機器手臂輔助腹腔鏡腎部分切除小腎細胞惡性腫瘤:奇美醫院經驗分享
陳經國, 黃冠華1
奇美醫學中心 外科部 泌尿外科，1泌尿腫瘤科
Robotic-assisted laparoscopic partial nephrectomy for small renal cell carcinoma : Chi Mei Medical Center experience
Keng-Kok Tan, Kuan-Hua Huang1
Division of Urology, Department of Surgery, 1Division of Uro-Oncology
Chi Mei Medical Center
Introduction:
Partial nephrectomy is an effective surgical treatment for small renal masses, and the benefit of renal function preservation. Laparoscopic partial nephrectomy is still one of the more challenging procedures in urology. Minimizing warm ischemia time (WIT) and bleeding requires efficient intracorporeal suturing. Robotic system offers the surgeon to perform complex reconstructive procedures with more precision, dexterity and rapidity. We present the experience and outcome in robotic-assisted laparoscopic partial nephrectomy (RALPN) for small renal cell carcinoma in our institution.
Patients and Methods:
From May 2012 to November 2014, 22 patients underwent RALPN for small renal cell carcinoma in Chi Mei Medical Center, operated by single surgeon with retroperitoneal approach. Patient demographics, tumor characteristics, intraoperative, and postoperative data including tumor size, warm ischemia time, and estimated blood loss (EBL) were analyzed.
Results:
The average age of the patients (14 male, 8 female) was 53.5 (range 36-75) years. Average BMI was 25.41 (range 17.4-33.9) kg/m2. A total of 9 patients had tumor on right and 13 patients had tumor on the left. Location wise the distribution was as follows: Upper pole (n = 8), midpole (n = 3), lower pole (n = 10) and 1 had hilar mass. Average tumor size was 3.14 cm (range 1.7-6.7 cm). Average operative time was 253.95 (range 155-430) min; Average consule time was 126.95 (range 78-218) min. Mean warm ischemia time was 20min 04 sec (range 10min40sec~32min36sec). Mean blood loss was 265.9 (range 0-1000) ml, 4 patients need blood transfusion. Pathologic examination revealed clear cell type in 17 patients, papillary type in 2 patients and Chromophobe type in 3 patients. All margins were negative.
Conclusion:
Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal masses. Robotic partial nephrectomy had shorter WIT compared to the previous reported laparoscopic partial nephrectomy data.