Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA.
Eur Urol. 2010 May;57(5):815-20. doi: 10.1016/j.eururo.2010.01.011. Epub 2010 Jan 22.
Robot-assisted partial nephrectomy (RAPN) is emerging as a viable approach for nephron-sparing surgery (NSS), though many reports to date have been limited by evaluation of a relatively small number of patients.
We present the largest multicenter RAPN experience to date, culling data from four high-volume centers, with focus upon functional and oncologic outcomes.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective chart review was performed for 183 patients who underwent RAPN at four centers between 2006 and 2008.
RAPN was performed using methods outlined in the supplemental video material. Though operative technique was similar across all institutions, there were minor variations in trocar placement and hilar control.
Perioperative parameters, including operative time, warm ischemic time, blood loss, and perioperative complications were recorded. In addition, we reviewed functional and oncologic outcomes.
Mean age at treatment was 59.3 yr. Mean tumor size was 2.87 cm. Mean total operative time was 210 min while mean ischemic time was 23.9 min. Calyceal repair was required in 52.1% of procedures. Mean estimated blood loss was 131.5 ml. Sixty-nine percent of excised tumors were malignant, of which 2.7% exhibited positive surgical margins. The incidence of major complications was 8.2%. At up to 26 mo follow-up, there have been no documented recurrences and no significant change in serum creatinine (1.03 vs 1.04 mg/dl, p=0.84) or estimated glomerular filtration rate (eGFR) from baseline (82.2 vs 79.4 mg/ml per square meter, p=0.74). The study is limited by its retrospective nature, and the outcomes are likely influenced by the robust prior laparoscopic renal experience of each of the surgeons included in this study.
RAPN is a safe and efficacious approach for NSS, offering short ischemic times, as well as perioperative morbidity equivalent to other standard approaches. Moreover, RAPN is capable of providing patients with excellent functional and oncologic outcomes.
机器人辅助部分肾切除术（RAPN）作为保肾手术（NSS）的一种可行方法正在兴起，尽管迄今为止的许多报告都受到评估的患者数量相对较少的限制。
我们报告了迄今为止最大的多中心 RAPN 经验，从四个高容量中心收集数据，重点关注功能和肿瘤学结果。
设计、地点和参与者：对 2006 年至 2008 年间在四个中心接受 RAPN 的 183 名患者进行了回顾性图表审查。
RAPN 使用补充视频材料中概述的方法进行。尽管所有机构的手术技术都相似，但在套管针放置和肾门控制方面存在细微差异。
记录围手术期参数，包括手术时间、热缺血时间、失血量和围手术期并发症。此外，我们还回顾了功能和肿瘤学结果。
治疗时的平均年龄为 59.3 岁。平均肿瘤大小为 2.87 厘米。总手术时间平均为 210 分钟，热缺血时间平均为 23.9 分钟。在 52.1%的手术中需要修复肾盏。平均估计失血量为 131.5 毫升。切除的肿瘤中 69%为恶性，其中 2.7%有阳性手术切缘。主要并发症的发生率为 8.2%。在长达 26 个月的随访中，没有记录到任何复发，血清肌酐（1.03 与 1.04mg/dl，p=0.84）或肾小球滤过率（eGFR）从基线（82.2 与 79.4mg/ml 每平方米，p=0.74）没有明显变化。该研究受到其回顾性性质的限制，并且结果可能受到每位参与研究的外科医生之前丰富的腹腔镜肾脏经验的影响。
RAPN 是一种安全有效的 NSS 方法，提供短的缺血时间，以及与其他标准方法相当的围手术期发病率。此外，RAPN 能够为患者提供出色的功能和肿瘤学结果。
