達文西腹腔鏡部分腎臟切除血管平滑肌脂肪瘤
黃韋銘、黃冠華1、李高漢、賴韋宏2
奇美醫學中心 外科部 泌尿外科 ，1泌尿腫瘤科；
2戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Robotic-assisted retroperitoneoscopic partial nephrectomy for renal angiomyolipoma
Ng Woei Ming, Steven Kuan-Hua Huang1, Kau Han Lee, Wei-Hong Lai2
Division of Urology, Department of Surgery, Division of Uro-Oncology1,
Chi Mei Medical Center, Tainan, Taiwan;
Division of Urology2, Department of Surgery,
Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose:
Renal AML is considered as a benign kidney tumor with hamartomatous features. However, it often leads to hemorrhagic complications such as retroperitoneal hematoma or hematuria if large size. Invasive interventions including embolization, nephron-sparing surgery, or even nephrectomy were suggested for larger tumor. Robotic-assisted laparoscopic partial nephrectomy helps in reducing surgical time, warm ischemia time, surgical technique difficulty, intraoperative blood loss comparing to traditional laparoscopic partial nephrectomy. Retroperitoneal approach provides better identification to renal pedicle control; prevent bowel injury and sooner bowel recovery. However, there was less literature in reporting the robotic-assisted laparoscopic partial nephrectomy via retroperitoneal approach for angiomyolipoma.Hence, we are here to share our hospital’s clinical experience.
Materials and Methods:
In Chi-Mei Medical Center, we performed robotic-assisted retroperitoneoscopic partial nephrectomy since August 2012, there were 15 patients met the surgical indication of angiomyolipoma (tumor > 4cm or symptomatic) and underwent the nephron-sparing surgery with single surgeon, as the inclusion criteria. The tumor’s characteristic, intra-operative statuses, post-operative follows up outcome were analysis.
Results:
From august 2012 to September 2015, there were 3 male and 12 female patients met the inclusion criteria. The mean age was 53-year-old. Most of them were asymptomatic (86%) but larger tumor, the average tumor size was 5.22cm (2.3-13). The average nephrometry score was 6.35; Console time was 121mins (40-238); warm ischemia time was 15 min (5-28); estimated blood loss was 550ml (100-1300). Only 2 (13%) of patients need intraoperative transfusion; 2 (13%) patients need post-operative embolization (grade 3a complication). The average post-operative estimated glomerular filtration rate loss was 24% (7-40). The mean length of hospital stay was 4 days (2-8). There was no readmission rate within 30 days. Only 1 patient (6%) showed residual tumor during follow up imaging study
Conclusion:
Robotic-assisted retroperitoneoscopic partial nephrectomy has acceptable morbidity and outcomes, it is safe and feasible in patient of benign renal angiomyolipoma.