Schulster Michael L, Sidhom Daniel A, Sturgeon Kathryn, Borin James F, Bjurlin Marc A
Department of Urology, NYU Langone Health, 550 First Ave, New York, NY, 10016, USA.
Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, 101 Manning Drive 2nd Floor, Chapel Hill, NC, 27514, USA.
J Robot Surg. 2020 Jun;14(3):401-407. doi: 10.1007/s11701-019-01004-2. Epub 2019 Jul 17.
Standard of care for large or complex renal stones is percutaneous nephrolithotomy. Robotic pyelolithotomy, however, may be a feasible alternative, but limited data exist on its outcomes and complications. Our study objective was to describe the outcomes and peri-operative complications of robotic pyelolithotomy for complex renal calculi. We performed a retrospective analysis of robotic pyelolithotomy at our tertiary academic institution from 2015 to 2018. Demographics, stone clearance rates, complications, estimated blood loss, operative time, and length of stay were reported. 15 patients were included with a median age of 59 years (SD 15.3, 27-80) and BMI 25 kg/m (SD 4.6, 20.9-35.7). Median follow-up was 4 months. Median stone size was 3 cm (SD 1.2 cm, 2-5 cm). Concomitant pyeloplasty was performed in 2 patients, complete stone clearance in 11 (73%) cases and 4 out of 5 (80%) with a solitary stone. Median operative time was 191.5 min (SD 64.8 min, 110-303 min), with no open conversion. Median EBL was 70 ml (SD 65 ml, 20-250 ml) and median length of stay was 1 day (SD 1 day, 1-5 days). Median change in creatinine and eGFR were - 0.02 mg/dl and + 3 ml/min/1.73 m. There were no cases of sepsis or post-operative fever and only one case of transfusion. Robotic pyelolithotomy appears safe and effective. Ultimately, less bleeding, lower septicemia, renal parenchymal preservation, and favorable stone-free rates in a single procedure make this as an attractive option in the management of select patients with large renal stone disease.
对于大的或复杂的肾结石，标准治疗方法是经皮肾镜取石术。然而，机器人肾盂切开取石术可能是一种可行的替代方法，但关于其疗效和并发症的数据有限。我们的研究目的是描述机器人肾盂切开取石术治疗复杂肾结石的疗效和围手术期并发症。我们对2015年至2018年在我们的三级学术机构进行的机器人肾盂切开取石术进行了回顾性分析。报告了人口统计学、结石清除率、并发症、估计失血量、手术时间和住院时间。纳入了15例患者，中位年龄为59岁（标准差15.3，27 - 80岁），体重指数为25kg/m（标准差4.6，20.9 - 35.7）。中位随访时间为4个月。中位结石大小为3cm（标准差1.2cm，2 - 5cm）。2例患者同时进行了肾盂成形术，11例（73%）患者结石完全清除，5例单发结石患者中有4例（80%）结石完全清除。中位手术时间为191.5分钟（标准差64.8分钟，110 - 303分钟），无开放手术转换。中位估计失血量为70ml（标准差65ml，20 - 250ml），中位住院时间为1天（标准差1天，1 - 5天）。肌酐和估算肾小球滤过率的中位变化分别为 - 0.02mg/dl和 + 3ml/min/1.73m²。没有脓毒症或术后发热病例，仅有1例输血病例。机器人肾盂切开取石术似乎是安全有效的。最终，单次手术中出血少、败血症发生率低、肾实质得以保留且结石清除率良好，使其成为治疗部分大型肾结石疾病患者的有吸引力的选择。
