Robotic partial nephrectomy for complex renal tumors: Surgical technique
Robotic partial nephrectomy for complex renal tumors: Surgical technique
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DOI：
10.1016/j.eururo.2007.09.047
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发表时间：
2008-03-01
期刊：
影响因子：
23.4
通讯作者：
Pinto, Peter A.
中科院分区：
文献类型：
--
作者：
Rogers, Craig G.;Singh, Amar;Pinto, Peter A.
目的：腹腔镜肾部分切除术需要高级培训，以完成肿瘤切除和肾重建，同时最大限度地减少热缺血时间。复杂的肾肿瘤给保留肾单位的微创手术增加了额外的挑战。我们描述了我们的技术，说明与视频，机器人肾部分切除术的复杂的肾肿瘤，包括肝门，内生，和多个tumors.Methods：机器人的援助被用来切除14个肿瘤8例（平均年龄：50.3岁;范围：30-68岁）。3例患者患有遗传性肾癌。所有患者均具有复杂的肿瘤特征，包括肾门肿瘤（n = 5）、内生肿瘤（n = 4）和/或多发肿瘤（n = 3）。采用肺门夹闭，平均热缺血时间为31 min（范围：24-45 min）。平均失血230 ml（范围：100-450 ml）。组织学证实透明细胞肾细胞癌（n = 3），混合嗜酸细胞瘤（n = 2），嫌色细胞肾细胞癌（n = 2）和嗜酸细胞瘤（n = 1）。所有患者的手术切缘均为阴性。平均指数肿瘤大小为3.6 cm（范围：2.6-6.4 cm）。平均住院时间为2.6 d。在3个月的后续行动，没有患者经历了统计学显着的变化，血清肌酐或估计肾小球滤过率，并没有证据表明肿瘤recursion.Conclusions：机器人肾部分切除术是安全可行的选择患者复杂的肾肿瘤，包括肝门，内生，和多个肿瘤。机器人辅助可以促进微创，肾单位保留的方法，选择复杂的肾肿瘤患者，否则可能需要开放手术或全肾切除术。(C)2007年由Elsevier B. V.代表欧洲泌尿外科协会出版。
Objectives: Laparoscopic partial nephrectomy requires advanced training to accomplish tumor resection and renal reconstruction while minimizing warm ischemia times. Complex renal tumors add an additional challenge to a minimally invasive approach to nephron-sparing surgery. We describe our technique, illustrated with video, of robotic partial nephrectomy for complex renal tumors, including hilar, endophytic, and multiple tumors.Methods: Robotic assistance was used to resect 14 tumors in eight patients (mean age: 50.3 yr; range: 30-68 yr). Three patients had hereditary kidney cancer. All patients had complex tumor features, including hilar tumors (n = 5), endophytic tumors (n = 4), and/or multiple tumors (n = 3).Results: Robotic partial nephrectomy procedures were performed successfully without complications. Hilar clamping was used with a mean warm ischemia time of 31 min (range: 24-45 min). Mean blood loss was 230 ml (range: 100-450 ml). Histopathology confirmed clear-cell renal cell carcinoma (n 3), hybrid oncocytic tumor (n = 2), chromophobe renal cell carcinoma (n 2), and oncocytoma (n = 1). All patients had negative surgical margins. Mean index tumor size was 3.6 cm (range: 2.6-6.4 cm). Mean hospital stay was 2.6 d. At 3-mo follow-up, no patients experienced a statistically significant change in serum creatinine or estimated glomerular filtration rate and there was no evidence of tumor recurrence.Conclusions: Robotic partial nephrectomy is safe and feasible for select patients with complex renal tumors, including hilar, endophytic, and multiple tumors. Robotic assistance may facilitate a minimally invasive, nephron-sparing approach for select patients with complex renal tumors who might otherwise require open surgery or total nephrectomy. (C) 2007 Published by Elsevier B.V. on behalf of European Association of Urology.