Experience of robot-assisted partial nephrectomy: A report of 230 cases
10.16781/j.0258-879x.2016.09.1159
- Author:
Yang WANG
1
Author Information
1. Department of Urology, Changhai Hospital, Second Military Medical University
- Publication Type:Journal Article
- Keywords:
Kidney neoplasms;
Laparoscopy;
Partial nephrectomy;
Robotics
- From:
Academic Journal of Second Military Medical University
2016;37(9):1159-1164
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the efficacy and safety of robot-assisted partialnephrectomy (RAPN) by summarizing the surgical experience Methods The clinical data of 230 patients who underwent RAPN ln ChanghalHospital from March 2012 to June 2015 were analyzed. The patients included 161males and 69 females, with an average age of (51. 1± 12. 1) years old. There were 111 tumors ln the lett kidney and 118 in the right, with 1 case having tumors in bilateral kidneys. There were 13 hilar tumors and 8 endophytic tumors. There were 54 large tumors (>4 cm in diameter) and 3 tumors in solitary kidney. Preoperative glomerular filtration rate (GFR) test was normal in all cases. Kidney CTA scan showed single branch of the renal artery in 211 cases, two branches in 16 cases, and three branches in 3 cases. Results The surgery was successfully completed in all the 230 cases. A total of 198 cases were via transperitoneal approach, including 191 cases with medial camera port placement, 6 with lateral camera port placement and 1 with mix port placement; and 32 cases were via retroperitoneal approach. The mean surgery duration was (196±59) min and the mean blood loss was (148. 3± 126. 5) mL, despite 2 cases having a blood loss of more than 1 000 mL. There were 3 intraoperative blood transfusion cases and one conversion to open surgery. The mean warm ischemia time was (20. 7 ±9. 1) min. Themean postoperative hospital stay was (8. 9 ±3. 3) days. Serious gross hematuria occurred in 3 patients after the surgery, which was relieved by conservative treatment in one patient andDSA super-selective bleeding artery embolization in 2 patients. Urinary leakage occurred in one case and was cured by complete drainage. Cerebral embolism occurred in one case. Postoperative pathology reported malignant tumor in 195 cases, including renal clear cell carcinoma in 179 cases, chromophobe cell carcinoma in 11 cases and papillary renal cell carcinoma in 5 cases. T1N0M0 tumor was found in 154 cases and T2aN0M0 tumor was found in 41 cases; angiomyolipoma and other benign tumors were found in 35 cases. The maximum diameter of the tumor ranged from 1. 3 to 9. 0 cm, averaging (3. 41 + 1. 57) cm. There were no positive surgery margins in our cohort Conclusion RAPN is a safe and effective surgery for local renal tumors, and it has significant advantages in complete resection of the renal tumors and the reconstruction of the kidney.
