達文西手臂於單孔腹腔鏡腎臟輸尿管切除術有其角色? 單一教學醫院之經驗
倪雪雰、楊晨洸
台中榮總 外科部 泌尿外科
Laparoendoscopic single-site (LESS) nephroureterectomy, will robotic assist really help? a single hospital experience
Hsueh-Fen Ni, Cheng-Kuang Yang
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
Purpose: Laparoendoscopic single-site (LESS) nephroureterectomy has been proposed as an alternative to traditional laparoscopy. However there is still limitation during surgery, including poor vision during exposure of renal vein while performing left retroperitoneal nephroureterectomy. The aim of this study was to compare whether there are better outcomes while the surgery was assisted with robot.
Results:
We began from simple transperitoneal nephroureterectomy, (patient including non-function kidney with PN, non-function kidney with symptomatic renal stone, bil VUR Gr V, Papillary U.C). Patient was under peri-umbilical incision, using homemade or Gelport.
Sugery was then shifted retroperitoneal LESS nephroureterectomy, under Flank position and Gibson’s incision. Patient selection extend to upper urinary tract urothelial carcinoma, stage mainly ranging from T1-T2 . Benefit noted through OP time, amount of blood loss.
However, while the surgery was assisted with robot, no obvious improvement over outcome noted, including amount of blood loss and duration of post operation hospital stay.
Conclusions:
In our opinion, robotic laparoendoscopic single-site nephroureterectomy showed no obvious advantage while comparing with retroperitoneal LESS nephroureterectomy, including similar operation time(while docking time is counted) assistant demand, no obvious improvement over obtaining better vision and more collision during surgery