林嘉彥, 楊晨洸, 歐宴泉, 裘坤元, 程千里, 賀昊中, 蘇重光, 王賢祥, 陳卷書, 李建儀,
台中榮民總醫院 外科部 泌尿外科
Contemporary trends in robot-assisted laparoscopic partial nephrectomy in taiwanese patients
Chia-yen Lin, Cheng-kuang Yang, Yen-chuan Ou*, Kun-yuan Chiu, Chen-li Cheng, Hao-chung Ho, Chung-kuang Su, Shian-shiang Wang, Chuan-shu Chen, Jian-ri Li, Chi-feng Hung, Cheng-che ChenDivision of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: Nephron-sparing surgery (NSS) has recently become the gold standard for treating small renal mass. Only few studies on the Taiwanese population report on the results of partial nephrectomy.
Materials and Methods: The database of a single medical center covering the period from January 2005 to October 2014 was reviewed and patients who underwent partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), or robot-assisted laparoscopic partial nephrectomy (RLPN) were enrolled. The peri- and post-operative outcomes of the RLPN group were analyzed. The patients were then separated into three groups based on time periods to clarify trends in partial nephrectomy.
Results: Of 209 patients who received partial nephrectomy, 118 had OPN, 32 had LPN, and 59 had RLPN. Twelve patients of the RLPN group underwent zero-ischemia procedure. In the RLPN group, the mean PADUA score was 8.63±1.84, nephrometry score was 7.12±1.95, and mean overall operation time was 138.1±60.1 min, with mean warm ischemia time of 27.02±12.15 min. The mean estimated blood loss was 190.43 ml (20-1200 ml) with vessel clamping and 409.17 ml (50-2200 ml) in the zero ischemia group. The first period (2005-2008) had 44 cases (28 OPN, 8 LPN, and 8 RLPN); the second period (2009-2011) had 61 cases (38 OPN, 9 LPN, and 14 RLPN); and the last period (2012-2014) had 104 cases (52 OPN, 15 LPN, and 37 RLPN). The percentage of RLPN increased from 18.18% in the first period to 35.58% in the third period. Changes in the ratio of RLPN to OPN and LPN revealed a trend towards RLPN.
Conclusion: RLPN is a feasible and safe method for small renal tumor, making it the treatment of choice recently.