Clinical analysis of intraperitoneal robot-assisted laparoscopic radical nephrectomy for renal large tumor
Wang Qiang1, 2, Shi Lixin1, Wang Baojun1, Ma Xin1, Li Hongzhao1, Gao Jiangping1, Dong Jun1, Zhang Xu1
1.Department of Urology, Chinese PLA General Hospital, Beijing 100853, China; 2.Department of Urology, Organ Transplant Institute of 309th Hospital of PLA
Abstract：Objective: To summarize the experience of transperitoneal approach robotic-assisted laparoscopic surgery in renal large tumor and to discuss the technical safety and surgical outcomes in single center. Methods: We retrospectively analyzed the clinic data of 29 patients with renal large tumor undergoing transperitoneal approach robotic-assisted laparoscopic surgery in our center, and summarized the clinical characteristics and operative outcomes. Results: 101 cases underwent robotic-assisted laparoscopic radical nephrectomy during 2008 October to 2015 April. Among all these cases, 29 were diagnosed as renal large tumor (28.7% of the cases given radical nephrectomy), including 20 males and 9 females with the mean age of (54.9±11.9) years old;. Fourteen tumors were located in the left kidney, and 15 in the right kidney. The maximum diameter was 16 cm and average diameter was (9.56±2.36) cm. Eleven cases (39.29%) were complicated with tumor thrombosis. Twenty cases were accomplished by transperitoneal approach and all procedures were technically successful without open conversion. All the 11 cases combined with tumor thrombus were treated with renal artery embolization. Average operative time was (164.4±40.0) min and average blood loss was 50-1 200 mL. The gastrointestinal function recovered in (2.65±0.71) days, and drains were removed in (3.17±1.36) days. The length of hospital stay after operation was (6.8±2.5) days. No abdominal visceral or great vessel injury happened during the surgery, and no intra-abdominal infection or ileus occurred after surgery in all the cases. Tumor stage was pathologically classified as: 9 cases of T2N0-1M0-1, 14 cases of T3N0-1M0-1 and 6 cases of T4N0-1M0-1. During follow-up period of 1-24 months, metastasis and recurrence were found in 8 cases (27.6%). Conclusions: With initial surgery experience and short-term follow-up, transperitoneal approach robotic-assisted laparoscopic surgery is safe and feasible for renal large tumor. Extensive surgical experiences, long-term and more randomized trials will be required to better assess the appropriateness and potential of this technique.
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