James Brady Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Urology. 2012 Aug;80(2):316-21. doi: 10.1016/j.urology.2012.03.043. Epub 2012 Jun 13.
To report our initial experience with robot-assisted laparoscopic partial nephrectomy compared with traditional laparoscopic partial nephrectomy.
A retrospective review of the Johns Hopkins minimally invasive urologic surgery database identified 207 consecutive patients who had undergone laparoscopic or robotic-assisted laparoscopic partial nephrectomy from 2007 to 2011 by a single surgeon. The patient demographics and pathologic, operative, and perioperative outcomes were compared between the surgical techniques. The early oncologic outcomes are reported for the entire cohort.
A total of 102 and 105 patients underwent laparoscopic partial nephrectomy and robotic-assisted laparoscopic partial nephrectomy, respectively. The demographic data were comparable between the 2 groups. The clinical and pathologic tumor characteristics were similar between the 2 groups, and a significant proportion (≥48%) of patients in each group had moderate to high complexity tumors. Patients undergoing robotic-assisted laparoscopic partial nephrectomy had decreased warm ischemia times, estimated blood loss, and operative times on univariate and multivariate analysis. No difference was seen in the total perioperative or significant urologic complications between the 2 groups. A review of the early oncologic outcomes revealed no local recurrences and 1 case of metastatic renal cell carcinoma.
Minimally invasive partial nephrectomy is associated with favorable perioperative outcomes and low morbidity. Robotic-assisted laparoscopic partial nephrectomy appears to be associated with favorable warm ischemia times compared with laparoscopic partial nephrectomy.
报告我们在机器人辅助腹腔镜肾部分切除术方面的初步经验，并与传统腹腔镜肾部分切除术进行比较。
回顾性分析了约翰霍普金斯微创泌尿外科手术数据库，共纳入了 207 例连续患者，这些患者均由同一位外科医生在 2007 年至 2011 年间接受了腹腔镜或机器人辅助腹腔镜肾部分切除术。比较了两种手术技术的患者人口统计学和病理、手术和围手术期结果。报告了整个队列的早期肿瘤学结果。
共有 102 例患者接受了腹腔镜肾部分切除术，105 例患者接受了机器人辅助腹腔镜肾部分切除术。两组患者的人口统计学数据相当。两组患者的临床和病理肿瘤特征相似，且两组患者中均有相当比例（≥48%）的患者肿瘤具有中高度复杂性。机器人辅助腹腔镜肾部分切除术组的热缺血时间、估计失血量和手术时间在单因素和多因素分析中均有所减少。两组患者的总围手术期或显著的泌尿系统并发症无差异。早期肿瘤学结果回顾显示，无局部复发，1 例转移性肾细胞癌。
微创肾部分切除术具有良好的围手术期结果和低发病率。与腹腔镜肾部分切除术相比，机器人辅助腹腔镜肾部分切除术似乎与良好的热缺血时间相关。
