Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Eur Urol. 2012 Sep;62(3):553-61. doi: 10.1016/j.eururo.2012.05.021. Epub 2012 May 29.
Robotic technology is being increasingly adopted in urologic surgery.
To describe a contemporary surgical technique and report cumulative surgical outcomes of robot-assisted laparoscopic partial nephrectomy (RALPN) at our tertiary care institution.
DESIGN, SETTING, AND PARTICIPANTS: Medical charts of consecutive patients who underwent RALPN between June 2006 and November 2011 were reviewed from a prospectively maintained, institutional review board-approved database.
The main steps of our current surgical technique are described in this video tutorial: patient positioning and trocar placement; bowel mobilization; hilar dissection; tumor identification and demarcation; clamping of the hilum; tumor excision; renorraphy; hilar unclamping; and tumor retrieval.
Patients' characteristics and main surgical outcomes were analyzed.
A total of 400 patients (mean age: 58.5 yr, mean body mass index: 30.7 kg/m(2)) were included in this analysis. Mean renal tumor size was 3.17 cm (standard deviation [SD]: 1.64) and mean RENAL score was 7.2 (SD: 2). Six patients (1.5%) presented with a solitary kidney. Mean total operative time was 190.3 min (SD: 57), and mean warm ischemia time was 19.2 min (SD: 10.72). In 36 cases (9%), an unclamped hilum technique was used. After a mean follow-up of 12.4 mo (SD: 12.2), there was a decline of -9.2 ml/min per 1.73 m(2) (SD: 26.56) in estimated glomerular filtration rate. Most renal masses were malignant (74.5%), and the overall mean tumor size was 3.05 cm (SD: 1.66). Renal cell carcinoma with a clear cell histology represented the most frequent malignant diagnosis (64.4% of cases). A positive margin was observed in nine cases (2.25%). A total of 11 intraoperative complications (2.7%) occurred, and a conversion to open or laparoscopic PN was required in six cases (1.5%). A postoperative complication occurred in 61 cases (15.3%), the majority of them being low grade.
The standardization of each surgical step has allowed for optimization of RALPN and ultimately improved its outcomes and expanded its indications.
机器人技术在泌尿科手术中越来越多地被采用。
描述一种现代手术技术，并报告我们的三级护理机构中机器人辅助腹腔镜部分肾切除术（RALPN）的累积手术结果。
设计、设置和参与者：从一个前瞻性维护的机构审查委员会批准的数据库中回顾了 2006 年 6 月至 2011 年 11 月期间接受 RALPN 的连续患者的病历。
本视频教程介绍了我们当前手术技术的主要步骤：患者体位和套管放置；肠管移动；肾门解剖；肿瘤识别和划定；肾门夹闭；肿瘤切除；肾缝合；肾门松解；肿瘤取出。
本分析共纳入 400 例患者（平均年龄：58.5 岁，平均体重指数：30.7kg/m2）。平均肾肿瘤大小为 3.17cm（标准差[SD]：1.64），平均 RENAL 评分为 7.2（SD：2）。6 例患者（1.5%）为孤立肾。平均总手术时间为 190.3 分钟（SD：57），平均热缺血时间为 19.2 分钟（SD：10.72）。36 例（9%）采用未夹闭肾门技术。平均随访 12.4 个月（SD：12.2）后，估算肾小球滤过率下降-9.2ml/min/1.73m2（SD：26.56）。大多数肾肿瘤为恶性（74.5%），总体平均肿瘤大小为 3.05cm（SD：1.66）。透明细胞组织学的肾细胞癌占最常见的恶性诊断（64.4%的病例）。9 例（2.25%）发现切缘阳性。共发生 11 例术中并发症（2.7%），6 例（1.5%）需要转为开放或腹腔镜 PN。61 例（15.3%）发生术后并发症，大多数为低级别。
每个手术步骤的标准化都使 RALPN 得以优化，并最终改善了其结果并扩大了其适应证。
