機械手臂輔助手術治療上泌尿道結石:11件個案之臨床經驗

胡蔚祥,林益聖,歐宴泉,許兆畬,童敏哲

童綜合醫院 外科部 泌尿科

Robotic-assisted surgery for upper urinary tract urolithiasis: An experience including 11 cases

Wei-Shiang Hu, Yi-Sheng Lin, Yen-Chuan Ou, Chao-Yu Shu, Min-Che Tung

Division of Urology, Department of Surgery,

Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan

Purpose: To describe operative technique, perioperative measures, and early outcomes of robotic-assisted surgery for upper urinary tract urolithiasis.

Materials and Methods: We retrospectively reviewed the collected data regarding 11 patients who underwent robotic-assisted surgery for upper urinary tract urolithiasis between November 2011 and April 2019. All patients are examined by computed tomography prior to the robotic-assisted surgery. The operation is performed by the transperitoneal approach with the patient in the semi-lateral position. After removal of the calculus, a ureteral stent is inserted.

Results: There were 8 robotic-assisted ureterolithotomy and 3 robotic-assisted nephrolithotomy. Among these patients, one with nephrolithiasis presented initially with concurrent ipsilateral renal tumor and gall stones. We performed robotic-assisted pyelolithotomy, partial nephrectomy and cholecystectomy successfully in a single procedure. Another patient presented with right ureteral stone and prostate cancer. Robotic-assisted right ureterolithotomy and radical prostatectomy were performed in a single procedure. The mean age of the patients was 62 years old. The mean Body mass index (BMI) was 26.99 kg/m2. In the patients underwent robotic assisted ureterolithotomy, the peri-operative measures represented 5 mL of mean estimated blood loss (EBL) and 61.25 minutes of median operative time. In those underwent robotic-assisted nephrolithotomy, mean EBL was 70mL and mean operative time was 115 minutes. There was no perioperative complication. Initial stone-free rates were 100%. Mean stone diameter was 20.4 mm. Only 1 patient underwent robotic-assisted ureterolithotomy presented back to hospital within 90 days after the surgery due to ipsilateral ureteral stricture and was managed by the ureteroscopy.

Conclusions: Robotic-assisted ureterolithotomy takes equal operative time compared to ureteroscopy, but offers higher stone-free rate than ureteroscopy. Robotic-assisted nephrolithotomy provided less EBL than percutaneous nephrolithotomy. Robotic-assisted surgery is safe and feasible in large upper urinary tract urolithiasis. It also offers the benefit to manage concurrent lesions in a single procedure.