達文西輔助多處腎臟腫瘤部份切除手術：個案報告及文獻回顧

林祖丞¹、邵翊紘^1,2、吳俊德^1,2*

林口長庚紀念醫院 外科部泌尿科；長庚大學 醫學系

Robotic-assisted Multi-tumor Partial Nephrectomy:

Case Reports and Review of Literature

Tsu-Chen Lin¹, I-Hung Shao^1,2, Chun-Te Wu^1,2*

1. Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan; 2. College of Medicine, Chang Gung University, Taoyuan City, Taiwan

Introduction:

Partial Nephrectomy has the advantage of preserving the renal function, but carries an increased operative risk. When encountering multifocal tumors, a further increased intra-operative and post-operative complication may be associated with partial nephrectomy when compared with the management of a solitary tumor. Thus, we present 2 cases of multifocal and multilobular renal tumors managed with robotic-assisted partial nephrectomy. 

Case Reports:

The first case was a 56 year old female patient with a past systemic disease of hypertension and dyslipidemia. Upon health examination with abdominal sonography, a right renal mass lesion was observed. Thus, the patient then received computed tomography (CT) examination, which revealed multilobular right renal tumors measuring up to 4.8cm over upper pole. After well-discussion with the patient on the possible treatment plan, robotic-assisted right partial nephrectomy was decided. Pre-operative physical examination and laboratory survey revealed no abnormal finding. The patient then underwent right robotic-assisted partial nephrectomy. The patient underwent an uneventful post-operative recovery and was discharged on post-operative day 5. Pathology of papillary renal cell carcinoma was later confirmed. The second case was a 46 year old female patient with a past history of acute pyelonephritis. She suffered from right flank pain and further examination revealed a right ureter stone and hydronephrosis. During the CT exam, multiple tumors over right kidney were noted. Thus, the patient was referred to our hospital for further examination. CT urography was then arranged and showed 2 right renal tumors with fatty content, measuring 5.4 cm over lower pole and 2.2 cm over middle pole. After well-discussion with the patient, robotic-assisted right partial nephrectomy over the 2 tumors were performed. Pathology of angiomyolipoma of the 2 tumors were later confirmed. The patient then underwent smooth recovery and was discharged on post-operative day 4.

Conclusion:

        Multi-tumor partial nephrectomy has been shown to be associated with an increased surgical risk. However, with carefully selected patients, robotic-assisted partial nephrectomy can be a safe and effective nephron-preserving approach to patients with multilobular and multifocal renal tumors.