手輔助腹腔鏡部分腎臟切除及腹腔鏡部分腎臟切除手術結果比較

張東平¹、薛又仁^1、2、蕭毅君¹、黃建榮¹、賴昱維^1、2、邱文祥^1、2

¹台北市立聯合醫院仁愛院區外科部泌尿科；²國立陽明交通大學醫學院泌尿學科

Comparing the Perioperative Outcomes between Hand-Assisted Laparoscopic Partial Nephrectomy and Laparoscopic Partial Nephrectomy

Tung-Ping Chang¹, Thomas Y. Hsueh^1,2 Yi-Jiun Hsiao¹, Andy C. Huang¹, Yu-Wei Lai^1,2, Allen W. Chiu^1,2

Division of Urology, Department of Surgery, Taipei City Hospital Ren Ai branch, Taipei, Taiwan¹; Department of Urology, National Yang Ming Chiao Tung University, Taipei, Taipei, Taiwan²

Purpose: Minimally invasive partial nephrectomy became the standard surgical technique for small renal masses. We reported our single-institution experience with hand-assisted laparoscopic partial nephrectomy (HALPN) compared with laparoscopic partial nephrectomy (LPN) in safety, feasibility, and perioperative outcomes.

Materials and Methods: We retrospectively analyzed 46 patients who underwent hand-assisted laparoscopic partial nephrectomy(n=21) and laparoscopic partial nephrectomy(n=25) in a single institute between January 2014 and February 2022. All patients underwent a transabdominal approach. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between HALPN and LPN groups. We compared continuous variables for normality with a t-test and Categorical variables were analyzed using the chi-squared test or Fisher’s exact test. Statistical analyses were carried out with IBM SPSS statistical software and p<0.05 was considered statistically significant.

Results: 25 patients received LPN and 21 patients underwent HALPN and each of the groups had a case converted to open procedure. There was no significance between the two groups in the demographic data and disease characteristics including gender(p=0.314), age(p=0.503), BMI(p=0.435), ASA(p=0.134), initial symptoms of renal masses (p=0.648), comorbidities (DM, HTN, CAD, CKD), tumor sides (p=0.235), tumor size (p=0.484), RENAL score (p=0.648). Compared to LPN, HALPN revealed less estimated blood loss (EBL) (494.12±453.19 vs 345.24±285ml, p=0.44) and longer ischemia time(15.50±11.28vs 19.10±6.66 min, p=0.005). Though, there was no significance in operation time(p=0.681), intraoperative blood transfusion(p=0.673) and conversion rate(p=1). In the viewpoint of the postoperative parameters, there was no significance in postoperative complication(p=1), bowel recovery(p=0.785), ICU stay(p=0.963), and drainage removal days(p=0.278). Nevertheless, postoperative Serum creatinine level elevation (12% vs 38.1%, p=0.025) and postoperative day 5 higher pain score (0.56±0.96 vs 1.05±1.39, p=0.017) were noted in the HALPN group.

Conclusion: In our retrospective study, the HALPN group contributed to less EBL and longer ischemia time during operation. Post-operative complications, bowel recovery, and hospitalization were not significant, only a slight increase in Creatinine level and postoperative day 5 pain score were found.

Overall, HALPN remains a safe procedure for small renal masses and could be a feasible bridge surgery to totally minimally invasive partial nephrectomy, easing the transition and shortening the learning curve.