逆行性腎內切開手術相較於腹腔鏡手術處理腎囊腫之優勢：單一醫學中心經驗

謝佳駤¹、曾文歆^1,2、林才揚¹、劉建良³、李健逢⁴、黃冠華¹、邱文祥⁵

台南永康奇美醫院 外科部 泌尿科¹；國立中山大學生物醫學研究所²；台南永康奇美醫院 外科部 泌尿腫瘤科³，病理部⁴；台北馬偕醫院 泌尿科⁵

Advantages of Retrograde Intrarenal Incision versus Laparoscopic Surgery in Management of Pararenal Cysts: A Single-center Experience

Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Chye-Yang Lim¹, Chien-Liang Liu³、Chien-Feng Li⁴、Steven K. Huang¹、Allen W.Chiu⁵

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

² Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan;

⁵Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

Purpose: Renal cysts are a very common disease and parapelvic cysts are often located close to the collecting system, which increases risk of injury to adjacent organs or urine leakage during laparoscopic surgery. We report our experience with retrograde intrarenal surgery (RIRS) for internal incision of parapelvic cysts by flexible ureteroscope with lasers and compare perioperative outcomes for these two treatments.

Materials and Methods: We assessed 83 patients diagnosed with renal cysts who received operations between January 2019 and June 2022 at a single medical center. We excluded 2 patients who initially chose RIRS for internal incision but were converted to laparoscopic surgery because no renal cyst was found under flexible ureteroscopy (URS). We divided patients into two groups based on whether they underwent laparoscopic surgery (Group 1) or RIRS (Group 2) for internal incision. We then analyzed the perioperative outcomes of these two groups.

Results: In total, 60 (74%) patients in Group 1 underwent laparoscopic surgery and 21 (26%) in Group 2 underwent RIRS for internal incision. Average operative times were significantly shorter in Group2 (97.6 mins vs. 56.9 mins, p = 0.002). Laparoscopic surgery was associated with a higher usage rate of postoperative painkillers compared to RIRS (43% vs. 19% respectively, p = 0.047). The lengths of hospital stay were 2.53 and 1.48 days in the laparoscopic group and RIRS group, respectively (p=0.050).

Conclusions: This study demonstrated the advantages of RIRS for internal incision of parapelvic cysts, including shorter operation time, shorter length of hospital stay, and lower use of pain control after operations. Therefore, if patients’ conditions permit, it is recommended that minimal invasive surgery of RIRS for internal incision of parapelvic cyst should be given priority