Zhang Qijie, Shao Xianhua, Lu Yuanchen, Deng Junpeng, Zeng Tengyue, Que Hongliang, Sun Yi, Fan Zhongru, Li Quan, Xu Luwei, Xie Jianjun
Department of Urology, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, China.
Department of Anesthesiology, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Suzhou, China.
Transl Androl Urol. 2025 Mar 30;14(3):567-577. doi: 10.21037/tau-2024-735. Epub 2025 Mar 26.
Very limited information is available about the prone retroperitoneoscopic partial nephrectomy (RPN) in adults. This study aimed to evaluate the feasibility and clinical outcomes of prone RPN for posterior tumors in comparison with traditional lateral RPN in adults.
The recordings of 101 patients underwent RPN from January 2018 to March 2023 were retrospectively reviewed. Fifty-nine patients underwent surgeries with lateral RPN, and 42 underwent surgeries with prone RPN. Operative time, warm ischemia time, blood loss, renal function, operative complications, and arterial blood gas analysis were recorded and compared between the two groups. Additionally, a dorsal deviation score (DDS) was developed to quantitate the degree to which the tumor was dorsal, which helped to select a suitable operative approach clinically.
Patients in prone RPN group had shorter operative time (P<0.001), warm ischemia time (P=0.003), and less blood loss (P=0.03) in comparison with lateral RPN. In arterial blood gas analysis, no significant differences in arterial partial pressure of carbon dioxide (PaCO), arterial partial pressure of oxygen (PaO), and pH were observed between two groups before the operation and 30 min after positioning. For slightly posterior tumors (DDS =1), no significant difference in above parameters was observed. However, shorter operative time (P=0.03, P<0.001, respectively), warm ischemia time (P=0.02, P=0.03, respectively), and less blood loss (P=0.08, P=0.043, respectively) were noticed in prone RPN for moderate or severe posterior (DDS =2 or 3) tumors, especially posterior hilar tumors. Difference in renal function between two groups was insignificant. As for complications, a higher incidence of intraoperative complications appeared in lateral RPN group (11.9%) compared with prone RPN (2.4%), whereas there was no significant difference in postoperative complications.
Prone RPN is a feasible operative approach in clinical practice, and is superior to lateral RPN for moderate to severe posterior tumors, especially posterior hilar tumors.
关于成人俯卧位后腹腔镜下肾部分切除术（RPN）的信息非常有限。本研究旨在评估成人俯卧位RPN治疗肾后部肿瘤的可行性及临床疗效，并与传统侧卧位RPN进行比较。
回顾性分析2018年1月至2023年3月期间接受RPN手术的101例患者的记录。其中59例患者接受侧卧位RPN手术，42例接受俯卧位RPN手术。记录并比较两组患者的手术时间、热缺血时间、出血量、肾功能、手术并发症及动脉血气分析结果。此外，制定了背侧偏移评分（DDS）以量化肿瘤的背侧程度，有助于临床选择合适的手术入路。
与侧卧位RPN相比，俯卧位RPN组患者的手术时间（P<0.001）、热缺血时间（P=0.003）更短，出血量更少（P=0.03）。在动脉血气分析中，两组患者术前及体位摆放后30分钟的动脉二氧化碳分压（PaCO）、动脉氧分压（PaO）及pH值均无显著差异。对于轻度肾后部肿瘤（DDS =1），上述参数无显著差异。然而，对于中度或重度肾后部（DDS =2或3）肿瘤，尤其是肾门后肿瘤，俯卧位RPN的手术时间（分别为P=0.03、P<0.001）、热缺血时间（分别为P=0.02、P=0.03）更短，出血量更少（分别为P=0.08、P=0.043）。两组患者的肾功能差异无统计学意义。至于并发症，侧卧位RPN组术中并发症发生率（11.9%）高于俯卧位RPN组（2.4%），而术后并发症发生率无显著差异。
俯卧位RPN在临床实践中是一种可行的手术方法，对于中度至重度肾后部肿瘤，尤其是肾门后肿瘤，优于侧卧位RPN。
