Urol Oncol. 2013 Feb;31(2):275. doi: 10.1016/j.urolonc.2013.02.005.
Minimally invasive nephron sparing surgery is gaining popularity for small renal masses. Few groups have evaluated robot-assisted partial nephrectomy compared to other approaches using comparable patient populations. We present a matched pair analysis of a heterogeneous group of surgeons who performed robot-assisted partial nephrectomy and a single experienced laparoscopic surgeon who performed conventional laparoscopic partial nephrectomy. Perioperative outcomes and complications were compared.
All 249 conventional laparoscopic and robot-assisted partial nephrectomy cases from January 2007 to June 2010 were reviewed from our prospectively maintained institutional database. Groups were matched 1:1 (108 matched pairs) by R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines) nephrometry score, transperitoneal vs retroperitoneal approach, patient age and hilar nature of the tumor. Statistical analysis was done to compare operative outcomes and complications.
Matched analysis revealed that nephrometry score, age, gender, tumor side and American Society of Anesthesia physical status classification were similar. Operative time favored conventional laparoscopic partial nephrectomy. During the study period robot-assisted partial nephrectomy showed significant improvements in estimated blood loss and warm ischemia time compared to those of the experienced conventional laparoscopic group. Postoperative complication rates, and complication distributions by Clavien classification and type were similar for conventional laparoscopic and robot-assisted partial nephrectomy (41.7% and 35.0%, respectively).
Robot-assisted partial nephrectomy has a noticeable but rapid learning curve. After it is overcome the robotic procedure results in perioperative outcomes similar to those achieved with conventional laparoscopic partial nephrectomy done by an experienced surgeon. Robot-assisted partial nephrectomy likely improves surgeon and patient accessibility to minimally invasive nephron sparing surgery.
对于小的肾肿瘤，微创保肾手术越来越受欢迎。与使用可比患者人群的其他方法相比，少数小组已经评估了机器人辅助部分肾切除术。我们提出了一组异质外科医生进行机器人辅助部分肾切除术和一位经验丰富的腹腔镜外科医生进行常规腹腔镜部分肾切除术的匹配对分析。比较了围手术期结果和并发症。
从 2007 年 1 月至 2010 年 6 月，我们从我们的前瞻性维护机构数据库中回顾了所有 249 例常规腹腔镜和机器人辅助部分肾切除术病例。通过 R.E.N.A.L.（半径，外生/内生特性，肿瘤与收集系统或窦的接近程度，前/后，相对于极线的位置）肾切除术评分，经腹腔与后腹腔入路，患者年龄和肿瘤 hilar 性质，对两组进行了 1：1（108 对匹配）匹配。进行统计学分析以比较手术结果和并发症。
匹配分析显示，肾切除术评分，年龄，性别，肿瘤侧和美国麻醉医师协会身体状况分类相似。手术时间有利于常规腹腔镜部分肾切除术。在研究期间，与经验丰富的常规腹腔镜组相比，机器人辅助部分肾切除术的估计失血量和热缺血时间明显改善。术后并发症发生率以及 Clavien 分类和类型的并发症分布在常规腹腔镜和机器人辅助部分肾切除术中相似（分别为 41.7％和 35.0％）。
机器人辅助部分肾切除术有一个明显但迅速的学习曲线。克服后，机器人手术的围手术期结果与经验丰富的外科医生进行的常规腹腔镜部分肾切除术相似。机器人辅助部分肾切除术可能改善外科医生和患者对微创保肾手术的可及性。
