Yüksel Özgür Haki, Ötünçtemur Alper, Özbek Emin, Uruç Fatih, Verit Ayhan
Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
Okmeydani Research & Training Hospital, Dept. of Urology, Istanbul, Turkey.
Int Braz J Urol. 2015 Jul-Aug;41(4):707-13. doi: 10.1590/S1677-5538.IBJU.2014.0134.
The place of oncological cases of upper urinary system in the laparoscopic learning curve was investigated.
A total of 139 patients from two different centers underwent laparoscopic operations and were included in this retrospective study.
Mean operative times for oncological, and non-oncological cases were 101.3 (range 60-450), and 102.7 (45-490) minutes respectively. Fourty-two (31.3 %) patients were oncological cases. In 4 oncological cases, the surgeons switched to open surgery because of massive bleeding and six (14.2 %) oncological cases required blood transfusions during peri/postoperative periods. Pulmonary embolism was observed in one oncological case. In one non-oncological case, the surgeon switched to open surgery because of intestinal perforation and 10 (9.7 %) non-oncological cases needed blood transfusions during peri/postoperative periods. In addition, some complications such as intestinal perforation (n=1), mechanical ileus (n=1), and pulmonary embolism (n=1) were observed during postoperative period. Intestinal perforation was repaired using laparoscopic (n=1) method. Mechanical ileus was approached with open surgical technique. Mean hospital stay of the patients in the oncological and non-oncological series were 4.5 (3-23) and 4.5 (3-30) days respectively.
We think that renal oncological cases should be included in the spectrum of laparoscopic indications even at the beginning of the learning curve. Certainly, we still share the opinion that cancer cases which require highly challenging surgeries like radical cystectomy, and prostatectomy should be postponed till to gaining of higher level of experience.
研究上尿路肿瘤病例在腹腔镜学习曲线中的位置。
来自两个不同中心的139例患者接受了腹腔镜手术，并纳入本回顾性研究。
肿瘤病例和非肿瘤病例的平均手术时间分别为101.3分钟（范围60 - 450分钟）和102.7分钟（45 - 490分钟）。42例（31.3%）患者为肿瘤病例。4例肿瘤病例因大出血转为开放手术，6例（14.2%）肿瘤病例在围手术期/术后需要输血。1例肿瘤病例发生肺栓塞。1例非肿瘤病例因肠穿孔转为开放手术，10例（9.7%）非肿瘤病例在围手术期/术后需要输血。此外，术后观察到一些并发症，如肠穿孔（n = 1）、机械性肠梗阻（n = 1）和肺栓塞（n = 1）。肠穿孔采用腹腔镜方法修复（n = 1）。机械性肠梗阻采用开放手术技术处理。肿瘤系列和非肿瘤系列患者的平均住院时间分别为4.5天（3 - 23天）和4.5天（3 - 30天）。
我们认为即使在学习曲线开始阶段，肾脏肿瘤病例也应纳入腹腔镜适应证范围内。当然，我们仍然认同像根治性膀胱切除术和前列腺切除术等需要高难度手术的癌症病例应推迟到获得更高水平经验之后再进行。
