kidney masses ≤4cm. The total resection of the tumor is an ontological principle of paramount importance, this being a concern when considering PN. Positive surgical margins appear to be associated with small and endophytic tumors, with an incidence in the range 0–7% in patients undergoing APN, in the range 0.7–4% in LPN, and in the range 0–5.7% for those treated with RPN.<a class="elsevierStyleCrossRefs" href="#bib0190">8,15,21</a> Our series, though small, shows comparable results as it was described.The RPN is a technique that shows comparable rates of complications to OPN and less WIT than LPN.<a class="elsevierStyleCrossRefs" href="#bib0155">1,19</a> However, few publications have released their oncological results of this approach. In a series published in 2007 with 8 patients, there was no recurrence of disease at 15 months follow-up.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> According to the literature review to date of this presentation, there is only one paper published with oncological and functional results at 3-year follow-up in 134 patients. The authors report an overall survival of 97.01% and 90.2% at 3 years and 5 years of follow-up, a recurrence-free survival of 98.92% at 5 years of follow-up and cancer-specific survival of 99.04%.<a class="elsevierStyleCrossRef" href="#bib0265">23</a>As for the oncological results of our series, only one patient developed distant metastasis at 41 months follow-up (3%) with a recurrence-free survival of 92.3% at 3 years by recurrence-free survival of 92.3% at 48 months follow-up. Overall survival, recurrence-free and cancer-specific was of 100% at 3 years of follow-up. These findings are comparable to those described in the series by Khalifeh et al.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> and other similar studies of OPN and LPN (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<a class="elsevierStyleCrossRefs" href="#bib0260">22,24–26</a><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The renal function after PN will depend on: quality (renal function before surgery), quantity (renal parenchyma preserved during surgery) and speed (ischemia time).<a class="elsevierStyleCrossRef" href="#bib0285">27</a> Regarding the ischemia time, it has classically been described in the literature that kidney damage occurs when it is >30min. However, it seems that there is no known WIT threshold safety since it was demonstrated that every minute of ischemia contributes to the risk of developing acute renal failure and permanent impairment of renal function. For this reason, efforts must be directed to maintain the lowest WIT<a class="elsevierStyleCrossRefs" href="#bib0285">27,28</a> possible.The largest study comparing OPN vs. LPN showed a significant decrease in estimated blood loss, length of hospital stay and total operating time for LPN. However, patients undergoing LPN had higher WIT and higher incidence of postoperative complications (18.6%).<a class="elsevierStyleCrossRef" href="#bib0295">29</a>Several comparative studies have shown shorter ischemia time in RPN vs. LPN.<a class="elsevierStyleCrossRefs" href="#bib0155">1,30</a> Benway et al. reported an average WIT 19.7min in 129 RPN compared to 28.4min in 118 LPN (p<0.001).<a class="elsevierStyleCrossRef" href="#bib0160">2</a> The WIT in our series was 21.3min for patients undergoing RPN with clamping of the renal hilum (79.1%). There was a decrease of 1.1±18.4ml/min/1.73m2 with a 3.3% increase in CKD stage. None of our patients required temporary or permanent dialysis. These good results are the product of a minimum ischemia time and maximum preservation of healthy renal parenchyma. While several types of hilar clamping (Rummel tourniquet, laparoscopic and robotic bulldog) were used in this series there was no difference in ischemic times.Although our median follow-up was 3 years and it is the period of greatest statement to date, it is not enough to draw definitive conclusions on metastasis and cancer-specific survival. But it represents together with another series of RPN<a class="elsevierStyleCrossRef" href="#bib0265">23</a> an initial important step in cancer outcomes.Our series describes the functional and oncological results in a group of patients undergoing RPN. Although this is a group with a small number of cases, we believe our work makes a significant contribution to the limited literature on this subject.ConclusionThe analysis of functional and oncological outcomes focused on mid-term results of our series of RPN confirms its safety and efficacy. These results reinforce that the RPN is a surgical option that provides optimal preservation of renal function and cancer control in the medium-term.Conflict of interestThe authors declare that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres631161" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec644015" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres631162" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec644014" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical technique" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-08" "fechaAceptado" => "2015-10-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec644015" "palabras" => array:4 [ 0 => "Robot-assisted partial nephrectomy" 1 => "Conservative nephron surgery" 2 => "Renal cell carcinomas" 3 => "Oncological results" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec644014" "palabras" => array:4 [ 0 => "Nefrectomía parcial robótica" 1 => "Cirugía conservadora de nefronas" 2 => "Carcinoma de células renales" 3 => "Resultados oncológicos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundWe present the oncological and functional results from a series of 43 patients with renal tumors, treated consecutively with robot-assisted partial nephrectomy (RPN). Materials and methodBetween 2010 and 2014, we performed 95 RPNs. To assess the results, we included only those patients (n=43) who had a minimum follow-up of 2 years. A descriptive analysis was conducted of the demographic characteristics and perioperative variables. We employed Kaplan–Meier curves to assess overall survival, cancer-specific survival and recurrence-free survival. ResultsThe patients’ mean age was 53.1±13.5 years. The mean preoperative tumor size was 3.7±2.3cm. The mean surgical time was 102.2±37.1min. The mean ischemia time was 21.27±7.74min, with a median intraoperative bleeding volume of 150ml (IQR, 87.5–425). There was a 7% rate of postoperative complications (Clavien ≥III). There was no mortality.The average Fürhman grade was 2.5±0.56. There were no positive surgical margins or local recurrences. The median follow-up was 38±8 months, with an overall survival, recurrence-free survival and cancer-specific survival of 100% at 3 years of follow-up. The recurrence-free survival was 92,3% at 48 months of follow-up. The mean preoperative glomerular filtration rate was 91.04±28.17ml/min/1.73m2, and the postoperative rate was 89.9±27.69ml/min/1.73m2, with a nonsignificant reduction (p=0.74). ConclusionsThe functional and oncological results of our series confirm the safety and efficacy of RPN. RPN offers optimal preservation of renal function and oncological control in the medium term." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónPresentamos los resultados oncológicos y funcionales de una serie de 43 pacientes afectos de un tumor renal, tratados en forma consecutiva mediante nefrectomía parcial robótica (NPR). Material y métodoEntre los años 2010 y 2014 efectuamos 95 NPR. Para la evaluación de los resultados se incluyeron solo a los pacientes (n=43) que tuvieran un seguimiento mínimo de 2 años. Se realizó un análisis descriptivo de las características demográficas y variables perioperatorias. Se utilizaron curvas de Kaplan–Meier para evaluar la supervivencia global, supervivencia cáncer-específica y supervivencia libre de recurrencia. ResultadosLa edad media fue 53,1±13,5 años. El tamaño tumoral preoperatorio fue 3,7±2,3cm. El tiempo quirúrgico fue 102,2±37,1min. El tiempo de isquemia fue de 21,27±7,74min con una mediana de sangrado intraoperatorio de 150ml (RIC=87,5–425). Hubo un 7% de complicaciones postoperatorias Clavien ≥III. No hubo mortalidad.El grado de Fürhman promedio fue 2,5±0,56. No hubo márgenes quirúrgicos positivos ni recurrencia local. La mediana de seguimiento fue 38±8 meses, con una supervivencia global, una supervivencia libre de recurrencia y una supervivencia cáncer específica del 100% a 3 años de seguimiento. La supervivencia libre de recurrencia fue del 92,3% a 48 meses de seguimiento. La media de filtración glomerular preoperatoria fue 91,04±28,17 y la postoperatoria 89,9±27,69ml/min por 1,73m2, con una disminución no significativa (p=0,74). ConclusionesLos resultados funcionales y oncológicos de nuestra serie de NPR, confirman su seguridad y eficacia. La NPR ofrece una óptima preservación de la función renal y control oncológico a mediano plazo." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Castillo OA, Rodríguez-Carlin A, Borgna V. Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento. Actas Urol Esp. 2016;40:217–223." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1669 "Ancho" => 1651 "Tamanyo" => 101023 ] ] "descripcion" => array:1 [ "en" => "Survival free of recurrence of the disease was 92.3% CI (56.7–98.8) at 48 months of follow-up according to the Kaplan–Meier method. CI (confidence interval) is highlighted in orange." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "A, anterior; ASA, American Society of Anesthesiologists; SD, standard deviation; H, hiliar; P, posterior; R.E.N.A.L., nephrometry scoring system; X, lateral." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male/female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27/16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53.1±13.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Body mass index \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.2±3.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ASA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.7±0.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Side (right/left) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Tumor location</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Upper pole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 (34.89) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Medium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (32.55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Lower \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14 (32.55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Single kidney \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative tumor size (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.7±2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">TNM clinical stage</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–T1a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31 (72.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–T1b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (23.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–T2a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">R.E.N.A.L. score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6±1.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">R.E.N.A.L. location, n.° (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (23.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–AH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–P \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (25.58) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–PH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–X \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 (44.19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Tumor complexity (R.E.N.A.L.)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mild (4–6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 (74.42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moderate (7–9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (20.93) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High (10–12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035449.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "The values are expressed in average±SD or number (percentage), whenever applicable." ] ] ] "descripcion" => array:1 [ "en" => "Demographic characteristics of patients." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intraoperative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n.° (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Satava classification system \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Splenic laceration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diaphragm injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Grade 2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total intraoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (4.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035445.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n.° (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clavien classification system \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retroperitoneal hematoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (9.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arteriovenous fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (4.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IIIb \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">IVa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total postoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (16.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035446.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Perioperative complications." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "RCC, renal cell carcinoma; SD, standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Tumor history, n.°</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Malignant/benign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32/11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Malignant, n.°</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Clear cell RCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (62.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Papillary RCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Cromophobe RCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (6.97) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fürhman Grade \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.51±0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Pathological T stage<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–T1a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (78.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–T1b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–T3a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (9.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Benign, n.°</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Oncocytoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Angiomyolipoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 (13.95) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Simple cyst \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (4.65) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Inflammatory pseudotumor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">–Chronic pyelonephritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (2.32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor size (histopathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6±1.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Positive surgical margin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospital stay, days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.6±2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Follow-up period, months<a class="elsevierStyleCrossRef" href="#tblfn0020">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38±8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recurrence of disease, n° (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer-specific mortality, n° (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality from other causes, n° (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035450.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "The values are expressed in average±SD or number (%), whenever applicable." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Of RCCs according to the TNM 2010 classification." ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "Median." ] ] ] "descripcion" => array:1 [ "en" => "Oncological and postoperative results." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "SD, standard deviation; CKD, chronic kidney disease; EB, estimated bleeding; GFR, glomerular filtration rate estimated at ml/min/1.73m2; WIT, warm ischemia time." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0035">*</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EB, ml<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">150 (87.5–425) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical time, min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">102.2±37.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WIT, min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.27±7.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Without ischemia, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (20.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.96±0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative GFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">91.04±28.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.02±0.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative GFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">89.9±27.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Decrease of the GFR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.1±18.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Increase of CKD stage, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (3.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035447.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "The values are expressed in average±SD or number (percentage), whenever applicable." ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "Median (interquartile range)." ] 2 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "*" "nota" => "The differences between preoperative and postoperative GFR were not statistically significant (p=0.74)." ] ] ] "descripcion" => array:1 [ "en" => "Perioperative results and renal function assessment." ] ] 5 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Mt, metastasis; N/A, not applicable; OPN, open partial nephrectomy; LPN, laparoscopic partial nephrectomy; RPN, robotic partial nephrectomy, CSS, cancer-specific survival; OS, overall survival; Recur, recurrence." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Follow-up years \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Size, cm \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">n.° \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Type \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survival at 3 years, %</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survival at 5 years, %</th><th class="td" title="table-head " align="left" valign="top" scope="col">Mt, n.° \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Recur, n.° \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CSS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CSS \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fergany et al.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moinzadeh et al.<a class="elsevierStyleCrossRef" href="#bib0275">25</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lane et al.<a class="elsevierStyleCrossRef" href="#bib0280">26</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kaul et al.<a class="elsevierStyleCrossRef" href="#bib0260">22</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Khalifeh et al.<a class="elsevierStyleCrossRef" href="#bib0265">23</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current series \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1035448.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Oncological results in PN." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.M. 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Robot-assisted partial nephrectomy in 95 consecutive patients: Oncological and functional outcomes at 3 years of follow-up

Nefrectomía parcial robótica en 95 pacientes consecutivos: resultados oncológicos y funcionales a 3 años de seguimiento

O.A. Castilloa,b,

Corresponding author

octavio.castillo@indisa.cl

Corresponding author.

, A. Rodríguez-Carlina, V. Borgnaa

a Unidad de Urología y Centro de Cirugía Robótica, Clínica INDISA, Chile

b Facultad de Medicina, Universidad Andrés Bello, Chile

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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival free of recurrence of the disease was 92&#46;3&#37; CI &#40;56&#46;7&#8211;98&#46;8&#41; at 48 months of follow-up according to the Kaplan&#8211;Meier method&#46; CI &#40;confidence interval&#41; is highlighted in orange&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The incidence of renal cell carcinoma has increased significantly in recent years&#44; largely due to an increased use of images in the study of non-specific abdominal symptoms&#46; This has led to incidental diagnosis of smaller renal tumors and better nuclear differentiation susceptible to nephron sparing renal surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Currently&#44; 70&#37; of renal tumors diagnosed are &#60;7<span class="elsevierStyleHsp" style=""></span>cm &#40;T1&#41; and 45&#37; are renal tumors &#8804;4<span class="elsevierStyleHsp" style=""></span>cm &#40;T1a&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Radical nephrectomy &#40;RN&#41; is associated with increased incidence of postoperative chronic kidney disease &#40;CKD&#41; and of an increased mortality from cardiovascular disease&#44; liver&#44; renal failure and sepsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a> Partial nephrectomy &#40;PN&#41; is technically possible at least 50&#37; of stage T1 renal tumors&#44; with a cancer-specific survival equivalent to RN<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;5</span></a> and a significantly greater preservation of renal function&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a> For this reason&#44; the PN is the treatment of choice for small renal masses &#40;T1a&#41; and eventually for tumors T1b&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Open partial nephrectomy &#40;OPN&#41; continues to be the technique of choice in the treatment of stage T1 kidney damage&#46; Laparoscopic partial nephrectomy &#40;LPN&#41; has shown comparable preoperative and oncologic results to the OPN&#44; becoming a viable option for the treatment of small renal masses&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> However&#44; it is a complex surgical procedure with a long learning curve&#44; therefore reserved for reference centers&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Robotic partial nephrectomy &#40;RPN&#41; was first described in 2004&#44; using the Da Vinci<span class="elsevierStyleSup">&#174;</span> platform &#40;Intuitive Surgical&#44; Sunnyvale&#44; CA&#44; USA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> The potential benefits include a magnified stereoscopic display and fully articulated instruments under accurate control&#44; which theoretically they could reduce the technical problems associated with the LPN during the dissection of the tumor and renal reconstruction&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our goal is to present the oncological and functional results in 43 patients followed for at least 2 years in a series of 95 patients treated consecutively by RPN&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Between 2010 and 2014 we made 95 RPN consecutively to patients diagnosed with renal tumor&#46; In all cases&#44; the Da Vinci robotic system S-HD<span class="elsevierStyleSup">&#174;</span> &#40;Intuitive Surgical Inc&#46;&#44; Sunnyvale&#44; CA&#44; USA&#41; was used&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data were collected prospectively and analyzed retrospectively&#46; For the evaluation of oncological and functional results&#44; we took as population study patients that had a minimum follow-up of 2 years&#46; The preoperative evaluation included computerized tomography and&#47;or magnetic resonance&#46; In both cases the vascular phase reconstruction was performed to study the renal vasculature in relation to the tumor&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Demographic characteristics were analyzed&#44; as well as intraoperative and postoperative variables&#58; location and tumor size&#44; operative time&#44; warm ischemia time &#40;WIT&#41;&#44; estimated blood loss&#44; complications&#44; length of hospitalization&#44; surgical margins&#44; pathological stage &#40;TNM 2010&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> and histological type of tumor&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Surgical complexity of renal masses was classified as R&#46;E&#46;N&#46;A&#46;L&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> nephrometry scoring system<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> in groups of low&#44; moderate and high complexity&#46; Intraoperative complications were defined using the classification of Satava<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> and postoperative complications according to Clavien classification modified by Dindo&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Preoperative and postoperative renal function was calculated by estimated glomerular filtration rate &#40;GFR&#41; in ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> with the Cockroft&#8211;Gault formula&#46; Preoperative and postoperative renal function was classified according to the K&#47;DOQI guidelines 2002<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> in CKD stage 1 &#40;GFR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>kidney damage&#41;&#44; stage 2 &#40;GFR 60&#8211;89<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>kidney damage&#41;&#44; stage 3 &#40;GFR 30&#8211;59&#41;&#44; stage 4 &#40;15&#8211;30&#41; and stage 5 &#40;&#60;15 or dialysis&#41;&#46; For stages 1 and 2 of CKD&#44; kidney damage was defined as the presence of one or more of the following factors&#58; albuminuria&#44; pathological radiological images &#40;obstructive disease of the urinary tract and&#47;or abnormalities of the renal parenchyma&#41;&#44; urine sediment changes for more than 3 months &#40;hematuria and&#47;or leucocyturia&#41; and histological alterations&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Our follow-up protocol includes clinical examination&#44; computerized tomography of the chest&#8211;abdomen and pelvis&#44; and serum creatinine at 3 months after surgery&#44; which is repeated at 6 months and then annually up to 5 years&#46; The appearance of distant metastases and&#47;or local recurrence was considered progression of the disease&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">For the descriptive analysis&#44; continuous variables were recorded as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or medians<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>interquartile range&#46; The Kaplan&#8211;Meier method was used to calculate rates of overall survival&#44; cancer-specific survival and recurrence-free survival&#46; The differences between related samples by Student <span class="elsevierStyleItalic">t</span>-test were calculated&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgical technique</span><p id="par0065" class="elsevierStylePara elsevierViewall">Our technique of RPN has been described previously&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> The transperitoneal approach was used in all cases&#46; In all procedures a technique with 3 or 4 arms was performed&#46; When vascular control was required &#40;artery and&#47;or vein&#41;&#44; we used laparoscopic bulldog clamps type &#40;Aesculap<span class="elsevierStyleSup">&#174;</span>&#41; or robotic &#40;Scanlan<span class="elsevierStyleSup">&#174;</span>&#41;&#44; Rummel tourniquet types and Satinski laparoscopic clamp &#40;Storz<span class="elsevierStyleSup">&#174;</span>&#41; at the discretion of the surgeon&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In some cases&#44; tumor resection was performed without clamping the renal hilum &#40;&#8220;zero-ischemia&#8221;&#47;&#8220;no-clamps&#8221;&#41;&#44; either by using a laparoscopic clamp for selective compression of the renal parenchyma &#40;Simon Clamp&#46; Aesculap&#44; Inc&#46;&#44; Center Valley&#44; PA&#44; USA&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> single-section monopolar coagulation&#44; or by dissection and supraselective control of renal artery branches&#46; The use of intraoperative ultrasound robotics was routinely in order to identify more precisely the tumor boundaries&#44; especially in endophytic injury and&#47;or renal hilum&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">Of the total group of patients with conservative robotic surgery &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;&#44; 43 who met the criterion of minimum follow-up of 2 years were analyzed&#46; The demographic characteristics of these 43 patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mean age was 53&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;5 years and BMI 27&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;89<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The most common clinical staging was T1a in 31 patients &#40;72&#46;1&#37;&#41; and there were 2 cases &#40;4&#46;65&#37;&#41; of tumor in solitary kidney&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The distribution between the right&#47;left sides was 19&#47;24 and the average tumor size by computerized tomography was 3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3<span class="elsevierStyleHsp" style=""></span>cm&#46; The R&#46;E&#46;N&#46;A&#46;L&#46; average score was 6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;75&#46; Eleven patients &#40;25&#46;6&#37;&#41; had moderate renal masses and high surgical complexity&#44; according to nephrometry score and there were 3 injuries with the renal hilum contact &#40;7&#37;&#41;&#44; which were designated with the suffix &#8220;H&#8221;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The average operating time was 102&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;1<span class="elsevierStyleHsp" style=""></span>min&#46; Tumor resection was performed &#8220;without-pinch&#8221; of renal hilum in 9 patients&#58; 6 by compression of the renal parenchyma &#40;Simon Renal Pole Clamp&#41;&#44; and in one case with supraselective control branches of the renal artery&#46; A total control of the renal pedicle in 34 patients was performed&#44; with an average WIT of 21&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;74<span class="elsevierStyleHsp" style=""></span>min&#46; The median intraoperative blood loss was 150<span class="elsevierStyleHsp" style=""></span>ml &#40;interquartile range<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#46;5&#8211;425&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Perioperative complications are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There were 2 intraoperative complications&#44; one diaphragm injury and one spleen laceration which were repaired in the same surgical procedure &#40;Satava grade 2&#41;&#46; Seven patients &#40;16&#37;&#41; had postoperative complications&#59; the most frequent one was retroperitoneal hematoma that required transfusion of red blood cells &#40;Clavien II&#41; in 4 patients &#40;9&#37;&#41;&#46; Two patients &#40;4&#46;6&#37;&#41; had arteriovenous fistula&#44; which were treated by selective arterial embolization &#40;Clavien IIIa&#41;&#46; One patient had hemoperitoneum 12<span class="elsevierStyleHsp" style=""></span>h after surgery and he required urgent exploratory laparotomy for hemostasis and renal repair&#46; The patient evolved with an acute myocardial infarction that was resolved with medical treatment in intensive care unit &#40;Clavien IVa&#41;&#46; The median hospital stay was 3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2 days&#46; None of the patients required conversion to open or laparoscopic surgical technique and there was no mortality&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The histopathological features of the damages are described in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; 74&#46;4&#37; of tumors were renal cell carcinoma with an average F&#252;hrman grade of 2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#46; There were 3 cases of tumors pT3a &#8804;4<span class="elsevierStyleHsp" style=""></span>cm &#40;clinical 2 T1a and 1 T1b&#41; with perirenal fat and&#47;or renal sinus involvement&#46; There were no positive surgical margins and local recurrence&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The patients had a median follow-up of 38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 months&#44; with an overall survival&#44; recurrence-free and cancer-specific of 100&#37; at 3 years of follow-up&#46; The recurrence-free survival was 92&#46;3&#37; at 48 months of follow-up according to the Kaplan&#8211;Meier method &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A patient with a pT3a lesion with renal sinus involvement developed lung metastases at 41 months after surgery&#44; and is currently being treated with tyrosine kinase inhibitors&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding functional outcomes &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; the mean preoperative GFR was 91&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;17<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and the average postoperative control at 1 year was 89&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;69<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; with an average decrease of &#8722;1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;4<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;74&#41;&#46; There was a 3&#46;3&#37; increase in CKD stage and no patient required dialysis&#44; either temporary or permanent&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Traditionally PN was related to those patients with compelling indications such as solitary kidney &#40;congenital or acquired&#41;&#44; CKD and bilateral renal tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a> Today the most common indication for PN is in patients with renal tumor &#60;4<span class="elsevierStyleHsp" style=""></span>cm with normal contralateral kidney&#46; The PN has shown a cancer-specific survival equivalent to RN&#44; with a significantly greater preservation of renal function in patients with tumors stage T1&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#8211;6</span></a> In our series&#44; only 13&#46;9&#37; of patients had mandatory indication of PN by CKD and&#47;or solitary kidney&#44; 72&#37; were carriers of a renal tumor &#8804;4<span class="elsevierStyleHsp" style=""></span>cm &#40;T1a&#41; and 95&#37; &#60;7<span class="elsevierStyleHsp" style=""></span>cm &#40;T1b&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">There is enough evidence to conclude that CKD secondary to RN is associated with increased risk of death from cardiovascular events&#44; liver disease&#44; renal failure and sepsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a> It is in this context where we must raise the nephron-sparing renal surgery&#44; not only taking into account the risk of progression and cancer-specific mortality&#44; but also the risk of morbidity and mortality in the aftermath of surgery&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">New tools were recently introduced that could guide the surgical decision making in the conservative renal surgery nephron&#58; nephrometry scoring system R&#46;E&#46;N&#46;A&#46;L&#46;&#44; PADUA and C-Index&#46; Preliminary data support that those systems can improve academic information&#44; perioperative complication risk assessment and prediction of functional outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The R&#46;E&#46;N&#46;A&#46;L&#46; system was described in 2009 by Kutikov and Uzzo&#46; This system assigns points based on 5 tumor characteristics&#46; The acronym &#8220;R&#46;E&#46;N&#46;A&#46;L&#46;&#8221; refers to &#40;R&#41;adius &#40;tumor size as maximal diameter&#41;&#44; &#40;E&#41;xophytic&#47;endophytic&#44; &#40;N&#41;earness of tumor the collecting system or sinus&#44; &#40;A&#41;nterior&#47;posterior and the &#40;L&#41;ocation relative to the polar line&#46; This system classifies renal tumors in 3 surgical complexity groups&#58; mild &#40;4&#8211;6 points&#41;&#44; moderate &#40;7&#8211;9 points&#41; and high &#40;10&#8211;12 points&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> A higher rate of perioperative complications was associated to medium and high complexity renal tumors treated by RPN<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> according to this nephrometry system and&#44; for this reason&#44; we use this tool to describe the characteristics of renal masses in our series&#46; Although 25&#46;6&#37; of patients in our study were carriers of renal masses from moderate to high surgical complexity according to the R&#46;E&#46;N&#46;A&#46;L&#46; system&#44; only 3 patients &#40;6&#46;9&#37;&#41; had postoperative complications Clavien &#8805;III of which 2 were arteriovenous fistulas that were resolved by selective percutaneous angioembolization &#40;Clavien IIIa&#41; and hemoperitoneum 12<span class="elsevierStyleHsp" style=""></span>h after surgery&#46; This required urgent laparotomy for hemostasis and renal repair &#40;Clavien IVa&#41;&#46; It is important to highlight that 3 patients had R&#46;E&#46;N&#46;A&#46;L&#46; nephrometry score &#8805;8&#44; 2 being moderate and one of a high surgical complexity&#44; 2 of them with imperative indication for being solitary&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The open RN first described by Robson has been replaced over time by less radical alternatives&#44; including nephron-sparing surgery and minimally invasive surgery in patients with kidney masses &#8804;4<span class="elsevierStyleHsp" style=""></span>cm&#46; The total resection of the tumor is an ontological principle of paramount importance&#44; this being a concern when considering PN&#46; Positive surgical margins appear to be associated with small and endophytic tumors&#44; with an incidence in the range 0&#8211;7&#37; in patients undergoing APN&#44; in the range 0&#46;7&#8211;4&#37; in LPN&#44; and in the range 0&#8211;5&#46;7&#37; for those treated with RPN&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;15&#44;21</span></a> Our series&#44; though small&#44; shows comparable results as it was described&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The RPN is a technique that shows comparable rates of complications to OPN and less WIT than LPN&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;19</span></a> However&#44; few publications have released their oncological results of this approach&#46; In a series published in 2007 with 8 patients&#44; there was no recurrence of disease at 15 months follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> According to the literature review to date of this presentation&#44; there is only one paper published with oncological and functional results at 3-year follow-up in 134 patients&#46; The authors report an overall survival of 97&#46;01&#37; and 90&#46;2&#37; at 3 years and 5 years of follow-up&#44; a recurrence-free survival of 98&#46;92&#37; at 5 years of follow-up and cancer-specific survival of 99&#46;04&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">As for the oncological results of our series&#44; only one patient developed distant metastasis at 41 months follow-up &#40;3&#37;&#41; with a recurrence-free survival of 92&#46;3&#37; at 3 years by recurrence-free survival of 92&#46;3&#37; at 48 months follow-up&#46; Overall survival&#44; recurrence-free and cancer-specific was of 100&#37; at 3 years of follow-up&#46; These findings are comparable to those described in the series by Khalifeh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> and other similar studies of OPN and LPN &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;24&#8211;26</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">The renal function after PN will depend on&#58; quality &#40;renal function before surgery&#41;&#44; quantity &#40;renal parenchyma preserved during surgery&#41; and speed &#40;ischemia time&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Regarding the ischemia time&#44; it has classically been described in the literature that kidney damage occurs when it is &#62;30<span class="elsevierStyleHsp" style=""></span>min&#46; However&#44; it seems that there is no known WIT threshold safety since it was demonstrated that every minute of ischemia contributes to the risk of developing acute renal failure and permanent impairment of renal function&#46; For this reason&#44; efforts must be directed to maintain the lowest WIT<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">27&#44;28</span></a> possible&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The largest study comparing OPN vs&#46; LPN showed a significant decrease in estimated blood loss&#44; length of hospital stay and total operating time for LPN&#46; However&#44; patients undergoing LPN had higher WIT and higher incidence of postoperative complications &#40;18&#46;6&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Several comparative studies have shown shorter ischemia time in RPN vs&#46; LPN&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;30</span></a> Benway et al&#46; reported an average WIT 19&#46;7<span class="elsevierStyleHsp" style=""></span>min in 129 RPN compared to 28&#46;4<span class="elsevierStyleHsp" style=""></span>min in 118 LPN &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> The WIT in our series was 21&#46;3<span class="elsevierStyleHsp" style=""></span>min for patients undergoing RPN with clamping of the renal hilum &#40;79&#46;1&#37;&#41;&#46; There was a decrease of 1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;4<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> with a 3&#46;3&#37; increase in CKD stage&#46; None of our patients required temporary or permanent dialysis&#46; These good results are the product of a minimum ischemia time and maximum preservation of healthy renal parenchyma&#46; While several types of hilar clamping &#40;Rummel tourniquet&#44; laparoscopic and robotic bulldog&#41; were used in this series there was no difference in ischemic times&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Although our median follow-up was 3 years and it is the period of greatest statement to date&#44; it is not enough to draw definitive conclusions on metastasis and cancer-specific survival&#46; But it represents together with another series of RPN<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> an initial important step in cancer outcomes&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our series describes the functional and oncological results in a group of patients undergoing RPN&#46; Although this is a group with a small number of cases&#44; we believe our work makes a significant contribution to the limited literature on this subject&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">The analysis of functional and oncological outcomes focused on mid-term results of our series of RPN confirms its safety and efficacy&#46; These results reinforce that the RPN is a surgical option that provides optimal preservation of renal function and cancer control in the medium-term&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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            0 => "Robot-assisted partial nephrectomy"
            1 => "Conservative nephron surgery"
            2 => "Renal cell carcinomas"
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            0 => "Nefrectom&#237;a parcial rob&#243;tica"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present the oncological and functional results from a series of 43 patients with renal tumors&#44; treated consecutively with robot-assisted partial nephrectomy &#40;RPN&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Between 2010 and 2014&#44; we performed 95 RPNs&#46; To assess the results&#44; we included only those patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41; who had a minimum follow-up of 2 years&#46; A descriptive analysis was conducted of the demographic characteristics and perioperative variables&#46; We employed Kaplan&#8211;Meier curves to assess overall survival&#44; cancer-specific survival and recurrence-free survival&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The patients&#8217; mean age was 53&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;5 years&#46; The mean preoperative tumor size was 3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3<span class="elsevierStyleHsp" style=""></span>cm&#46; The mean surgical time was 102&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;1<span class="elsevierStyleHsp" style=""></span>min&#46; The mean ischemia time was 21&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;74<span class="elsevierStyleHsp" style=""></span>min&#44; with a median intraoperative bleeding volume of 150<span class="elsevierStyleHsp" style=""></span>ml &#40;IQR&#44; 87&#46;5&#8211;425&#41;&#46; There was a 7&#37; rate of postoperative complications &#40;Clavien &#8805;III&#41;&#46; There was no mortality&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The average F&#252;rhman grade was 2&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#46; There were no positive surgical margins or local recurrences&#46; The median follow-up was 38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 months&#44; with an overall survival&#44; recurrence-free survival and cancer-specific survival of 100&#37; at 3 years of follow-up&#46; The recurrence-free survival was 92&#44;3&#37; at 48 months of follow-up&#46; The mean preoperative glomerular filtration rate was 91&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;17<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; and the postoperative rate was 89&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;69<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; with a nonsignificant reduction &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;74&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The functional and oncological results of our series confirm the safety and efficacy of RPN&#46; RPN offers optimal preservation of renal function and oncological control in the medium term&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and method"
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos los resultados oncol&#243;gicos y funcionales de una serie de 43 pacientes afectos de un tumor renal&#44; tratados en forma consecutiva mediante nefrectom&#237;a parcial rob&#243;tica &#40;NPR&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Entre los a&#241;os 2010 y 2014 efectuamos 95 NPR&#46; Para la evaluaci&#243;n de los resultados se incluyeron solo a los pacientes &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41; que tuvieran un seguimiento m&#237;nimo de 2 a&#241;os&#46; Se realiz&#243; un an&#225;lisis descriptivo de las caracter&#237;sticas demogr&#225;ficas y variables perioperatorias&#46; Se utilizaron curvas de Kaplan&#8211;Meier para evaluar la supervivencia global&#44; supervivencia c&#225;ncer-espec&#237;fica y supervivencia libre de recurrencia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La edad media fue 53&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;5 a&#241;os&#46; El tama&#241;o tumoral preoperatorio fue 3&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3<span class="elsevierStyleHsp" style=""></span>cm&#46; El tiempo quir&#250;rgico fue 102&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#44;1<span class="elsevierStyleHsp" style=""></span>min&#46; El tiempo de isquemia fue de 21&#44;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;74<span class="elsevierStyleHsp" style=""></span>min con una mediana de sangrado intraoperatorio de 150<span class="elsevierStyleHsp" style=""></span>ml &#40;RIC<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>87&#44;5&#8211;425&#41;&#46; Hubo un 7&#37; de complicaciones postoperatorias Clavien &#8805;III&#46; No hubo mortalidad&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El grado de F&#252;rhman promedio fue 2&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;56&#46; No hubo m&#225;rgenes quir&#250;rgicos positivos ni recurrencia local&#46; La mediana de seguimiento fue 38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 meses&#44; con una supervivencia global&#44; una supervivencia libre de recurrencia y una supervivencia c&#225;ncer espec&#237;fica del 100&#37; a 3 a&#241;os de seguimiento&#46; La supervivencia libre de recurrencia fue del 92&#44;3&#37; a 48 meses de seguimiento&#46; La media de filtraci&#243;n glomerular preoperatoria fue 91&#44;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#44;17 y la postoperatoria 89&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#44;69<span class="elsevierStyleHsp" style=""></span>ml&#47;min por 1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; con una disminuci&#243;n no significativa &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;74&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los resultados funcionales y oncol&#243;gicos de nuestra serie de NPR&#44; confirman su seguridad y eficacia&#46; La NPR ofrece una &#243;ptima preservaci&#243;n de la funci&#243;n renal y control oncol&#243;gico a mediano plazo&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Please cite this article as&#58; Castillo OA&#44; Rodr&#237;guez-Carlin A&#44; Borgna V&#46; Nefrectom&#237;a parcial rob&#243;tica en 95 pacientes consecutivos&#58; resultados oncol&#243;gicos y funcionales a 3 a&#241;os de seguimiento&#46; Actas Urol Esp&#46; 2016&#59;40&#58;217&#8211;223&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Survival free of recurrence of the disease was 92&#46;3&#37; CI &#40;56&#46;7&#8211;98&#46;8&#41; at 48 months of follow-up according to the Kaplan&#8211;Meier method&#46; CI &#40;confidence interval&#41; is highlighted in orange&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A&#44; anterior&#59; ASA&#44; American Society of Anesthesiologists&#59; SD&#44; standard deviation&#59; H&#44; hiliar&#59; P&#44; posterior&#59; R&#46;E&#46;N&#46;A&#46;L&#46;&#44; nephrometry scoring system&#59; X&#44; lateral&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Side &#40;right</span>&#47;<span class="elsevierStyleItalic">left&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;32&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;32&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Preoperative tumor size &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">TNM clinical stage</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;T1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;72&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;T1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;23&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;T2a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">R&#46;E&#46;N&#46;A&#46;L&#46; score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">R&#46;E&#46;N&#46;A&#46;L&#46; location&#44; n&#46;&#176; &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;23&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;AH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;25&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;PH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;<span class="elsevierStyleSmallCaps">X</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;44&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Tumor complexity <span class="elsevierStyleItalic">&#40;R&#46;E&#46;N&#46;A&#46;L&#46;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild &#40;4&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;74&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate &#40;7&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;20&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High &#40;10&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1035449.png"
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The values are expressed in average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD or number &#40;percentage&#41;&#44; whenever applicable&#46;</p>"
            ]
          ]
        ]
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of patients&#46;</p>"
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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        "tabla" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intraoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&#46;&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Satava classification system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Splenic laceration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grade 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diaphragm injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Grade 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total intraoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&#46;&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clavien classification system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Retroperitoneal hematoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arteriovenous fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IIIb&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">IVa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total postoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;16&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Perioperative complications&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">RCC&#44; renal cell carcinoma&#59; SD&#44; standard deviation&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Tumor history&#44; n&#46;&#176;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Malignant&#47;benign&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&#47;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Malignant&#44; n&#46;&#176;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Clear cell RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;62&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Papillary RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Cromophobe RCC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">F&#252;rhman Grade</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pathological T stage</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;T1a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;78&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;T1b&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;T3a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Benign&#44; n&#46;&#176;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Oncocytoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Angiomyolipoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;13&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Simple cyst&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#46;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Inflammatory pseudotumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8211;Chronic pyelonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tumor size &#40;histopathology&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Positive surgical margin</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hospital stay&#44; days</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Follow-up period&#44; months</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Recurrence of disease&#44; n&#176; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Cancer-specific mortality&#44; n&#176; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mortality from other causes&#44; n&#176; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The values are expressed in average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD or number &#40;&#37;&#41;&#44; whenever applicable&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Of RCCs according to the TNM 2010 classification&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Median&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Oncological and postoperative results&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">SD&#44; standard deviation&#59; CKD&#44; chronic kidney disease&#59; EB&#44; estimated bleeding&#59; GFR&#44; glomerular filtration rate estimated at ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; WIT&#44; warm ischemia time&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Value<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EB&#44; ml<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150 &#40;87&#46;5&#8211;425&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical time&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">102&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">WIT&#44; min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Without ischemia&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;20&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative creatinine &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative GFR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#46;04<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative creatinine &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative GFR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Decrease of the GFR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Increase of CKD stage&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;3&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1035447.png"
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          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">The values are expressed in average<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">SD</span> or number &#40;percentage&#41;&#44; whenever applicable&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Median &#40;interquartile range&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">The differences between preoperative and postoperative GFR were not statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;74&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Perioperative results and renal function assessment&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Mt&#44; metastasis&#59; N&#47;A&#44; not applicable&#59; OPN&#44; open partial nephrectomy&#59; LPN&#44; laparoscopic partial nephrectomy&#59; RPN&#44; robotic partial nephrectomy&#44; CSS&#44; cancer-specific survival&#59; OS&#44; overall survival&#59; Recur&#44; recurrence&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Follow-up years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Size&#44; cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">n</span>&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survival at 3 years&#44; &#37;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Survival at 5 years&#44; &#37;</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Mt&#44; <span class="elsevierStyleItalic">n</span>&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Recur&#44; <span class="elsevierStyleItalic">n</span>&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fergany et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">OPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Moinzadeh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lane et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">LPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kaul et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Khalifeh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Current series&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RPN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&#47;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Oncological results in PN&#46;</p>"
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