Basatac Cem, Akpinar Haluk
Department's name: Istanbul Bilim University, Department of Urology, Istanbul, Turkey.
Urol J. 2019 Oct 21;16(5):469-474. doi: 10.22037/uj.v0i0.4713.
The aim of our study is to evaluate the feasibility and effectiveness of robotic partial nephrectomy per-formed with segmental clamping of tumor-feeding arteries.
Thirty-six patients with renal tumor who underwent robotic partial nephrectomy with segmental renal artery clamping were included in this study. Prospectively recorded patient demographics, mean operation time, estimated blood loss, warm ischemia time, length of hospital stay, pre- and postoperative renal functions and oncological outcomes were analyzed retrospectively. All complications were graded based on the modified Clavien-Dindo classification system. Surgical success was defined as no conversion from segmental artery clamping to the main renal artery clamping.
Mean tumor size was 40 mm and, R.E.N.A.L nephrometry score was 6.74. Mean operation time, esti-mated blood loss and warm ischemia time were 162 min, 236 ml, and 16 min, respectively. Five postoperative complications were observed. There were no significant differences in terms of renal functional outcomes before and after surgery (P = .18). Of 36 patients, 34 were completed successfully; however, main renal artery clamping was required in two patients due to excessive bleeding from the tumor bed. The success rate of the segmental renal artery clamping technique was determined as % 94.4 (34/36) in our study.
Segmental renal artery clamping may be considered as a reliable and effective surgical method for vascular control during robotic partial nephrectomy. For this technique, tumor characteristics and intrarenal vascu-lar anatomy should be precisely evaluated by the preoperative contrast-enhanced computerized tomography with 3-D reconstruction.
本研究旨在评估采用肿瘤供血动脉节段性夹闭进行机器人辅助部分肾切除术的可行性和有效性。
本研究纳入了36例行机器人辅助部分肾切除术并采用肾动脉节段性夹闭的肾肿瘤患者。回顾性分析前瞻性记录的患者人口统计学资料、平均手术时间、估计失血量、热缺血时间、住院时间、术前和术后肾功能以及肿瘤学结局。所有并发症均根据改良的Clavien-Dindo分类系统进行分级。手术成功定义为未从节段性动脉夹闭转为肾主动脉夹闭。
平均肿瘤大小为40mm，R.E.N.A.L肾计量评分6.74。平均手术时间、估计失血量和热缺血时间分别为162分钟、236毫升和16分钟。观察到5例术后并发症。手术前后肾功能结局无显著差异（P = 0.18）。36例患者中，34例手术成功完成；然而，2例患者因肿瘤床出血过多需要进行肾主动脉夹闭。在我们的研究中，肾动脉节段性夹闭技术的成功率确定为94.4%（34/36）。
肾动脉节段性夹闭可被视为机器人辅助部分肾切除术期间血管控制的一种可靠且有效的手术方法。对于该技术，术前应通过三维重建的对比增强计算机断层扫描精确评估肿瘤特征和肾内血管解剖结构。
