Miyake Hideaki, Motoyama Daisuke, Matsushita Yuto, Watanabe Hiromitsu, Ito Toshiki, Sugiyama Takayuki, Otsuka Atsushi
Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
J Endourol Case Rep. 2020 Dec 29;6(4):370-373. doi: 10.1089/cren.2020.0102. eCollection 2020.
Surgical treatment of synchronous multifocal renal tumors arising in a solitary kidney remains an extremely unique and stressful challenge, since it is not easy to completely remove multiple tumors and effectively preserve the renal function without perioperative complications. In this report, we describe our experience of three patients with multifocal renal tumors detected in a solitary kidney who were treated by robot-assisted partial nephrectomy (RAPN). Two men and one woman were found to have two small renal tumors in a solitary kidney, and subsequently underwent RAPN at our institution. The location of the renal tumors and surgical approach in each patient were as follows: one tumor on the abdominal side and another on the dorsal side with a transperitoneal approach, both on the abdominal side with a transperitoneal approach, and both on the dorsal side with a retroperitoneal approach. In this series, after clamping the main renal artery and resection of one tumor, an inner running suture was placed, followed by early declamping of the renal artery and then renorrhaphy, and the same procedure was repeated to manage the remaining tumor. In all patients, the trifecta outcomes were achieved, and there were no changes in the chronic kidney disease stage 1 month after RAPN, resulting in no requirement of postoperative dialysis. Although it is necessary to carefully select optimal candidates, RAPN with an early declamping technique could be a safe and feasible approach for the treatment of patients with synchronous multifocal renal tumors arising in a solitary kidney, facilitating the complete resection of tumor foci, minimization of warm ischemic injury, and effective preservation of the renal function.
对于单肾中出现的同步性多灶性肾肿瘤进行手术治疗仍然是一项极其独特且压力巨大的挑战，因为要在不出现围手术期并发症的情况下完全切除多个肿瘤并有效保留肾功能并非易事。在本报告中，我们描述了三例在单肾中检测到多灶性肾肿瘤并接受机器人辅助部分肾切除术（RAPN）治疗的患者的经验。两名男性和一名女性被发现单肾中有两个小肾肿瘤，随后在我们机构接受了RAPN。每位患者肾肿瘤的位置和手术入路如下：一个肿瘤在腹侧，另一个在背侧，采用经腹入路；两个肿瘤均在腹侧，采用经腹入路；两个肿瘤均在背侧，采用腹膜后入路。在本系列中，在夹闭肾动脉主干并切除一个肿瘤后，进行内连续缝合，随后早期松开肾动脉，然后进行肾缝合，对剩余肿瘤重复相同操作。所有患者均实现了三联成功结局，RAPN术后1个月慢性肾脏病分期无变化，无需术后透析。尽管有必要仔细挑选最佳候选者，但采用早期松开技术的RAPN对于治疗单肾中出现的同步性多灶性肾肿瘤患者可能是一种安全可行的方法，有助于肿瘤病灶的完全切除、将热缺血损伤降至最低并有效保留肾功能。
