Abstract：Objective: To investigate the safety and feasibility of robot-assisted laparoscopic nephron sparing surgery for bilateral synchronous sporadic renal tumors. of bilateral synchronous sporadic renal cell carcinoma who underwent robot-assisted laparoscopic nephron sparing surgery were retrospectively studied. These included 20 males and 1 female with a mean age of 52.0 years old (rang from 39 to 67 years old). The average tumor size was 3.34 cm (rang from 2.0 to 4.0 cm). Pre-operative CT scan or MRI scan showed patients suffered bilateral synchronous sporadic renal tumors. All patients underwent bilateral surgeries in staged procedures according to the patients conditions and tumor characteristics, and every case at least receipted once robot-assisted laparoscopic nephron sparing surgery. The surgical techniques including retroperitoneal partial or radical nephrectomy, trans/retroperitoneal robot-assisted laparoscopic partial nephrectomy and renal artery cold perfusion robot-assisted laparoscopic partial nephrectomy. Results: Forty-two operations on the 21 patients were all successfully performed. There were 38 cases of partial nephrectomy, including 28 cases of robotic and 10 cases of retroperitoneal laparoscopic. 5 cases robotic and one case retroperitoneal laparoscopic partial nephrectomy applied renal artery cold perfusion technique. 4 cases underwent retroperitoneal radical nephrectomy owing to high tumor stage. The mean operation time was 135.3 min (rang from 60 to 240 min). The mean warm ischemia time was 21.9 min (rang from 8 to 45 min) and the mean cold ischemia time for 6 cases of renal artery cold perfusion robotic laparoscopic partial nephrectomy was 65 min (rang from 45 to 120 min). The mean estimated blood loss was144.8 mL (rang from 20 to 1 300 mL). The mean postoperative hospital stay was 6.5 days (rang from 4 to 13 days), and the mean postoperative fasting time was 2 days (rang from 1 to 4 days). The pathological diagnosis confirmed 39 cases of clear cell renal cell carcinoma and one cases of chromophobe and 2 cases of papillary renal cell carcinoma. The mean pre-operative creatinine was 93.0 μmoL/L (rang from 63.5 to 193.7 μmoL/L). The mean post-operative creatinine was124.9 μmoL/L(rang from 70.1 to 258.4 μmoL/L), slightly higher than the preoperative value without significant difference. No dialysis were needed. No recurrence or metastasis was observed during a median follow-up of 23.5 moths (rang from 3 to 36) moths months. Conclusions: Robot-assisted laparoscopic partial nephrectomy take the advantage of enhancing surgical visualization and precision of robotic surgery. It is safe and feasible to use this technique for bilateral synchronous renal cell carcinoma. Its tumor control and renal function reservation are satisfactory in short term results. However, further investigation with a larger population group and longer follow up were required.
黄庆波，马鑫，王保军，巩会杰，李世超，刘启明，李宏召，董隽，朱捷，张旭. 机器人辅助腹腔镜保留肾单位手术治疗同时性双侧肾肿瘤:策略与疗效分析[J]. 微创泌尿外科杂志, 2017, 6(1): 14-18.
Huang Qingbo , Ma Xin , Wang Baojun , Gong Huijie , Li Shicao ,Liu Qiming , Li Hongzhao , Dong Jun , Zhu Jie , Zhang Xu. Robot-assisted laparoscopic nephron sparing surgery for bilateral synchronous sporadic renal tumor: the strategy and outcome. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2017, 6(1): 14-18.
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