使用機器手臂輔助、腹腔鏡及傳統開腹方式執行輸尿管狹窄重建手術的比較

戴盟哲¹、盧星華^1,2、魏子鈞^1,2、范玉華^1,2、林志杰^1,2、林子平^1,2、黃逸修^1,2、

鍾孝仁^1,2、吳宏豪^1,2、黃志賢^1,2、張延驊^1,2、林登龍^1,2

台北榮民總醫院 泌尿部¹；國立陽明大學醫學院 泌尿學科 書田泌尿科學研究中心²

The comparison of robot-assisted, laparoscopic and open method for benign ureteral stricture

Meng-Che Tai¹, Shing-Hwa Lu^1,2, Tzu-Chun Wei^1,2, Yu-Hua Fan^1,2, Chi-Cheh Lin^1,2, Tzu-Ping Lin^1,2, Eric Y.H. Huang^1,2, Hsiao-Jen Chung^1,2, William J.S. Huang^1,2, Howard H.H. Wu^1,2, Yen-Hwa Chang^1,2, Alex T.L. Lin^1,2

Department of Urology, Taipei Veterans General Hospital¹, Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan²

Purpose: There are different approaches for the repair of benign ureteral stricture. Traditionally, these procedures have been performed by open surgery. With development of technology, minimally invasive approaches have been performed widely. The purpose of this study is to compare the outcome, feasibility, and perioperative results of robot-assisted, laparoscopic and open surgery method.

Materials and Methods: We retrospectively collected ureteropelvic junction obstruction and ureteral stricture patients who received reconstruction surgery from January, 2006 to August, 2017. Statistical analyses were performed for patients’ characteristics, perioperative data and clinical outcomes.

Results: Totally 91 patients were enrolled for analysis. We categorized these patients into three groups according the operative approaches. Thirty three patients received reconstructive surgery by robot-assisted method (Group I), 26 patients by laparoscopic method (Group II) and 32 patients by open method (Group III). All the procedures were completed successfully without open conversion. Average estimated blood loss, total operative time and complication rate showed no significant difference. Mean post-operative days of hospitalization were 6.4 ± 3.1 for Group I, 5.2 ± 1.4 for Group II and 8.1 ± 3.4 for Group III (P=0.001). At a median follow-up of 17.8 months, recurrence rate was 15.2%, 23.1% and 21.9% in Group I, Group II and Group III, respectively (P=0.700). These patients received further interventions such as long-term percutaneous nephrostomy, long-term double-J stent placement and balloon dilatation.

Conclusions: In our analysis, minimally invasive approach for ureteral reconstruction surgery could minimize the post-operative hospital stay. There is a tendency of lower recurrent rate by robot-assisted method although it showed no significant difference in limited case numbers. Thus, we need to collect more cases to make the conclusions in the future.