非钳式机器人辅助部分肾切除术:来自单一中心的手术经验。

IF 1.4 Q3 UROLOGY & NEPHROLOGY Central European Journal of Urology Pub Date : 2023-01-01 DOI:10.5173/ceju.2023.261
Matteo Zanoni, Fabio Grizzi, Paolo Vota, Giovanni Toia, Cinzia Mazzieri, Maria Chiara Clementi, Edoardo Beatrici, Gianluigi Taverna
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引用次数: 0

摘要

机器人辅助部分肾切除术(RAPN)是一种局部肾肿瘤的微创治疗方法,有时会导致热缺血时间延长和严重的并发症。本研究报告了手术结果,包括可行性、阳性切缘、手术中和术后并发症。材料与方法:2011年1月至2022年11月,某中心对287例患者进行了无钳外缝合RAPN。该研究记录了术前患者的特征,估计肾小球滤过率,根据术前的方面和尺寸进行解剖(PADUA)分类,并使用肾肾测量评分系统。记录术中细节及并发症。术后30天内的并发症按照Clavien-Dindo系统进行分类。随访预约安排在第一年的第1、3和6个月,随后每6个月随访一次,然后每年随访一次。结果:研究对象男性145人,女性142人,平均年龄58.9岁,平均体重指数26.7 kg/m2。平均PADUA评分8.3分,平均控制台时间83分钟,估计失血量280 mL,平均住院时间3天,无术中并发症。然而,4例(1.4%)患者出现术后出血,需要开腹手术(Clavien-Dindo IIIB期),4例(1.4%)患者手术切缘阳性。结论:在微创肾部分切除术中,非钳形选择性动脉夹持是一种安全可行的治疗小肿瘤的方法。需要进一步的随机前瞻性研究来证实不夹持的RAPN是否能提供任何肾功能益处并减少围手术期出血并发症。
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Off-clamp robotic-assisted partial nephrectomy: surgical experience from a single centre.

Introduction: Robot-assisted partial nephrectomy (RAPN) is a minimally invasive treatment for localized renal tumours, which can sometimes result in extended warm ischaemic time and serious complications. This study reports on surgical outcomes including feasibility, positive margins, and complications during and after surgery.

Material and methods: From January 2011 to November 2022, a single centre performed off-clamp sutureless RAPN on 287 patients. The study recorded preoperative patient characteristics, estimated glomerular filtration rate, and tumour features according to the preoperative aspects and dimensions used for an anatomical (PADUA) classification, and utilized the RENAL nephrometry scoring system. Intraoperative details and complications were documented. Postoperative complications within 30 days were classified according to the Clavien-Dindo system. Follow-up appointments were scheduled at 1, 3, and 6 months in the first year, followed by subsequent appointments every 6 months, and then annually.

Results: The study included 145 males and 142 females, with a mean age of 58.9 years and a mean body mass index of 26.7 kg/m2. The mean PADUA score was 8.3, the average console time was 83 minutes, and the estimated blood loss was 280 mL. The average hospital stay was 3 days, and no intraoperative complications were observed. However, 4 patients (1.4%) experienced post-operative haemorrhage that required laparotomy (Clavien-Dindo stage IIIB), and 4 patients (1.4%) had positive surgical margins.

Conclusions: Off-clamp selective arterial clamping during minimally invasive partial nephrectomy is a safe and feasible approach for small renal tumours. Further randomized prospective studies are required to confirm if RAPN without clamping offers any renal functional benefits and reduces perioperative bleeding complications.

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来源期刊
Central European Journal of Urology
Central European Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.30
自引率
8.30%
发文量
48
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