達文西機械手臂輔助腹腔鏡部份腎切除: 單一腎臟多部位腫瘤切除病例報告
洪巨軒、王彥傑、林志明
國泰綜合醫院 外科部 泌尿外科
Roboitc-assisted laparoscopic partial nephrectomy:
Multipfocal tumors in solitary kidney
Chu-Hsuan Hung, Yen-Chieh Wang, Chih-Ming Lin
Division of Urology, Department of Surgery, Cathay General Hospital
Abstract: Partial nephrectomy was gold standard for renal tumor less than 4cm. When in the situation of multifocal tumors (3 or more), the concern of nephrectomy or partial nephrectomy is a important issue.
We report a case of a 52 year-old man presenting with right multiple renal tumor. He received left nephrectomy 4 years ago while left renal tumor noted in health examination via abdominal computed tomography (CT). The pathology revealed left renal cell carcinoma (RCC), clear cell type, pT2aN0M0, stage II. After surgery, he got CT followed up annually. However, follow-up CT revealed three tumors at right kidney, suspected RCC. Due to in solitary kidney status, we discussed with patient about the advantages and disadvantages between nephrectomy and partial nephrectomy.
After discussion with patient, we choose robotic-assisted laparoscopic partial nephrectomy for the multipfocal renal tumors. The warm ischemia time was 29 minutes. Estimated blood loss was 50ml. Post-op course was smooth. The right kidney pathology reported RCC, clear cell type, pT1b(3)N0M0, stage I. The post-op creatinine was 1.47 mg/dL, similar as pre-op data. There was no complication during post-op 3 months follow-up.
Conclusion: Robotic partial nephrectomy for 3 or more tumors in a single kidney is safe and feasible in selected patients. Robotic partial nephrectomy is a well-established technique in the management of multifocal tumors in a single kidney.