Study Findings Confirm New F.A.S.T Procedure Achieves Same Results as Standard Robotic Partial Kidney Surgery in Much Less Time — Even with Complex Tumors.
Aug 30, 2012
An innovative procedure to streamline a robotic partial nephrectomy, the surgical removal of a kidney tumor, significantly reduces the critical time the kidney is without blood flow, otherwise known as warm ischemia time (W.I.T), by nearly 25 percent, according to an analysis led by researchers at NewYork-Presbyterian Hospital/Columbia University Medical Center.
The study, published in the Journal of Endourology in June, confirms that the procedure, known as first assistant sparing technique (F.A.S.T), achieves the same results as standard robotic partial nephrectomy surgery in much less time, regardless of tumor size, location, or complexity. The F.A.S.T incorporates steps typically performed by surgical assistants into the robotic process.
F.A.S.T Opens Door to Minimally Invasive Surgery for Complex Renal Tumors
"By incorporating F.A.S.T into our robotic approach, for the first time we were able to cut W.I.T down to an average of 15 minutes — and 18 minutes for more complicated tumors," said the lead author and investigator, Dr. Ketan K. Badani, chief of robotic and minimally invasive surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center and associate professor of urology at Columbia University College of Physicians and Surgeons. "As a result, we're able to offer a minimally invasive partial nephrectomy to almost anyone with a renal tumor, regardless of its size or complexity."
The study results were confirmed by comparing F.A.S.T with standard robotic techniques in a retrospective six-month review of 44 patients who underwent robotic partial nephrectomy. F.A.S.T was as efficient as the standard robotic approach at completely excising a tumor with no positive surgical margins, a measure of oncological efficacy, despite tumor size or location, or other complicating factors.
Kidney Surgery: A Race Against Time to Restore Blood Flow
A partial nephrectomy entails removing the tumor while preserving the kidney. During the procedure, blood flow must be temporarily cut off from the kidney. "As a rule of thumb," said Dr. Badani, "the maximum time blood flow can be cut off from the kidney is 30 minutes, to avoid irreversible damage. But studies suggest that every minute blood flow to the kidney is blocked can have a cumulative effect on kidney function." With F.A.S.T, a series of steps typically performed by surgical assistants — ultrasound, clamping to cut off and restore blood flow to the kidney, passing of needles, and stitches — can be incorporated into the robotic process, shaving off critical WIT minutes.
The F.A.S.T approach evolved over the course of about two years, as Dr. Badani and his colleagues continually looked for new timesaving steps. "I work in an environment where we're constantly trying to improve upon what we're doing," he said. "Two years from now, we hope to have an even better technique."
The team of urologic surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center performing partial nephrectomies for renal tumors includes Ketan Badani, M.D., director of robotic surgery, Mitchell C. Benson, M.D., chair of the department of Urology, James McKiernan, M.D., director of urologic oncology and G. Joel de Castro, M.D., director of urologic oncology NewYork-Presbyterian/The Allen Hospital.
Co-authors are William T. Berg, Chad R. Rich, Gina M. Badalato, Christopher M. Deibert, Chris O. Wambi, and Mitchell C. Benson of NewYork-Presbyterian Hospital/Columbia University Medical Center, and Jaime Landman of the University of California Irvine. For more information, patients may call 866-NYP-NEWS.
NewYork-Presbyterian Hospital/Columbia University Medical Center
NewYork-Presbyterian Hospital/Columbia University Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Columbia University College of Physicians and Surgeons. NewYork-Presbyterian/Columbia provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian Hospital also comprises NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian Hospital/Westchester Division and NewYork-Presbyterian/The Allen Hospital. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians & Surgeons was the first institution in the country to grant the M.D. degree. Among the most selective medical schools in the country, the school is home to the largest medical research enterprise in New York State and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu