Division of Urology, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Hong Kong Med J. 2011 Feb;17(1):33-8.
To evaluate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy and standard laparoscopic partial nephrectomy in a teaching hospital.
Retrospective study.
Division of Urology, Department of Surgery, Queen Mary and Tung Wah hospitals, Hong Kong.
The first 10 consecutive patients who had robot-assisted laparoscopic partial nephrectomy for renal tumours between January 2008 and September 2009 with prospective data collection were evaluated. Their outcomes were compared with the last 10 consecutive patients in our database, who had standard laparoscopic partial nephrectomy between November 2004 and October 2007.
Demographics, tumour characteristics, perioperative outcomes, renal function, and pathological outcomes.
There were no differences between the groups with regard to age (63 vs 56 years; P=0.313) and tumour size (2.7 vs 2.8 cm; P=0.895). No significant difference was found between the two groups with respect to the operating room time (376 vs 361 min; P=0.722), estimated blood loss (329 vs 328 mL; P=0.994), and length of hospital stay (7 vs 14 days; P=0.213). A statistically significant shorter mean warm ischaemic time for the robot-assisted group was noted (31 vs 40 minutes; P=0.032). Respective renal functional outcomes as shown by the difference between day 0 and day 60 serum creatinine levels were comparable (+10 vs +7 mmol/L; P=0.605). In both groups, there were no intra-operative complications or instances of surgical margin tumour involvement. Three patients endured postoperative complications in the standard laparoscopic group (a perinephric haematoma, urine leakage, and lymph leakage) compared with one in the robot-assisted group (a perinephric haematoma). These complications all resolved with conservative treatment.
Robot-assisted laparoscopic partial nephrectomy is a technically feasible alternative to standard laparoscopic partial nephrectomy, and provides comparable results. Robot-assisted laparoscopic partial nephrectomy appears to offer the advantage of decreased warm ischaemic time. Longer follow-up is required to assess renal function and oncological outcomes. Further experience and randomised trials are necessary to compare robot-assisted with standard laparoscopic partial nephrectomy.
评估教学医院机器人辅助腹腔镜肾部分切除术和标准腹腔镜肾部分切除术的围手术期结果。
回顾性研究。
香港玛丽医院和东华医院泌尿外科。
2008 年 1 月至 2009 年 9 月，前瞻性收集了 10 例连续接受机器人辅助腹腔镜肾部分切除术治疗肾肿瘤的患者的数据。将他们的结果与我们数据库中最后 10 例连续接受标准腹腔镜肾部分切除术的患者进行比较，这些患者于 2004 年 11 月至 2007 年 10 月接受治疗。
人口统计学、肿瘤特征、围手术期结果、肾功能和病理结果。
两组患者的年龄（63 岁比 56 岁；P=0.313）和肿瘤大小（2.7cm 比 2.8cm；P=0.895）无差异。两组患者的手术室时间（376 分钟比 361 分钟；P=0.722）、估计失血量（329 毫升比 328 毫升；P=0.994）和住院时间（7 天比 14 天；P=0.213）无显著差异。机器人辅助组的平均热缺血时间明显缩短（31 分钟比 40 分钟；P=0.032）。两组术后第 60 天血清肌酐水平的差异（+10 毫摩尔/升比+7 毫摩尔/升；P=0.605）表明肾功能结果相当。两组均无术中并发症或手术切缘肿瘤累及。标准腹腔镜组有 3 例（肾周血肿、尿漏和淋巴漏）术后并发症，机器人辅助组有 1 例（肾周血肿）。这些并发症均经保守治疗治愈。
机器人辅助腹腔镜肾部分切除术是标准腹腔镜肾部分切除术的一种可行的替代方法，可获得相当的结果。机器人辅助腹腔镜肾部分切除术似乎具有缩短热缺血时间的优势。需要更长时间的随访来评估肾功能和肿瘤学结果。进一步的经验和随机试验是必要的，以比较机器人辅助与标准腹腔镜肾部分切除术。
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