Department of Urology, Glickman Urological and Kidney Institute, Cleveland, OH 44195, USA.
J Endourol. 2012 Mar;26(3):230-4. doi: 10.1089/end.2011.0187. Epub 2012 Feb 21.
The desire to decrease morbidity from multiple port sites and progress toward a natural orifice approach has stimulated interest in laparoendoscopic single-site (LESS) surgery. Limitations, however, including clashing of instruments and loss of triangulation, have prevented widespread dissemination of LESS. To overcome these problems, the advantages of the robotic platform have been applied to single-site surgery. The objective of this article is to review our experience and summarize the current literature pertaining to robot-assisted LESS renal surgery.
Twenty-eight robot-assisted LESS kidney procedures were identified from our prospectively maintained LESS database. These included 11 radical nephrectomies, 5 partial nephrectomies, 3 nephroureterectomies, 7 pyeloplasties, 1 simple nephrectomy, and 1 renal cyst decortication. Perioperative and postoperative data were analyzed.
Of 28 cases, 4 conversions occurred. The remaining procedures were performed with no extraincisional trocars. Mean follow-up was 11.3 months for radical nephrectomy, 21.3 months for partial nephrectomy, 17.8 months for nephroureterectomy, 12.9 months for pyeloplasty, 4 months for simple nephrectomy, and 1.6 months for renal cyst decortication. Patients who underwent radical nephrectomy, partial nephrectomy, and nephroureterectomy all had negative surgical margins and have remained disease free during the follow-up period. Six of seven patients who underwent pyeloplasty reported complete resolution of symptoms while the seventh reports significant improvement.
We present a large experience with robot-assisted LESS kidney surgery demonstrating the wide variety of procedures that can be performed. Further follow-up of this patient population is needed to document continued oncologic efficacy and durability of results.
减少多端口发病率并向自然腔道方法发展的愿望激发了对腹腔镜单部位（LESS）手术的兴趣。然而，包括器械冲突和失去三角测量在内的局限性阻碍了 LESS 的广泛传播。为了克服这些问题，机器人平台的优势已应用于单部位手术。本文的目的是回顾我们的经验并总结有关机器人辅助 LESS 肾脏手术的当前文献。
从我们前瞻性维护的 LESS 数据库中确定了 28 例机器人辅助 LESS 肾脏手术。其中包括 11 例根治性肾切除术、5 例部分肾切除术、3 例肾输尿管切除术、7 例肾盂成形术、1 例单纯肾切除术和 1 例肾囊肿去皮质术。分析了围手术期和术后数据。
在 28 例病例中，有 4 例发生了转换。其余手术均无额外的切口套管进行。根治性肾切除术的平均随访时间为 11.3 个月，部分肾切除术为 21.3 个月，肾输尿管切除术为 17.8 个月，肾盂成形术为 12.9 个月，单纯肾切除术为 4 个月，肾囊肿去皮质术为 1.6 个月。接受根治性肾切除术、部分肾切除术和肾输尿管切除术的患者均获得了阴性手术切缘，并且在随访期间未出现疾病复发。7 例肾盂成形术患者中有 6 例报告症状完全缓解，而第 7 例报告症状显著改善。
我们提供了大量机器人辅助 LESS 肾脏手术的经验，展示了可以进行的各种手术。需要对该患者人群进行进一步随访，以记录持续的肿瘤学疗效和结果的耐久性。
