Department of Urology, School of Medicine, Koç University, 34010, İstanbul, Turkey.
Department of Urology, VKF American Hospital, 34365, Istanbul, Turkey.
J Robot Surg. 2021 Oct;15(5):671-677. doi: 10.1007/s11701-020-01158-4. Epub 2020 Oct 13.
One of the most important steps of the partial nephrectomy (PN) is hemostatic control of tumor bed which also effects the warm ischemia time (WIT). Argon beam coagulation (ABC) for decades is a well-known method for surface controls during major open surgical sites. This study aimed to compare peri- and postoperative relevant parameters in patients with ABC or internal renorrhaphy (IR) during robot-assisted partial nephrectomy (RAPN). One hundred seventy patients with ≤ 7 cm tumors, who underwent RAPN at our institutions, were included in this retrospective study. Tumor bed was controlled by either IR or by ABC after closing isolated overt collecting system defects. No additional IR was performed in patients with ABC. Estimated blood loss (EBL), WIT, estimated glomerular filtration rate (eGFR) change, on- vs. off-clamp procedure as well as Clavien-Dindo > 2 complications in both groups were compared. Eighty-seven (51.1%) patients had ABC and 83 (48.9%) had IR as their tumor bed control method. Tumor size, side and RENAL nephrometry score in both groups were similar. Mean warm ischemia time (WIT) was 20.8 min in ABC group and 23.8 min in IR group (p = 0.03). In 4-7 cm tumors, WIT was 19.9 min in ABC group while 26.6 min in IR group (p = 0.026). eGFR change from baseline and EBL favored ABC in entire cohort as well as in 4-7 cm tumors with statistical significance. There were more off-clamp procedures with ABC in ≤ 4 cm tumors. No ABC specific complications were observed. Within 2 years of follow-up, no patient developed recurrences. The control of the tumor base with ABC during RAPN shortens the warm ischemia times significantly compared to IR. Besides, ABC had better EBL and GFR changes outcomes. With close monitoring of intra-abdominal pressure and frequent venting, disturbing complications of ABC could completely be avoided. ABC was found to be feasible, safe and effective during RAPN.
在部分肾切除术 (PN) 中，最重要的步骤之一是控制肿瘤床的止血，这也会影响热缺血时间 (WIT)。氩束凝固 (ABC) 作为一种众所周知的方法，几十年来一直用于主要开放手术部位的表面控制。本研究旨在比较在机器人辅助部分肾切除术 (RAPN) 中使用 ABC 或内部肾缝合 (IR) 时围手术期相关参数。我们的机构共纳入了 170 名接受 ≤ 7 cm 肿瘤的 RAPN 患者，本回顾性研究将肿瘤床通过 IR 或 ABC 控制，在闭合孤立的显性集合系统缺陷后。在接受 ABC 的患者中，不再进行额外的 IR。比较两组患者的估计失血量 (EBL)、WIT、估计肾小球滤过率 (eGFR) 变化、夹闭与非夹闭手术以及 Clavien-Dindo > 2 并发症。87 例 (51.1%) 患者采用 ABC，83 例 (48.9%) 患者采用 IR 作为肿瘤床控制方法。两组患者的肿瘤大小、侧别和 RENAL 肾肿瘤评分相似。ABC 组的平均热缺血时间 (WIT)为 20.8 分钟，IR 组为 23.8 分钟 (p = 0.03)。在 4-7 cm 肿瘤中，ABC 组的 WIT 为 19.9 分钟，IR 组为 26.6 分钟 (p = 0.026)。整个队列以及 4-7 cm 肿瘤中，eGFR 从基线的变化和 EBL 均有利于 ABC，具有统计学意义。在≤4 cm 的肿瘤中，ABC 组有更多的非夹闭手术。未观察到与 ABC 相关的特定并发症。在 2 年的随访中，没有患者出现复发。与 IR 相比，RAPN 中使用 ABC 控制肿瘤基底可显著缩短热缺血时间。此外，ABC 有更好的 EBL 和 GFR 变化结果。密切监测腹腔内压和频繁通风，可以完全避免 ABC 的并发症。在 RAPN 中，ABC 被发现是可行的、安全的和有效的。
