機器手臂輔助之腹腔鏡腎臟部分切除術於4-7cm腎腫瘤經驗
鄭元佐、陳彥達、羅浩倫
高雄長庚紀念醫院 泌尿科
Robotic-assisted Laparoscopic Partial Nephrectomy in clinical T1b Renal Tumors – Single Center Experience
Yuan-Tso Cheng, Yen-Ta Chen, Hao-Lun Luo
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Purpose: Robotic-assisted laparoscopic partial nephrectomy (RALPN) has surpass traditional laparoscopic surgery and be considered alternative standard form of treatment as well as open surgery in small renal mass (tumor size <4 cm, T1a). We investigate the applicability of RALPN in larger counterpart T1 tumor (4cm< tumor size <7cm, T1b) in a single tertiary medical center.
Materials and Methods: We retrospectively review record of patient received RALPN in our institute since 2015 April. Exclusion criteria are tumors size less than 4 cm and tumors were considered benign lesion such as harmatoma preoperatively. RALPN performed in 9 patients have single renal tumor size between 4cm to 7cm preoperatively. The perioperative data is evaluated and discussed.
Results: The average tumor size is 4.7± 0.7cm (range 4.1 to 6cm). The average R.E.N.A.L Nephrometry is 7.4±1.7 (range 6 to 10). Two patients had tumor size in longest diameter underestimated more than 15% in preoperative image study. Guided by intracoporeal ultrosonography, all tumors are resected with margin free of malignant tumor. Using Clavien-Dindo classification, no grade 3 or above complication. Two patients experience intraoperative blood loss more than 500ml and received blood transfusion. All patient regain strength to daily activity within 4 days and average postoperative hospital stay is 3.3 days.
Conclusion: RALPN can be safely performed in clinical T1b renal tumors, even in surgeons are in the learning curve of Robotic surgery. The long-term oncological outcome requires further evaluation.