Department of Urology, E.O. Ospedali Galliera, Genoa, Italy.
Department of Anesthesiology, E.O. Ospedali Galliera, Genoa, Italy.
Minerva Urol Nefrol. 2020 Dec;72(6):723-728. doi: 10.23736/S0393-2249.20.04005-9. Epub 2020 Aug 4.
Renal cell carcinoma still represents 2-3% of all tumors but its mortality is decreased in the last decades due to the early detection of small masses and to the innovative surgical techniques. The aim of our study was to evaluate safety and feasibility of clampless and sutureless laparoscopic partial nephrectomy (CSLPN) in terms of intra- and postoperative functional results, complication rate and oncological outcome.
We evaluated patients undergoing CSLPN between July 2013 and December 2019. Inclusion criteria were single, organ confined tumor with size ≤4 cm, intraparenchymal depth ≤1.5 cm, renal nephrometry score between 4 and 6 and no close contact with the collecting system.
Overall, 62 patients underwent CSLPN. Mean operative time was 105 minutes, mean intraoperative blood loss was 165 mL. Mean drain time and hospital stay were respectively 2.5 and 4.2 days. Mean 24 hours hemoglobin (Hb) decrease was 2.5 g/dL. No significative variations are described in pre- and postoperative renal function. Twelve patients had postoperative complications. At a median follow-up of 38.5 months all the patients are alive and disease free.
Different techniques have been proposed to reduce warm ischemia time (WIT). In our experience we found many benefits in an off-clamp procedure: it gives an ischemia-related advantage, reduces the overall operating time, eliminates the risks associated with the isolation of hilar vessels. In conclusion CSLPN is a safe and effective procedure for selected renal masses; it does not increase complication rate and offers excellent functional and oncological outcomes.
尽管肾细胞癌仍占所有肿瘤的 2-3%，但其死亡率在过去几十年中有所下降，这要归功于对小肿块的早期发现和创新的手术技术。我们研究的目的是评估无夹闭和无缝合腹腔镜部分肾切除术（CSLPN）在围手术期功能结果、并发症发生率和肿瘤学结果方面的安全性和可行性。
我们评估了 2013 年 7 月至 2019 年 12 月期间接受 CSLPN 的患者。纳入标准为单发性、器官局限性肿瘤，最大直径≤4cm，肿瘤位于肾实质内深度≤1.5cm，肾肿瘤评分在 4-6 分之间，且与收集系统无密切接触。
共有 62 例患者接受了 CSLPN。平均手术时间为 105 分钟，术中平均出血量为 165ml。平均引流时间和住院时间分别为 2.5 天和 4.2 天。平均 24 小时血红蛋白（Hb）下降 2.5g/dL。术前和术后肾功能无明显变化。12 例患者术后出现并发症。在中位随访 38.5 个月时，所有患者均存活且无疾病。
已经提出了许多不同的技术来减少热缺血时间（WIT）。在我们的经验中，我们发现无夹闭术有许多好处：它提供了与缺血相关的优势，缩短了总手术时间，消除了与隔离肾门血管相关的风险。总之，CSLPN 是一种安全有效的治疗选择，适用于选定的肾肿瘤；它不会增加并发症发生率，并提供出色的功能和肿瘤学结果。
