以機器手臂輔助使用超音波刀執行零缺血的部分腎臟切除手術
楊佩珊 侯鎮邦 林友翔 陳建綸 張慧朗 崔克宏
林口長庚紀念醫院 泌尿科
Using a harmonic scalpel “drilling and clamping” method to implement zero-ischemic robot-assisted partial nephrectomy
Pei-Shan Yang, Cheng-Pang Hou, Yu-Hsiang Lin, Chien-Lun Chen, Phei-Lang Chang, Ke-Hung Tsui
Department of Urology, Chang Gung Memorial Hospital at Linkou, Taiwan
Purpose:
Robot-assisted partial nephrectomy (RAPN) has gradually become a popular minimally invasive nephron-sparing surgical option for small renal tumors. Ischemic injury should be minimized because it impacts renal function outcomes following partial nephrectomy. Herein, we detail the technique and present initial perioperative outcomes of our novel harmonic scalpel “Drilling and Clamping” method to implement zero-ischemic RAPN.
Materials and Methods:
We prospectively collected baseline and perioperative data of patients who underwent zero-ischemic RAPN performed by our harmonic scalpel “Drilling and Clamping” method. From April 2012 to December 2014, a total of 19 consecutive zero-ischemic RAPN procedures were performed by a single surgeon.
Results:
For 18 of the 19 cases, RAPN using our harmonic scalpel "Drilling and Clamping" method was successfully completed without the need for hilar clamping. The median tumor size was 3.4 cm (range: 1.8-6.2); operative time was 3.2 hours (range: 1.9-4.5); blood loss was 100 ml (range:30-950); and postoperative hospital stay was 5 days (3-26). One patient required intraoperative blood transfusion. Two patients had intra or postoperative complications: one was converted to traditional laparotomy because of massive bleeding, while another had post-operative stress ulcer. Pathology confirmed renal cell carcinoma in 12 patients (63.2%), angiomyolipoma in 6 patients: (31.5%), and oncocytoma in one patient (5.3%). Mean pre- and post-operative serum creatinine (0.82 mg/dl and 0.85 mg/dl, respectively), estimated glomerular filtration rate (eGFR) (84.12 and 82.18, respectively), and hemoglobin (13.27g/dl and 12.71g/dl, respectively) were comparable.
Conclusion:
We present a novel zero-ischemic technique for RAPN. We believe that this technique is feasible and reproducible. Our initial results are encouraging and further studies are ongoing.