机器人辅助部分肾切除术治疗多个同侧肾肿瘤的技术和结果。

Techniques and outcomes of robot-assisted partial nephrectomy for the treatment of multiple ipsilateral renal masses.

机构信息

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

IRCCS Humanitas Clinic, Rozzano, Milan, Italy.

出版信息

Minerva Urol Nephrol. 2023 Apr;75(2):223-230. doi: 10.23736/S2724-6051.23.05161-3. Epub 2023 Feb 27.

DOI:10.23736/S2724-6051.23.05161-3

PMID:36847584

Abstract

BACKGROUND

Patients with multiple ipsilateral renal masses have an augmented risk of metachronous contralateral lesions and are likely to undergo repeated surgeries. We report our experience with the technologies currently available and the surgical techniques to preserve healthy parenchyma while guaranteeing oncological radicality during robot-assisted partial nephrectomy (RAPN).

METHODS

The data were collected at three tertiary-care centers, where 61 patients with multiple ipsilateral renal masses were treated with RAPN between 2012 and 2021. RAPN was performed with da Vinci Si or Xi surgical system using TilePro (Life360; San Francisco, CA, USA), indocyanine green fluorescence and intraoperative ultrasound. Three-dimensional reconstructions were built in some cases preoperatively. Different techniques were employed for hilum management. The primary endpoint is to report intra- and postoperative complications. Secondary endpoints were the estimated blood loss (EBL), warm ischemia time (WIT) and positive surgical margins (PSM) rate.

RESULTS

Median preoperative size of the largest mass was 37.5 mm (24-51) with a median PADUA and R.E.N.A.L. score of 8 (7-9) and 7 (6-9). One hundred forty-two tumors were excised, with a mean number of 2.32. The median WIT was 17 (12-24) minutes, and the median EBL was 200 (100-400) mL. Intraoperative ultrasound was employed in 40 (67.8%) patients. The rate of early unclamping, selective clamping and zero-ischemia were respectively 13 (21.3%), 6 (9.8%) and 13 (21.3%). ICG fluorescence was employed in 21 (34.42%) patients and three-dimensional reconstructions were built in 7 (11.47%) patients. Three (4.8%) intraoperative complications occurred, all classified as grade-1 according to EAUiaiC. Postoperative complications were reported in 14 (22.9%) cases with 2 Clavien-Dindo grade >2 complications. Four (6.56%) patients had PSM. Mean period of follow-up was 21 months.

CONCLUSIONS

In experienced hands, with the employment of the currently available technologies and surgical techniques, RAPN can guarantee optimal outcomes in patients with multiple ipsilateral renal masses.

摘要

背景

患有多个同侧肾肿瘤的患者发生对侧病变的风险增加，并且可能需要多次手术。我们报告了在机器人辅助部分肾切除术（RAPN）中使用当前可用技术和保留健康肾实质同时保证肿瘤根治性的手术技术的经验。

方法

该数据收集自三家三级护理中心，2012 年至 2021 年期间，61 例患有多个同侧肾肿瘤的患者接受了 RAPN 治疗。RAPN 使用 da Vinci Si 或 Xi 手术系统和 TilePro（Life360；旧金山，加利福尼亚州，美国）、吲哚菁绿荧光和术中超声进行。一些病例在术前进行了三维重建。采用不同的技术进行肾门管理。主要终点是报告术中及术后并发症。次要终点是估计失血量（EBL）、热缺血时间（WIT）和阳性手术切缘（PSM）率。

结果

最大肿瘤的术前中位大小为 37.5mm（24-51），PADUA 和 R.E.N.A.L.评分中位数分别为 8（7-9）和 7（6-9）。切除了 142 个肿瘤，平均数量为 2.32 个。中位 WIT 为 17 分钟（12-24），中位 EBL 为 200 毫升（100-400）。术中超声在 40 例（67.8%）患者中应用。早期无夹闭、选择性夹闭和无缺血的比例分别为 13 例（21.3%）、6 例（9.8%）和 13 例（21.3%）。21 例（34.42%）患者采用吲哚菁绿荧光，7 例（11.47%）患者进行三维重建。3 例（4.8%）患者术中发生并发症，均根据 EAUiaiC 分级为 1 级。14 例（22.9%）患者发生术后并发症，其中 2 例 Clavien-Dindo 分级>2 级。4 例（6.56%）患者有 PSM。平均随访时间为 21 个月。