Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Investig Clin Urol. 2019 Mar;60(2):99-107. doi: 10.4111/icu.2019.60.2.99. Epub 2019 Feb 15.
In this study, we described our initial experience and analyze the learning curve of segmental renal artery branch clamping with hand-assisted laparoscopic partial nephrectomy (PN) using special instruments.
We conducted a retrospective review of consecutive cases of hand-assisted laparoscopic PN (LPN) between May 2015 and April 2018. Patient demographics, tumor characteristics, perioperative details, postoperative complications, and warm ischemic time for segmental artery branch clamping were included in our analysis. We used the cumulative sum (CUSUM) method to generate learning curves.
Segmental renal artery branch clamping was successfully completed in 16 of 20 patients. The median tumor size was 2.9 cm (range, 1.7-7.0 cm), median operation time was 185 minutes (range, 140-245 minutes), median blood loss was 291 mL (range, 100-600 mL), and median hospital stay was 5 days (range, 4-7 days). The median selective ischemic time was 21 minutes (range, 16-35 minutes). No patient had postoperative complications, acute or delayed bleeding. The median pre- and postoperative serum creatinine levels (0.91 and 0.98 mg/dL, respectively), and the pre- and postoperative estimated glomerular filtration rate (89.7 and 79.6 mL/min per 1.73 m, respectively) were similar. Upon visual assessment of the CUSUM plots, a downward inflection point for decreasing total operation time was observed in the 9th case and estimated blood loss in the 12th case.
Our study shows that segmental renal artery branch clamping hand-assisted LPN for localized renal tumors is feasible, safe, and has a relatively short learning curve.
本研究描述了我们使用特殊器械进行手助腹腔镜部分肾切除术（LPN）时，对节段性肾动脉分支夹闭的初步经验，并分析了学习曲线。
我们对 2015 年 5 月至 2018 年 4 月期间连续进行的手助腹腔镜部分肾切除术（LPN）患者的病例进行回顾性分析。纳入患者的人口统计学、肿瘤特征、围手术期细节、术后并发症以及节段性动脉分支夹闭的热缺血时间等数据。我们使用累积和（CUSUM）方法生成学习曲线。
20 例患者中，16 例成功完成节段性肾动脉分支夹闭。肿瘤大小中位数为 2.9cm（范围，1.7-7.0cm），手术时间中位数为 185 分钟（范围，140-245 分钟），术中出血量中位数为 291ml（范围，100-600ml），住院时间中位数为 5 天（范围，4-7 天）。选择性缺血时间中位数为 21 分钟（范围，16-35 分钟）。无患者出现术后并发症，包括急性或迟发性出血。术前和术后血清肌酐水平中位数分别为 0.91mg/dL 和 0.98mg/dL，术前和术后估算肾小球滤过率中位数分别为 89.7ml/min/1.73m2 和 79.6ml/min/1.73m2，差异无统计学意义。根据 CUSUM 图的直观评估，第 9 例患者的总手术时间和第 12 例患者的估计出血量呈下降趋势。
本研究表明，对于局限性肾肿瘤，节段性肾动脉分支夹闭的手助腹腔镜部分肾切除术是可行、安全的，并且学习曲线相对较短。
