Karavitakis Markos, Grivas Nikolaos, Zabaftis Christos, Nikitakis Filippos, Tsela Smaragda, Leotsakos Ioannis, Katafigiotis Ioannis, Mitropoulos Dionysios
2nd Department of Urology, Lefkos Stavros-The Athens Clinic, 11528 Athens, Greece.
1st Urology Department, National and Kapodistrian University of Athens, 15784 Athens, Greece.
Curr Oncol. 2025 May 23;32(6):297. doi: 10.3390/curroncol32060297.
Partial nephrectomy (PN) is the standard treatment for renal cell carcinoma (RCC), offering cancer control with renal preservation. Three-dimensional laparoscopy addresses the limitations of traditional two-dimensional systems by enhancing depth perception and accuracy. This study evaluates the impact of 3D laparoscopy on PN for larger and complex tumors. We retrospectively analyzed 200 laparoscopic nephrectomies by a single surgeon between 2020 and 2024, comparing pre-3D and post-3D groups (100 cases each). Key outcomes included the rate of PN, warm ischemia time (WIT), and operative time. The post-3D group demonstrated a significant increase in PN for tumors >4 cm (48% vs. 35%, = 0.028) and high RENAL scores ≥8 (41% vs. 29%, = 0.035). Median WIT was significantly shorter (24 min vs. 29 min, = 0.018 for larger tumors; 26 min vs. 32 min, = 0.022 for high complexity). Total operative time was also reduced (175 min vs. 195 min, = 0.031). Positive surgical margins were lower in the post-3D group (0% vs. 2%), and complication rates were comparable (5% vs. 4%, = 0.712). Three-dimensional laparoscopy significantly improves the feasibility and precision of PN for larger and complex tumors, enhancing outcomes without increasing complications.
肾部分切除术（PN）是肾细胞癌（RCC）的标准治疗方法，可在保留肾脏的同时控制癌症。三维腹腔镜检查通过增强深度感知和准确性克服了传统二维系统的局限性。本研究评估三维腹腔镜检查对较大和复杂肿瘤行PN的影响。我们回顾性分析了2020年至2024年期间由同一外科医生进行的200例腹腔镜肾切除术，比较了三维腹腔镜检查前和三维腹腔镜检查后两组（每组100例）。主要结果包括PN率、热缺血时间（WIT）和手术时间。三维腹腔镜检查后组中，肿瘤>4 cm的PN率显著增加（48%对35%，P = 0.028），RENAL评分≥8的高复杂性肿瘤的PN率也显著增加（41%对29%，P = 0.035）。中位WIT显著缩短（较大肿瘤为24分钟对29分钟，P = 0.018；高复杂性肿瘤为26分钟对32分钟，P = 0.022）。总手术时间也有所减少（175分钟对195分钟，P = 0.031）。三维腹腔镜检查后组的手术切缘阳性率较低（0%对2%），并发症发生率相当（5%对4%，P = 0.712）。三维腹腔镜检查显著提高了较大和复杂肿瘤行PN的可行性和精确性，在不增加并发症的情况下改善了治疗效果。
