Robotic-assisted laparoscopic partial nephrectomy: Technique and initial clinical experience with daVinci robotic system
Robotic-assisted laparoscopic partial nephrectomy: Technique and initial clinical experience with daVinci robotic system
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DOI：
10.1016/j.urology.2004.06.049
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发表时间：
2004-11-01
期刊：
影响因子：
2.1
通讯作者：
Peschel, R
中科院分区：
文献类型：
--
作者：
Gettman, MT;Blute, ML;Peschel, R
目标。目的：探讨应用达芬奇机器人系统进行腹腔镜肾部分切除术的可行性。在2002年11月至2003年8月间，13例实性或可疑囊性肾肿块患者接受了机器人辅助腹腔镜部分肾切除术。其中8例在阻断肾动脉前行动脉内置管冷却肾。其余5例患者在夹住肾门后行部分肾切除术。肿瘤切除和体内缝合完全由远程机器人完成。回顾性分析围手术期资料及病理结果。平均病变直径为3.5 cm（范围2.0 ~ 6.0）。平均手术时间215分钟（范围130 ~ 262），平均失血量170 mL（范围50 ~ 300）。平均热缺血时间为22分钟（15 ~ 29分钟），平均冷缺血时间为33分钟（18 ~ 43分钟）。住院时间平均为4.3天（范围2至7天）。切除的病变包括10例肾细胞癌，2例嗜瘤细胞瘤，1例复杂肾囊肿。在1例中，尽管冰冻切片为阴性，但仍出现了正边缘；行腹腔镜肾切除术，未见肿瘤残留。1例患者术后出现肠梗阻。随访2 ~ 11个月，未见复发。机器人辅助部分肾切除术是可行的。机器人部分肾切除术可以安全地使用经腹膜或腹膜后入路进行。使用常规腹腔镜器械时，必须有第二名助手进行辅助。(C) 2004爱思唯尔公司
Objectives. To develop and assess the feasibility of laparoscopic partial nephrectomy performed using the daVinci robotic system.Methods. Between November 2002 and August 2003, 13 patients with solid or suspicious cystic renal masses underwent robotic-assisted laparoscopic partial nephrectomy. In 8 cases, an intra-arterial catheter was inserted for renal cooling before occlusion of the renal artery. The remaining 5 patients underwent partial nephrectomy after the renal hilum had been clamped. Tumor excision and intracorporeal suturing were performed entirely with telerobotics. The perioperative data and pathologic results were retrospectively reviewed.Results. The mean lesion diameter was 3.5 cm (range 2.0 to 6.0). The mean operative time was 215 minutes (range 130 to 262), and the mean blood loss was 170 mL (range 50 to 300). The mean warm ischemia was 22 minutes (range 15 to 29), and the mean cold ischemia time was 33 minutes (range 18 to 43). The length of hospital stay averaged 4.3 days (range 2 to 7). The resected lesions included renal cell carcinoma in 10, oncocytoma in 2, and a complex renal cyst in 1. In I case, a positive margin occurred despite negative frozen sections; laparoscopic nephrectomy was performed and showed no residual tumor. One patient experienced postoperative ileus. At 2 to 11 months of follow-up, no recurrence had been observed.Conclusions. Robotic-assisted partial nephrectomy is feasible. Robotic partial nephrectomy can be safely performed using a transperitoneal or retroperitoneal approach. A second scrubbed assistant is mandatory to provide assistance using conventional laparoscopic instruments with this technique. (C) 2004 Elsevier Inc.