Lee Randall A, Strauss David, Kutikov Alexander
Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA.
Transl Androl Urol. 2020 Dec;9(6):3140-3148. doi: 10.21037/tau.2019.12.24.
Partial nephrectomy is recommended for surgical management of small renal masses (SRM), or lesions ≤7 cm. The decision for surgical intervention involves a balanced patient assessment. Minimally invasive approach, which includes laparoscopic and robotic techniques, has shown to have improved blood loss, length of hospitalization, and post-operative pain while maintaining oncologic efficacy when compared to an open approach. Transperitoneal approach is preferred at most centers; however, retroperitoneoscopic minimally invasive surgery (MIS) partial nephrectomy expertise is essential for comprehensive kidney cancer care. With advances in surgical technology and deep penetration of robotics into surgical training and practice, robotic partial nephrectomy has become the modality of choice in modern clinical practice. This review discusses the indications and outcomes for various minimally invasive approaches of partial nephrectomy.
对于小肾肿瘤(SRM)或直径≤7 cm的病变,建议采用部分肾切除术进行手术治疗。手术干预的决策需要对患者进行全面评估。与开放手术相比,包括腹腔镜和机器人技术在内的微创方法已显示出术中失血减少、住院时间缩短以及术后疼痛减轻,同时保持了肿瘤学疗效。大多数中心更倾向于经腹入路;然而,腹膜后腹腔镜微创手术(MIS)部分肾切除术的专业技能对于全面的肾癌治疗至关重要。随着手术技术的进步以及机器人技术在手术培训和实践中的深入应用,机器人辅助部分肾切除术已成为现代临床实践中的首选术式。本综述讨论了部分肾切除术各种微创方法的适应证和治疗效果。