Department of Urology, Shanxi Provincial People's Hospital, 29 Shuangtasi Street, Taiyuan, 030012, China.
Lasers Surg Med. 2020 Jun;52(5):402-407. doi: 10.1002/lsm.23153. Epub 2019 Sep 3.
Laparoscopic partial nephrectomy (LPN) has gained acceptance as a minimally invasive treatment option for small renal masses (SRMs). Laser-assisted LPN (LLPN) provided a bloodless tumor excision without renal artery clamping owing to the excellent coagulative and hemostatic properties of the lasers. The primary aim of this study is to evaluate the technical feasibility and outcomes of 2-μm continuous thulium LLPN and conventional LPN (CLPN) in the treatment of patients with SRMs.
STUDY DESIGN/MATERIALS AND METHODS: A retrospective analysis was performed for the medical charts of 312 patients with SRMs who underwent minimally invasive nephron-sparing surgery in our institution between January 2013 and December 2017. All 36 LLPN patients were matched with 36 CLPN patients. Surgical data, complications, pathological variables, oncological, functional, and health-related quality of life (HRQoL) outcomes were reviewed.
The two groups were similar in demographic characteristics. The renal vessels were not clamped in the LLPN group. Compared with the CLPN group, patients in the LLPN group had shorter warm ischemia time (WIT) (0 vs. 12.4 minutes, P = 0.000), longer tumor resection time (9.5 vs. 2.2 minutes; P = 0.000), and decreased operative time (84.1 vs. 95.5 minutes, p = 0.029). There were no open conversions and no transfusion in both groups. Median follow-ups for LLPN and CLPN were 56.2 and 48.6 months, respectively. The complication rate, renal functional outcomes, local recurrence rates, recurrence-free survival rates, and SF-36 questionnaire score were similar between the two groups.
Although this matched pair study showed CLPN had a longer WIT and higher operative time, the oncological and functional outcomes of LLPN and CLPN were similar. Both LLPN and CLPN are viable treatment options for select patients with SRMs. Lasers Surg Med. © 2019 Wiley Periodicals, Inc.
腹腔镜部分肾切除术（LPN）已作为治疗小肾肿瘤（SRM）的微创治疗选择而被广泛接受。激光辅助 LPN（LLPN）由于激光具有出色的凝固和止血特性，因此无需进行肾动脉阻断即可实现无血肿瘤切除。本研究的主要目的是评估 2μm 连续铥激光辅助 LPN（LLPN）与传统 LPN（CLPN）治疗 SRM 患者的技术可行性和结果。
研究设计/材料和方法：回顾性分析了 2013 年 1 月至 2017 年 12 月在我院接受微创保肾手术治疗的 312 例 SRM 患者的病历资料。所有 36 例 LLPN 患者均与 36 例 CLPN 患者相匹配。回顾了手术数据、并发症、病理变量、肿瘤学、功能和健康相关生活质量（HRQoL）结果。
两组患者的人口统计学特征相似。LLPN 组未夹闭肾血管。与 CLPN 组相比，LLPN 组患者的热缺血时间（WIT）更短（0 与 12.4 分钟，P=0.000），肿瘤切除时间更长（9.5 与 2.2 分钟；P=0.000），手术时间更短（84.1 与 95.5 分钟，p=0.029）。两组均无开放转换和输血。LLPN 和 CLPN 的中位随访时间分别为 56.2 和 48.6 个月。两组的并发症发生率、肾功能结果、局部复发率、无复发生存率和 SF-36 问卷评分相似。
尽管这项匹配对研究表明 CLPN 的 WIT 更长，手术时间更长，但 LLPN 和 CLPN 的肿瘤学和功能结果相似。LLPN 和 CLPN 都是治疗 SRM 患者的可行选择。激光外科学杂志。© 2019 威利父子公司
