微拉雷射應用於腎細胞癌患者之部分腎臟切除手術:病例報告及文獻回顧
郭名翔 沈坤宏
奇美醫學中心 外科部 泌尿外科
Partial nephrectomy with vela laser in renal cell carcinoma: case report and literature review
Ming-Hsiang Kuo, Kun-Hung Shen
Department of Surgery, Division of Urology
Chi Mei Medical Center, Tainan, Taiwan
Purpose:
Laser prostatectomy is increasingly being considered as a valid clinical alternative to TURP which resulting in relatively low rates of intraoperative and perioperative complications. Vela (1.9um thulium laser) laser is also the optimum laser for interdisciplinary interventions in urology. We introduce a case or renal cell carcinoma receiving partial nephrectomy with Vela laser.
Material:
This 48-year-old female patient had past history of DM, HTN, Hyperlipidemia, Obesity (93 kg), left ureteral stone S/P URS-SM, right ureteral stone s/p ESWL, right APN, Bilateral renal stones. She suffered from gross hematuria for a month. The CTU showed: Right renal nodule, exophytic nodular lesion about 2.2 cm. So she received right renal biopsy on 2014/12/11. The pathology revealed: Clear cell renal cell carcinoma(cT1aN0M0). Right retroperitoneal laparoscopic partial nephrectomy with Vela laser was performed after discussing with the patient. Total blood loss was 250 ml with warm ischemia time 30 mins. Post-operative care was stable that she discharged on Post-operative Day 4. Pathology was compatible with previous biopsy with free margin.
Conclusion:
Laser its use in other endourology application or tumor resection was relatively rare. We would like to introduce a case of our own experience and the pros and cons compared with laparoscopic partial nephrectomy in blood loss, surgical outcomes, length of hospitalization and prognosis of disease control if available.