Cordier J, Neisius A, Thomas C, Hampel C, Thüroff J W, Brenner W, Roos F C
Urologische Klinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg Universität Mainz.
Aktuelle Urol. 2015 Nov;46(6):461-6. doi: 10.1055/s-0041-106168. Epub 2015 Nov 24.
In contrast to conventional laparoscopic partial nephrectomy, the approach of robot-assisted partial nephrectomy (RAPN) shows a steep learning curve with shorter warm ischaemia times (WIT) and comparable postoperative outcomes. Therefore RAPN is considered a good minimally-invasive surgical procedure for patients presenting with a renal cell carcinoma in clinical stage cT1a. The aim of the presented study was to evaluate the perioperative outcomes of our patients after RAPN and to illustrate the learning curve based on characteristic perioperative parameters such as WIT.
The data of 109 patients treated by RAPN in our clinic between January 2010 and April 2015 were retrospectively analysed regarding perioperative, laboratory and oncological outcomes. Postoperative complications until 30 days after surgery were documented. We analysed the data of the largest patient population treated by a single urologist, comparing WIT, operating time, blood loss and decline of the glomerular filtration rate between the first and the second 30 consecutive cases.
Mean WIT was 18.4 min (SD±10.2), mean operating time was 199 min (SD±20), and mean estimated blood loss was 657 millilitres (SD±715 ml). Mean loss of GFR was reported to be 4.99 mg/dl/1.73 m (2) (SD±15.44). 83 (76%) malignant lesions were removed. 11 patients (10%) had a R1 resection, one patient had a R2 resection and in 2 cases the resection status was Rx. 22% of patients developed postoperative complications. Intraoperative complications were documented in 2 cases. According to the Clavien-Dindo Classification, 6% of patients had grade 1 and 2 complications and 13% developed grade 3 and 4 complications. WIT was significantly lower after 30 consecutive cases treated by one urologist. Regarding operating time, GFR or blood loss no significant correlation was found.
Our data is in line with the surgical outcomes described in the literature. RAPN is a safe surgical technique with a steep learning curve. In our experience, 30 surgical cases provide a urologist with sufficient expertise to achieve good perioperative results. Weaknesses of this report include the retrospective design and insufficient documentation in some cases.
与传统腹腔镜部分肾切除术相比，机器人辅助部分肾切除术（RAPN）的学习曲线较陡，热缺血时间（WIT）更短，术后结果相当。因此，RAPN被认为是临床分期为cT1a的肾细胞癌患者的一种良好的微创手术方法。本研究的目的是评估我们的患者在接受RAPN后的围手术期结果，并根据WIT等特征性围手术期参数来说明学习曲线。
回顾性分析2010年1月至2015年4月间在我们诊所接受RAPN治疗的109例患者的围手术期、实验室和肿瘤学结果。记录术后30天内的术后并发症。我们分析了由一位泌尿外科医生治疗的最大患者群体的数据，比较了连续30例患者中前30例和后30例的WIT、手术时间、失血量和肾小球滤过率的下降情况。
平均WIT为18.4分钟（标准差±10.2），平均手术时间为199分钟（标准差±20），平均估计失血量为657毫升（标准差±715毫升）。据报告，肾小球滤过率的平均下降为4.99毫克/分升/1.73平方米（2）（标准差±15.44）。切除了83个（76%）恶性病变。11例患者（10%）为R1切除，1例患者为R2切除，2例患者的切除状态为Rx。22%的患者出现术后并发症。2例记录了术中并发症。根据Clavien-Dindo分类，6%的患者有1级和2级并发症，13%的患者出现3级和4级并发症。在一位泌尿外科医生连续治疗30例患者后，WIT显著降低。关于手术时间、肾小球滤过率或失血量，未发现显著相关性。
我们的数据与文献中描述的手术结果一致。RAPN是一种安全且学习曲线较陡的手术技术。根据我们的经验，30例手术病例可为泌尿外科医生提供足够的专业知识，以取得良好的围手术期效果。本报告的不足之处包括回顾性设计以及某些病例记录不充分。
