以軟式輸尿管鏡與達文西機器手臂治療大於兩公分以上的腎盂結石的預後分析

葉育汝¹、翁淑娟²、林友翔¹、曹書瀚¹、蔡翰宇¹、陳建綸¹、張慧朗¹、侯鎮邦¹

 Comparative analysis of the surgical outcomes for renal pelvic stones larger than 2 cm using the flexible ureteroscope and the Da Vinci robotic surgery

Yu-Ju Yeh, Shu-Chuan Weng, Yu-Hsiang Lin, Chien-Lun Chen, Phei-Lang Chang, Chen-Pang Hou

Purpose:

This study aims to evaluate the surgical outcomes of patients with renal pelvic stones larger than 2 cm who underwent retrograde intrarenal surgery (RIRS) lithotripsy and compare the results with those who received robotic-assisted laparoscopic pyelolithotomy (RALP).

Materials and Methods:

The records were obtained from December 2016 to July 2022 for selected patients who underwent RIRS or RALP in our institution. The patients were excluded if their ECOG performance status were >1, stone diameter < 20 mm, presented with multiple intracalyceal stones or complex staghorn stones, having a cancer history or congenital urinary system abnormality. Those who had undergone urinary system reconstruction surgery were also excluded. The patients were able to decide to receive the procedure with an RIRS or a RALP. A single surgeon carried out all the surgeries. Their preoperative, operative, and postoperative data were recorded. The clinical results, such as urinary tract infection, analgesics requirement, the rate of returning to the emergent room, the rates of stone clearance, surgical complications, and the medical expenditure for the treatment courses, were analyzed and compared between the two cohorts.

Results:

In total, 77 patients met the inclusion criteria. Among them, 50 patients received RIRS lithotripsy, whereas 27 received RALP. Our analysis found that the RALP group had a larger mean stone diameter and a higher degree of hydronephrosis than the RIRS group. The other pre-op variables, such as age, gender, ASA score, and commodities, were not significantly different between the two groups. The RIRS group was superior to the RAPL group in regards to operative time (77 vs. 174 minutes, p<0.001), days of post-op hospital stay (1.6 vs. 3.6 days, p<0.001), pain scores (p<0.001), and the cost of hospitalization (82012 vs.193153 NT, p<0.001). Regarding postoperative outcomes, our study revealed comparable rates of postoperative urinary tract infection, rates of prolonged analgesics requirements, and rates of returning to ER between the two groups. However, the RALP group had a higher stone clearance rate than the RIRS group (81.5% vs. 52.0%, p = 0.014). 

Conclusion:

For surgical treatment of renal pelvis stones > 2 cm, RAPL has a better stone clearance rate. Although the safety was comparable between the two procedures, patients who received RAPL also paid a more significant price in terms of increased medical expenses, extended hospital stays, and surgical wound pain.