Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis.
Robotic partial nephrectomy for renal hilar tumors: a multi-institutional analysis.
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DOI：
10.1016/j.juro.2008.08.022
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发表时间：
2008-12
期刊：
影响因子：
--
通讯作者：
Pinto PA
中科院分区：
文献类型：
--
作者：
Rogers CG;Metwalli A;Blatt AM;Bratslavsky G;Menon M;Linehan WM;Pinto PA
目的腹腔镜肾部分切除术是一种先进的外科手术，需要掌握微创技术。位于肾门附近的肿瘤是一个额外的挑战。我们报告了一项机器人肾部分切除术治疗肾门肿瘤的多机构研究，并描述了我们的结果。材料和方法我们评估了两家机构接受机器人肾部分切除术治疗肾门肿瘤的患者。肾门肿瘤在术前影像上被定义为毗邻肾动脉和/或肾静脉的肿瘤。夹闭肾门部血管后，行肾动脉切开切除肿瘤，缝合重建肾。结果11例患者均成功行肾部分切除术，年龄30~76岁，平均56.4岁。肿瘤大小2.3~6.4 cm，平均3.8 cm。热缺血时间20~39分钟，平均28.9分钟；手术时间154~253分钟，平均202分钟。术中平均失血220ml(50~750)。平均住院时间2.6d(1~4天)。组织病理学检查证实肾透明细胞癌8例，乳头状癌1例，嫌色细胞癌2例。所有病例的手术切缘均为阴性。结论肾部分切除术是一种安全可行的手术方法。机器人辅助可能有助于肿瘤切除和肾脏重建，以应对挑战性的肾门肿瘤，为可能需要开放手术或全肾切除的特定患者提供一种微创和保留肾单位的手术选择。
PurposeLaparoscopic partial nephrectomy is an advanced surgical procedure requiring technical skill in minimally invasive techniques. Tumors located adjacent to the renal hilum pose an additional challenge. We report a multi-institutional study of robotic partial nephrectomy for renal hilar tumors and describe our results.Materials and MethodsWe evaluated patients from 2 institutions who underwent robotic partial nephrectomy for renal hilar tumors. Renal hilar tumors were defined as tumors abutting the renal artery and/or renal vein on preoperative imaging. After clamping the renal hilar vessels tumors were excised with fine dissection from the renal vessels followed by sutured renal reconstruction.ResultsRobotic partial nephrectomy was successfully performed on 11 patients (mean age 56.4 years, range 30 to 76). Mean tumor size was 3.8 cm (range 2.3 to 6.4). Mean warm ischemia time was 28.9 minutes (range 20 to 39) and mean operating time was 202 minutes (range 154 to 253). Mean blood loss was 220 ml (range 50 to 750). Mean hospital stay was 2.6 days (range 1 to 4). Histopathological evaluation confirmed 8 cases of clear cell renal cell carcinoma, 1 of papillary renal cell carcinoma and 2 of chromophobe renal cell carcinoma. Surgical margins were negative for malignancy in all cases.ConclusionsRobotic partial nephrectomy is a safe and feasible approach for select patients with renal hilar tumors. Robotic assistance may facilitate tumor resection and renal reconstruction for challenging renal hilar tumors, offering a minimally invasive and nephron sparing surgical option for select patients who might otherwise require open surgery or total nephrectomy.
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