限局性腎腫瘍に対する daVinci^<TM> S システムを用いたロボット支援腹腔鏡下腎部分切除術(RALPN) : 初期5症例の治療成績の検討  [in Japanese] ROBOT-ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY USING daVinci S^<TM> : SURGICAL SYSTEM FOR LOCALIZED RENAL TUMOR : REPORT OF INITIAL FIVE CASES  [in Japanese]

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Abstract

(目的) 近年,小径腎腫瘍に対する手術療法は腹腔鏡下腎部分切除術(LPN)がトレンドである.しかし,温阻血(WIT)が必要となるLPNでは手術操作の煩雑性や時間的な制約により,出血や温阻血の延長が元で合併症のリスクが高まる傾向がある.当施設では2010年8月より小径腎腫瘍に対しロボット支援腹腔鏡下腎部分切除術(RALPN)を開始し,5例のRALPNを施行した.現在までに本邦でのRALPNの報告は無く,本術式の方法,成績や安全性等を検討し報告する.<br> (対象と方法) 5症例の患者年齢は41~65(中央値:61)歳,男性4例,女性1例.腫瘍径は15~28(同:20)mmで,腫瘍位置により経腹膜アプローチ(2例)と後腹膜(3例)を施行した.<br> (結果) 5例のRALPNは単一術者により施行され,全例でロボット手術を完遂し開放手術への移行は無かった.手術時間は2時間30分から4時間24分(中央値:3時間09分),出血量は10から50mL(同:29mL)で,輸血例は無かった.摘出重量は4から13g(同:7g),温阻血時間は13から26分(同:18分)であった.術中術後に特記すべき有害事象を認めず,再手術施行例も無い.病理診断は全例とも腎細胞癌pT1aであり,マージンもフリーであった.<br> (結論) ダビンチを導入することにより,腹腔鏡手術の難点である鉗子操作の制限は改善され,腫瘍切離,止血縫合などの手技が安定化した.ロボット支援腹腔鏡下腎部分切除術は,低侵襲性を維持した上に術中術後の合併症の発生を低下させ,WITを短縮し術後の腎機能やQOLの改善にも有効と考えられた.<br>

(Objectives) For the management of patients with small renal tumor, laparoscopic partial nephrectomy (LPN) provides similar oncological control as radical nephrectomy (RN) and is superior to RN with respect to preserving renal function and preventing chronic kidney disease (CKD). The challenge of LPN is to resect a tumor in a bloodless field within a limited warm ischemia time (WIT), followed by hemostatic renorrhaphy under restricted movement of laparoscopic forceps. Therefore, LPN still remains challenging to even experienced laparoscopic surgeon. DaVinci device improved the movability of forceps in LPN and provided three-dimensional visualization. We evaluated outcome and safety of our first series of robot-assisted laparoscopic partial nephrectomy (RALPN) for localized kidney tumor. There was no previous report of RALPN undertaken in our country.<br> (Patients and methods) Since August 2010, our team carried out RALPN for a total of five cases of renal tumor. There were four males and one female with an age range of 41 to 65 years-old. Size of tumor ranged from 15 to 28mm, located in exophytic region, and four cases in right side and one in left. RALPN was undertaken by single surgeon through transperitoneal approach in two cases and retroperitoneal in tree.<br> (Results) RALPN was completed in all patients without conversion to open or hand-assisted surgery. The median operative time and the estimated blood loss were 189 minutes, ranged from 150 to 264, and 29ml, from 10 to 50, respectively. The median volume of removed tumor and the length of WIT were 7g, ranged from 4 to 13g, and 18 minutes, from 13 to 26 minutes, respectively. No complications or reoperations were associated during or post our RALPN cases. Pathological examination of removed tumor showed renal cell carcinoma with negative surgical margin in all cases.<br> (Conclusions) Introduction of daVinci<sup>TM</sup> device to LPN made this procedure, RALPN, a secured and promising one, which leading to shorten the WIT and to achieve satisfied renorrhaphy. Even for the complex and technically challenging renal tumors, robotic assistance is expected to provide patients the benefit of minimally invasive surgery with safety and satisfactory renal function.<br>

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 102(5), 679-685, 2011-09-20

    THE JAPANESE UROLOGICAL ASSOCIATION

References:  23

Codes

  • NII Article ID (NAID)
    10030041830
  • NII NACSIS-CAT ID (NCID)
    AN00196577
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    00215287
  • NDL Article ID
    11239701
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-203
  • Data Source
    CJP  NDL  J-STAGE 
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