Silagy A W, Young R, Kelly B D, Reeves F, Furrer M, Costello A J, Challacombe B J, Corcoran N M, Kearsley J, Dundee P, Agarwal D K
Department of Urology Royal Melbourne Hospital Melbourne VIC Australia.
Department of Urology Austin Health Melbourne VIC Australia.
BJUI Compass. 2021 Mar 12;2(3):211-218. doi: 10.1002/bco2.78. eCollection 2021 May.
To evaluate local clinical outcomes of sliding clip renorrhaphy, from inception to current utilization for open, laparoscopic, and robotically assisted partial nephrectomy.
We reviewed prospectively maintained databases of three surgeons performing partial nephrectomies with the sliding-clip technique at teaching hospitals between 2005 and 2019. Baseline characteristics, operative parameters, including surgical approach, RENAL Nephrometry Score, and post-operative outcomes, including Clavien-Dindo classification of complications, were recorded for 76 consecutive cases. We compared perioperative and 90-day events with patient and tumor characteristics, stratified by operative approach and case complexity, using Wilcoxon rank-sum test for continuous variables and the Chi-squared or Fisher's exact test, for binary and categorical variables, respectively.
Open surgery (n = 15) reduced ischemia time and operative time, but increased hospital admission time. Pre- and post-operative estimated glomerular filtration rates did not change significantly by operative approach. Older patients ( = .007) and open surgery ( = .003) were associated with a higher rate of complications (any-grade). Six grade ≥3 complications occurred: these were associated with higher RENAL Nephrometry Score ( = .016) and higher pathological tumor stage ( = .045). Limits include smaller case volumes which incorporate the learning curve cases; therefore, these data are most applicable to lower volume teaching hospitals.
The sliding-clip technique for partial nephrectomy was first described by Agarwal et al and has low complication rates, acceptable operative time, and preserves renal function across open and minimally invasive surgeries. This series encompasses the initial learning curve with developing the technique through to present-day emergence as a routine standard of practice.
评估从最初应用到目前在开放性、腹腔镜及机器人辅助下部分肾切除术（PN）中使用的滑动夹肾缝合术的局部临床疗效。
我们回顾了2005年至2019年间在教学医院采用滑动夹技术进行部分肾切除术的三位外科医生的前瞻性维护数据库。记录了76例连续病例的基线特征、手术参数（包括手术入路、RENAL肾计量评分）以及术后结果（包括并发症的Clavien-Dindo分类）。我们使用Wilcoxon秩和检验比较连续变量的围手术期和90天事件与患者及肿瘤特征，并分别使用卡方检验或Fisher精确检验比较二元和分类变量，按手术入路和病例复杂性进行分层。
开放性手术（n = 15）减少了缺血时间和手术时间，但增加了住院时间。手术入路对术前和术后估计肾小球滤过率无显著影响。老年患者（P = 0.007）和开放性手术（P = 0.003）与更高的并发症发生率（任何级别）相关。发生了6例3级及以上并发症：这些与更高的RENAL肾计量评分（P = 0.016）和更高的病理肿瘤分期（P = 0.045）相关。局限性包括纳入学习曲线病例的病例数量较少；因此，这些数据最适用于病例数量较少的教学医院。
部分肾切除术的滑动夹技术最早由Agarwal等人描述，并发症发生率低，手术时间可接受，并且在开放性和微创手术中均能保留肾功能。本系列涵盖了从技术开发的最初学习曲线到如今作为常规实践标准出现的过程。
