Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave., Bronx, NY 10467, USA.
J Endourol. 2012 Oct;26(10):1372-9. doi: 10.1089/end.2012.0093. Epub 2012 Jul 31.
Incidental detection of small renal masses has significantly increased over the last two decades with the advent of cross-sectional imaging. The shift in stage has been met with a shift in treatment modality because the preservation of renal parenchyma can prevent adverse outcomes. Robot-assisted laparoscopic partial nephrectomy (RALPN) needs significant surgeon expertise, and preoperative planning is imperative.
Between December 2010 and September 2011, virtual surgical planning (VSP) was used in consecutive patients with renal tumors that were suspicious for renal-cell carcinoma who were undergoing RALPN by a single surgeon. Three-dimensional (3D) reconstructions were examined and manipulated preoperatively, and an operative plan formulated. Intraoperative anatomy and preoperative 3D reconstructions were compared in real time.
A total of 10 patients underwent RALPN with preoperative VSP. Average patient age at intervention was 54.6 years and average tumor size was 4.3 cm (range 1.7-7.5 cm). Tumor laterality was evenly distributed. Nephrometry score ranged from 5A to 10P, and final tumor pathology results revealed malignancy in 80%. No complications occurred intraoperatively, and an excellent correlation was noted between preoperative 3D reconstruction and intraoperative anatomy. All patients underwent a successful partial nephrectomy with no positive margins on final pathology results. Mean length of surgery was 232.9 minutes (range 156-435 min), and mean estimated blood loss was 370 mL (range 75-1800 mL). Warm ischemia time ranged from 20 to 50 minutes (mean 33.9 min). Data regarding postoperative renal function were available for six patients with an average loss of function of 9.5% (range 2%-17%).
The implementation of this novel technology has significantly improved our ability to plan RALPN preoperatively. Tumor depth and complexity of tumor resection are assessed and the appropriate operative intervention and approach planned. Tumor proximity to vascular structures and collecting system were reliably predicted and therefore anticipated. Overall, these advantages created a safer surgical endeavor.
随着横断面成像技术的出现，过去二十年中偶然发现的小肾肿瘤数量显著增加。由于保留肾实质可以预防不良后果，因此治疗方式也发生了转变。机器人辅助腹腔镜部分肾切除术（RALPN）需要外科医生具备丰富的专业知识，术前规划至关重要。
2010 年 12 月至 2011 年 9 月，由一位外科医生对怀疑患有肾细胞癌的连续患者的肾肿瘤进行了 RALPN，并使用了虚拟手术规划（VSP）。术前对三维（3D）重建进行了检查和操作，并制定了手术计划。术中解剖结构与术前 3D 重建进行了实时比较。
共 10 例患者接受了 RALPN 术前 VSP。介入时患者的平均年龄为 54.6 岁，肿瘤平均大小为 4.3cm（范围 1.7-7.5cm）。肿瘤侧别分布均匀。肾肿瘤评分（Nephrometry score）范围为 5A 至 10P，最终肿瘤病理结果显示恶性肿瘤占 80%。术中无并发症发生，术前 3D 重建与术中解剖结构具有极好的相关性。所有患者均成功进行了部分肾切除术，最终病理结果无肿瘤阳性切缘。手术平均时长为 232.9 分钟（范围 156-435 分钟），平均估计失血量为 370ml（范围 75-1800ml）。热缺血时间范围为 20-50 分钟（平均 33.9 分钟）。术后肾功能数据可用于 6 例患者，平均功能丧失 9.5%（范围 2%-17%）。
这项新技术的实施显著提高了我们术前规划 RALPN 的能力。评估了肿瘤深度和肿瘤切除的复杂性，并规划了适当的手术干预和方法。可靠地预测并预期了肿瘤与血管结构和集合系统的接近程度。总体而言，这些优势使手术更安全。
