DeLong Jessica M, Shapiro Oleg, Moinzadeh Alireza
Institute of Urology, Lahey Clinic, Burlington, Massachusetts 01805, USA.
Can J Urol. 2010 Jun;17(3):5207-12.
INTRODUCTION/OBJECTIVE: Partial nephrectomy is an effective surgical treatment for small renal masses. We compare a single surgeon's experience with consecutive laparoscopic and robotic partial nephrectomy to assess potential perioperative outcomes. A review of the literature is provided.
A retrospective review was performed comparing 15 consecutive patients undergoing laparoscopic partial nephrectomy to the subsequent consecutive 13 patients undergoing robotic assisted partial nephrectomy for small renal tumors. All patients had normal contralateral kidney appearance on cross sectional imaging. A similar transperitoneal technique was employed for both cohorts. A 4-arm technique was used for the robotic cases using the da Vinci (Intuitive Surgical, Sunnyvale, USA) surgical system. Patient demographics, tumor characteristics, intraoperative, and postoperative data including tumor size, warm ischemia time, and estimated blood loss (EBL) were compared using Student t-test, Wilcoxon rank-sum, or Chi square test as appropriate.
All cases were completed laparoscopically or with robotic assistance without conversion to open surgery. Demographic data were not statistically different between the two groups. Warm ischemia time (WIT) was shorter in the robotic group: 29.7 minutes versus 39.9 minutes for the laparoscopic group (p < 0.0001). Operative time was longer in the robotic group: 253 versus 352 minutes (p < 0.0001). Mean hospital stay and postoperative complication rates were not statistically different. Two (13%) of patients in the laparoscopic group required conversion of partial nephrectomy to radical nephrectomy while none did in the robotic group. Final pathology revealed negative margins in all cases.
Robotic partial nephrectomy resulted in decreased WIT as compared to the conventional laparoscopic approach. Total operating time was increased in the robotic group.
引言/目的：肾部分切除术是治疗小肾肿块的有效手术方法。我们比较了一位外科医生连续进行腹腔镜和机器人辅助肾部分切除术的经验，以评估潜在的围手术期结果。并提供文献综述。
进行回顾性研究，比较连续15例行腹腔镜肾部分切除术的患者与随后连续13例行机器人辅助肾部分切除术治疗小肾肿瘤的患者。所有患者在横断面成像中对侧肾脏外观正常。两组均采用类似的经腹技术。机器人手术病例采用四臂技术，使用达芬奇（直观外科，美国桑尼维尔）手术系统。使用学生t检验、Wilcoxon秩和检验或卡方检验，适当比较患者的人口统计学、肿瘤特征、术中及术后数据，包括肿瘤大小、热缺血时间和估计失血量（EBL）。
所有病例均在腹腔镜或机器人辅助下完成，未转为开放手术。两组间人口统计学数据无统计学差异。机器人组的热缺血时间（WIT）较短：腹腔镜组为29.7分钟，机器人组为39.9分钟（p < 0.0001）。机器人组的手术时间较长：分别为253分钟和352分钟（p < 0.0001）。平均住院时间和术后并发症发生率无统计学差异。腹腔镜组有2例（13%）患者需要将肾部分切除术转为根治性肾切除术，而机器人组无此情况。最终病理显示所有病例切缘阴性。
与传统腹腔镜手术相比，机器人辅助肾部分切除术可缩短热缺血时间。机器人组的总手术时间增加。
