Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd, Nanjing, 210008, Jiangsu, People's Republic of China.
Int Urol Nephrol. 2021 Mar;53(3):455-463. doi: 10.1007/s11255-020-02664-y. Epub 2020 Oct 1.
Surgical removal of completely endophytic renal tumors has presented great technical difficulties for surgeons. In this study, we aim to introduce the role and use of intraoperative ultrasound (IOUS) performed in robotic-assisted renal partial nephrectomy (RAPN) for endophytic renal tumors.
We retrospectively assessed the demographics data and surgical outcomes of 58 consecutive endophytic renal tumor patients who were all attributed 3 points for the 'E' domain of the RENAL nephrometry score or 3 points for the exophytic rate of the PADUA score between October 2016 and September 2018. 38 patients who had undergone RAPN with IOUS were grouped. RAPN was carried out in another 20 patients without IOUS and these 20 patients were also grouped.
Patients in IOUS-guided group had significantly lower estimated blood loss (P < 0.001), shorter warm ischemia time (P = 0.010) and improved MIC (Margin, ischemia, and complications) rate (P = 0.026) and Pentafecta achievement (P = 0.016) compared to non IOUS-guided group. In multivariate logistic regression analysis, RAPN with IOUS was an independent predictor of MIC achievement (odds ratio 3.595; confidence interval 1.023-12.633; P = 0.046). Surface-intermediate-base (SIB) margin score was lower for IOUS-guided group vs non IOUS-guided group (P = 0.029).
RAPN for completely endophytic renal tumors is a feasible procedure in terms of complication rates, oncologic and functional outcomes. A robotic ultrasound probe operated by console surgeon generates a favorable perioperative outcomes and surgical margin rates after RAPN.
完全内生性肾肿瘤的外科切除对外科医生来说极具技术难度。本研究旨在介绍术中超声（IOUS）在机器人辅助肾部分切除术（RAPN）治疗内生性肾肿瘤中的作用和应用。
我们回顾性评估了 2016 年 10 月至 2018 年 9 月期间，所有“E”域 RENAL 肾肿瘤评分达到 3 分或 PADUA 外生率达到 3 分的 58 例连续内生性肾肿瘤患者的人口统计学数据和手术结果。其中 38 例患者接受了 IOUS 引导下的 RAPN，并将其分为 IOUS 引导组。另外 20 例患者未接受 IOUS 引导下的 RAPN，并将其分为非 IOUS 引导组。
与非 IOUS 引导组相比，IOUS 引导组患者的估计失血量明显较少（P<0.001），热缺血时间更短（P=0.010），MIC（切缘、缺血和并发症）率改善（P=0.026）和 Pentafecta 实现率更高（P=0.016）。多因素逻辑回归分析显示，RAPN 联合 IOUS 是 MIC 实现的独立预测因素（比值比 3.595；95%置信区间 1.023-12.633；P=0.046）。IOUS 引导组的表面-中间-基底（SIB）切缘评分低于非 IOUS 引导组（P=0.029）。
对于完全内生性肾肿瘤，RAPN 在并发症发生率、肿瘤学和功能结果方面是可行的。控制台外科医生操作的机器人超声探头在 RAPN 后产生了有利的围手术期结果和手术切缘率。
