達文西機器手臂輔助部分腎臟切除手術比起傳統部分腎臟切除手術
是否有更好的腎元保留率?
曲元正、邵翊紘、馮思中、張英勛、莊正鏗、虞凱傑、林柏宏、劉忠一
林口長庚紀念醫院外科部 泌尿科系
Robotic-assisted partial nephrectomy may help to spare more nephron than open partial nephrectomy
Yuan-Cheng Chu, I-Hung Shao, See-Tong Pang, Ying-Hsu Chang, Cheng-Keng Chuang, Kai-Jie Yu, Po-Hung Lin, Chung-Yi Liu
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou medical center, Taoyuan, Taiwan
Purpose:
Robotic assisted partial nephrectomy was one of the treatment choice for renal cell carcinoma. Because the minimal invasive operation had less admission day and less post-operative pain syndrome, robotic assisted surgery become more and more popular.
The robotic system help operator to have better surgical filed. Therefore, robotic-assisted partial nephrectomy may help spare more nephron than open partial nephrectomy.
Materials and Methods:
Retrospective review the Patients with diagnosis of renal cell carcinoma received partial nephrectomy (open or robotic) between 2007 to 2015 in Chang Gung Memorial hospital in Linkou.
Results:
There are 75 patients received open partial nephrectomy (OPN) and 80 patients received robotic assisted partial nephrectomy (RPN). Mean follow up was 40 months. The post-operative eGFR was significant higher in OPN group. Besides, we calculated resection ratio (actual tumor size/specimen size) showed OPN group is 39.8% and RPN group is 51.7%.
The factors corelated to resection ratio was significantly are robotic assisted system, PADUA score, specimen size and tumor size.
Conclusion:
Robotic-assisted partial nephrectomy possibly provided better resection ratio with similar tumor size. Resection ratio is associated with robotic-assisted system, tumor size and PADUA score, but not associated with positive surgical margin.
Higher complexity lead to less resection ratio, thus fewer parenchyma preserved. Robotic-assisted system could possibly spare more parenchyma and no increased risk of positive surgical margin and complication.