Ener Kemal, Canda Abdullah Erdem, Altinova Serkan, Atmaca Ali Fuat, Alkan Erdal, Asil Erem, Ozcan Muhammet Fuat, Akbulut Ziya, Balbay Mevlana Derya
Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
Department of Urology, School of Medicine, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
Kaohsiung J Med Sci. 2016 Jan;32(1):16-21. doi: 10.1016/j.kjms.2015.09.008. Epub 2015 Oct 31.
The aim of this study was to evaluate outcomes of robotic partial nephrectomy (RAPN) procedures. At two centers, 42 patients underwent RAPN. Radius, Exo/Endophytic, Nearness, Anterior/Posterior, Location (R.E.N.A.L.) nephrometry and PADUA scores of patients were calculated by computed tomography (CT) or magnetic resonance imaging (MRI). Intra- and perioperative (0-30 days) complications were evaluated using modified Clavien classification. A four-arm da Vinci-S robotic surgical system was used and outcomes were evaluated retrospectively. Mean age of the patients was 52.3 ± 6.5 years. Mean tumor size was 3.1 ± 1.0 (1.4-6.6) cm. R.E.N.A.L. nephrometry and PADUA scores were 6.0 ± 1.5 and 7.5 ± 0.9, respectively. Mean surgical time was 127.7 ± 18.7 minutes and estimated blood loss was 100 ± 18.1 cc. Mean warm ischemia time was 16.0 ± 8.9 (0-30) minutes. Intraoperative complications did not develop in any patient. Median hospital stay was 3.0 (2-6) days. Except for 17 patients, hilar clamping was performed in 25 patients. Histopathology results included 34 renal cell carcinoma (22 clear cell, 7 chromophobe cell, 4 papillary cell, and 1 clear papillary cell). Oncocytoma (n = 4), adenoma (n = 1), fibroadipose tissue (n = 1), papillary epithelial hyperplasia (n = 1), and chronic pyelonephritis (n = 1) were present. Surgical margins were negative in all patients. During a median follow-up period of 15.5 ± 10.9 (3-46) months, neither local recurrence nor distant metastasis was detected. In conclusion, RAPN is a safe, minimally invasive surgical approach, with excellent surgical and oncological outcomes in T1 kidney tumors. Zero ischemia off-clamp RAPN is also safe in selected masses with the advantage of avoiding complete renal ischemia.
本研究的目的是评估机器人辅助部分肾切除术（RAPN）的手术效果。在两个中心，42例患者接受了RAPN手术。通过计算机断层扫描（CT）或磁共振成像（MRI）计算患者的半径、外生性/内生性、接近度、前后位、位置（R.E.N.A.L.）肾测量评分和帕多瓦评分。使用改良的Clavien分类法评估术中及围手术期（0 - 30天）并发症。使用四臂达芬奇 - S机器人手术系统，并对结果进行回顾性评估。患者的平均年龄为52.3±6.5岁。平均肿瘤大小为3.1±1.0（1.4 - 6.6）cm。R.E.N.A.L.肾测量评分和帕多瓦评分分别为6.0±1.5和7.5±0.9。平均手术时间为127.7±18.7分钟，估计失血量为100±18.1cc。平均热缺血时间为16.0±8.9（0 - 30）分钟。所有患者均未发生术中并发症。中位住院时间为3.0（2 - 6）天。除17例患者外，25例患者进行了肾门阻断。组织病理学结果包括34例肾细胞癌（22例透明细胞癌、7例嫌色细胞癌、4例乳头状细胞癌和1例透明乳头状细胞癌）。存在嗜酸细胞瘤（n = 4）、腺瘤（n = 1）、纤维脂肪组织（n = 1）、乳头状上皮增生（n = 1）和慢性肾盂肾炎（n = 1）。所有患者的手术切缘均为阴性。在中位随访期15.5±10.9（3 - 46）个月期间，未检测到局部复发或远处转移。总之，RAPN是一种安全的微创手术方法，对于T1期肾肿瘤具有优异的手术和肿瘤学效果。零缺血非阻断性RAPN对于选定的肿块也是安全的，具有避免完全肾缺血的优势。
