Di Cosmo Giacomo, Verzotti Enrica, Silvestri Tommaso, Lissiani Andrea, Knez Roberto, Pavan Nicola, Rizzo Michele, Trombetta Carlo, Liguori Giovanni
Università degli Studi Trieste, Urology Department - Cattinara Hospital, Trieste.
Arch Ital Urol Androl. 2018 Sep 30;90(3):195-198. doi: 10.4081/aiua.2018.3.195.
Nephron-sparing surgery (NSS) is of one of the most studied fields in urology due to the balancing between renal function preservation and oncological safety of the procedure. Aim of this short review is to report the state of the art of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during robotassisted partial nephrectomy (RAPN).
We performed a literature review by electronic database on Pubmed about the use of intra-operative US in RAPN to evaluate the usefulness and the feasibility of this procedure.
Several studies analyzed the use of different US probes during RAPN. Among them some focused on using contrastenhanced ultra sonography (CEUS) for improving the dynamic evaluation of microvascular structure allowing the reduction of ischemia time (IT). We reported that nowaday the use of intraoperative US during RAPN could be helpful to improve the preservation of renal tissue without compromising oncological safety. Moreover, during RAPN there is no need for assistant to hand the US probe increasing surgeon autonomy.
The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure. Moreover US could be useful to reduce ischemia time (IT). The advantages of nephron-sparing surgery over radical nephrectomy is well established with a pool of data providing strong evidence of oncological and survival equivalency. With the progressive growth of robot-assisted partial nephrectomy (RAPN) techniques, the use of several tools has been progressively developed to help the surgeon in the identification of masses and its vascular net. In this short review we tried to analyze the current use of intra-operative ultrasound as an operative tool to improve localization of small renal masses partially or completely endophytic during RAPN.
由于在保留肾功能与手术肿瘤学安全性之间取得平衡，保留肾单位手术（NSS）是泌尿外科领域研究最多的领域之一。本简短综述的目的是报告术中超声作为一种手术工具的最新进展，该工具可在机器人辅助部分肾切除术（RAPN）期间改善对部分或完全内生性小肾肿块的定位。
我们通过电子数据库在PubMed上进行了文献综述，以评估术中超声在RAPN中的应用，以评估该方法的实用性和可行性。
多项研究分析了RAPN期间不同超声探头的使用情况。其中一些研究聚焦于使用对比增强超声（CEUS）来改善微血管结构的动态评估，从而减少缺血时间（IT）。我们报告称，如今在RAPN期间使用术中超声有助于在不影响肿瘤学安全性的情况下更好地保留肾组织。此外，在RAPN过程中无需助手手持超声探头，从而增加了术者的自主性。
在部分肾切除术中使用机器人超声探头可使术者在最大程度自主的情况下优化肿瘤识别，并在部分肾切除术这一关键步骤中受益于机器人器械的精准性和灵活性。此外，超声有助于减少缺血时间（IT）。保留肾单位手术相对于根治性肾切除术的优势已得到充分证实，大量数据有力地证明了其在肿瘤学和生存率方面的等效性。随着机器人辅助部分肾切除术（RAPN）技术的不断发展，越来越多的工具被开发出来，以帮助术者识别肿块及其血管网络。在本简短综述中，我们试图分析术中超声作为一种手术工具在RAPN期间改善对部分或完全内生性小肾肿块定位的当前应用情况。
