機械手臂輔助部分腎臟切除手術之臨床預後：

臺北榮民總醫院十五年經驗

楊牧穎¹、蘇楷森¹、蔡承翰^1,2、許自翔^1,2、陳威任^1,2、

黃子豪^1,2、魏子鈞^1,2、黃奕燊^1,2、林志杰^1,2、林登龍^1,2、黃逸修^1,2、鍾孝仁^1,2

¹台北榮民總醫院泌尿部

²國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心

Outcomes of Robotic-Assisted Partial Nephrectomy for Renal Tumors: A 15-year Experience of Taipei Veterans General Hospital

Mu-Ying Yang¹, Kai-Sen Su¹, Cheng-Han Tsai^1,2, Tzu-Hsiang Hsu^1,2, Wei-Jen Chen^1,2, Tzu-Hao Huang^1,2, Tzu-Chun Wei^1,2, I-Shen Huang^1,2, Chih-Chieh Lin^1,2,

Alex Tong-Long Lin^1,2, Eric Yi-Hsiu Huang^1,2, Hsiao-Jen Chung^1,2

¹ Department of Urology, Taipei Veterans General Hospital

² Department of Urology, School of Medicine and Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Partial nephrectomy is the gold standard for localized renal cell carcinoma (RCC) according to international guidelines. Robotic-assisted partial nephrectomy (RAPN) has emerged as a preferred minimally invasive approach, offering superior surgical precision and perioperative outcomes. However, achieving optimal oncological control while preserving renal function remains technically demanding, particularly in complex tumors. We report the outcomes of a high-volume center with standardized RAPN protocols and long-term experience.

Materials and Methods:

We retrospectively analyzed 835 RAPN procedures performed at Taipei Veterans General Hospital (2009–2024). A standardized workflow featuring preoperative 3D imaging and individualized planning was implemented. Surgical complexity was categorized by R.E.N.A.L. and PADUA scores. Global renal function was assessed via eGFR, while split renal function was evaluated using Technetium-99m DTPA renal scintigraphy to measure effective renal plasma flow (ERPF) pre- and postoperatively.

Results:

A total of 835 RAPN procedures were performed in 825 patients (including 9 bilateral and 1 metachronous repeat RAPN), comprising 603 RCC and 232 benign lesions. The median tumor size was 3.6 (IQR 2.6–5.0) cm. Median R.E.N.A.L. and PADUA scores were 8 (IQR 7–9) and 9 (IQR 8–10), respectively, indicating a high proportion of complex tumors. Median warm ischemia time was 23 (IQR 17–34) minutes, and median blood loss was 150 (IQR 80–300) mL. The transfusion rate was 8.0%, and the major complication rate (Clavien-Dindo ≥III) was 4.4%. Renal function was well preserved, with a median eGFR decline of 10.7% (IQR 1.2–19.7) at 12 months. Regarding split renal function, the median decline in ERPF of the affected kidney was 18.3% (IQR 5.6–30.9) at the 12-month follow-up. Notably, 0% positive surgical margin was identified among the 603 RCC cases. Over a median follow-up of 45 (IQR 21–86) months, local recurrence and distant metastasis rates were 1.7% and 2.7%, respectively. The 10-year cancer-specific survival rate was 98.6%.

Conclusions:

Our real-world data from a high-volume institution demonstrate that RAPN is safe and effective, providing exceptional oncological control and renal function preservation even in complex renal tumors. These findings support RAPN as the standard approach for nephron-sparing surgery in routine clinical practice