達文西機械手臂Si與Xi系統施行腎臟輸尿管及膀胱袖口切除手術之比較

陳人傑¹、黃逸修^1,2、黃子豪^1,2、林子平^1,2、鍾孝仁^1,2、盧星華^1,2、張延驊^1,2、黃志賢^1,2

臺北榮民總醫院 泌尿部¹; 國立陽明交通大學醫學院 泌尿學科 書田泌尿科學研究中心²

Robotic-Assisted Radical Nephroureterectomy with Bladder Cuff Excision using Da Vinci Xi Vs. Si System: Are There Any Differences?

Jen-Chieh Chen¹, Eric Yi-Hsiu Huang^1,2, Tzu-Hao Huang^1,2, Tzu-Ping Lin^1,2, Hsiao-Jen Chung^1,2, Shing-Hwa Lu^1,2, Yen-Hwa Chang^1,2, William J.S. Huang^1,2

Department of Urology, Taipei Veterans General Hospital¹; Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan²

Purpose:

To compare the peri-operative parameters, complication rate, and outcomes of the da Vinci Si and Xi surgical system for radical nephroureterectomy with bladder cuff excision (RNU BCE) in patient diagnosed with localized upper urinary tract urothelial carcinoma (UTUC).

Materials and Methods:

From October 2010 to December 2020, a total of 142 UTUC patients underwent RNU BCE with da Vinci surgical system were enrolled. The patients were randomly assigned to Si or Xi system depending on the availability. Among them, 81 patients were operated with Si and 61 patients with Xi system. The peri-operative parameters, complications, and outcomes were investigated. Complications were graded using the Clavien-Dindo classification. The Pearson’s chi-square test, two-sample t test, and Kaplan-Meier method were used for statistical analysis.

Results:

The mean age was 73.2 years in Si group and 72.9 years in Xi group. Both groups were similar in sex, body mass index (BMI), and preoperative American Society of Anesthesiologists (ASA) physical status classification. The mean operative time did not differ between groups (Si group: 355.4 ± 127.23 minutes; Xi group 353.35 ± 92.78 minutes). There was no significant difference in estimated blood loss (EBL) (Si group: 139.96 ± 232.6 ml; Xi group 176.92 ± 184.35 minutes, P = 0.638). There was no difference in minor complication rate (Si group: 9.8%; Xi group 11.4%, P = 0.406) and major complication rate (Si group: 2.4%; Xi group: 4.9%, P = 0.624). The mean length of hospital stay was 8.4 days in Si group and 8.3 days in Xi group (P = 0.207). There was no conversion to open or laparoscopic surgery in both systems. The median follow-up was 31 months, and there was no survival difference (overall survival, cancer-specific survival, and disease-free survival) between groups.

Conclusion:

Both Si and Xi da Vinci system were comparable in terms of operative time, EBL, length of hospital stay, complication rate, conversion rate, and survival outcomes in patients with UTUC treated with RNU BCE.