Michli Eddie E, Parra Raul O
Department of Urology, Cooper University Hospital, Camden, New Jersey 08103, USA.
Urology. 2009 Feb;73(2):302-5. doi: 10.1016/j.urology.2008.09.056. Epub 2008 Nov 26.
To report on our initial experience with robotic-assisted partial nephrectomy. Laparoscopic partial nephrectomy requires experience and a lengthy learning curve to successfully accomplish tumor excision and renal reconstruction, which may adversely prolong the ischemia time. The advent of robotic-assisted laparoscopic surgery has proved successful in prostate cancer surgery, encouraging a growing number of centers to apply this technology to complex renal surgery.
A total of 20 consecutive patients underwent robotic-assisted partial nephrectomy from September 2007 to April 2008. The surgical technique we used followed the standard 4-port laparoscopic partial nephrectomy technique. Renal hilum clamping was used in 12 cases. The demographic data and perioperative outcomes were retrospectively reviewed.
The mean patient age and body mass index was 66 years and 29 kg/m(2), respectively. The mean tumor size was 2.7 cm. The mean operative and warm ischemia time was 142 and 28 minutes, respectively. The mean estimated blood loss was 263 mL, and 3 patients required a blood transfusion. One intraoperative complication required open conversion. Two postoperative complications were observed; 1 patient developed a pulmonary embolism and 1 developed an abscess at the resection site. The average hospital stay was 2.8 days. Pathologic examination of the lesions revealed 14 cases of renal cell carcinoma and 6 of benign lesions. All resection margins were free of tumor.
The results of our study have shown that robotic partial nephrectomy is safe and practical for patients with small renal tumors considered candidates for open partial nephrectomy. In our experience, the procedure can be performed with safe ischemia time and offers all the advantages of a minimally invasive procedure.
报告我们在机器人辅助下肾部分切除术方面的初步经验。腹腔镜肾部分切除术需要经验以及较长的学习曲线才能成功完成肿瘤切除和肾脏重建，这可能会不利地延长缺血时间。机器人辅助腹腔镜手术在前列腺癌手术中已被证明是成功的，促使越来越多的中心将该技术应用于复杂的肾脏手术。
2007年9月至2008年4月，共有20例连续患者接受了机器人辅助肾部分切除术。我们使用的手术技术遵循标准的四孔腹腔镜肾部分切除术技术。12例患者采用了肾蒂阻断。对人口统计学数据和围手术期结果进行了回顾性分析。
患者的平均年龄和体重指数分别为66岁和29kg/m²。肿瘤平均大小为2.7cm。平均手术时间和热缺血时间分别为142分钟和28分钟。平均估计失血量为263mL，3例患者需要输血。1例术中并发症需要转为开放手术。观察到2例术后并发症；1例患者发生肺栓塞，1例在切除部位发生脓肿。平均住院时间为2.8天。病变的病理检查显示14例肾细胞癌和6例良性病变。所有切除边缘均无肿瘤。
我们的研究结果表明，对于被认为适合开放性肾部分切除术的小肾肿瘤患者，机器人辅助肾部分切除术是安全可行的。根据我们的经验，该手术可以在安全的缺血时间内进行，并具有微创手术的所有优点。
