.: ORİJİNAL ARAŞTIRMA
Impact of Surgical Method and Renal Nephrometry Score on Perioperative Results of Minimally Invasive Partial Nephrectomies
Minimal İnvaziv Parsiyel Nefrektomilerin Perioperatif Sonuçlarında Cerrahi Yöntem ve Renal Nefrometri Skorunun Etkisi
J Reconstr Urol. 2020;10(2):61-8
doi: 10.5336/urology.2020-78102
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Partial nephrectomy (PN) is the optimal surgical treatment for localised renal tumors. In addition, minimally invasive PN methods are preferred more due to the superior aspects to open surgery, The aim of this study was to compare the perioperative outcomes of robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN), performed by a single surgeon, according to the surgical method and RENAL nephrometry score (RNS). Material and Methods: In our study, the records of patients who underwent PN between August 2009 and December 2016 at our hospital were reviewed retrospectively. Warm ischemia time (WIT) (min), operative time (OT) (min) and estimated blood loss (EBL) (cc) were evaluated as perioperative parameters. Patients were divided into groups according to surgical method as LPN group (n=30) and RPN group (n=30), and RNS [RNS<7 (n=44), Group A and RNS≥7 (n=16), Group B] regardless of the surgical method, and the perioperative values were compared. Results: There were no statistically significant differences in patient and tumor characteristics between the groups. There was no statistically significant difference in RNS between LPN and RPN groups. WIT, OT and EBL were statistically lower in RPN when compared to LPN and in Group A when compared with Group B. Conclusion: Robot-assisted surgical approach is an effective alternative method for perioperative parameters to pure laparoscopy for PN. Nevertheless, surgeons' choice of surgical methods that they have experienced will enable them to achieve clinically satisfactory results. Low tumor complexity in RNS is associated with less EBL, shorter OT and WIT in partial nephrectomies.
Keywords: Nephrectomy; laparoscopy; robotic surgical procedures
Objective: Partial nephrectomy (PN) is the optimal surgical treatment for localised renal tumors. In addition, minimally invasive PN methods are preferred more due to the superior aspects to open surgery, The aim of this study was to compare the perioperative outcomes of robotic partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN), performed by a single surgeon, according to the surgical method and RENAL nephrometry score (RNS). Material and Methods: In our study, the records of patients who underwent PN between August 2009 and December 2016 at our hospital were reviewed retrospectively. Warm ischemia time (WIT) (min), operative time (OT) (min) and estimated blood loss (EBL) (cc) were evaluated as perioperative parameters. Patients were divided into groups according to surgical method as LPN group (n=30) and RPN group (n=30), and RNS [RNS<7 (n=44), Group A and RNS≥7 (n=16), Group B] regardless of the surgical method, and the perioperative values were compared. Results: There were no statistically significant differences in patient and tumor characteristics between the groups. There was no statistically significant difference in RNS between LPN and RPN groups. WIT, OT and EBL were statistically lower in RPN when compared to LPN and in Group A when compared with Group B. Conclusion: Robot-assisted surgical approach is an effective alternative method for perioperative parameters to pure laparoscopy for PN. Nevertheless, surgeons' choice of surgical methods that they have experienced will enable them to achieve clinically satisfactory results. Low tumor complexity in RNS is associated with less EBL, shorter OT and WIT in partial nephrectomies.
Keywords: Nephrectomy; laparoscopy; robotic surgical procedures
ÖZET
Amaç: Lokalize böbrek tümörlerinde parsiyel nefrektomi (PN) ideal cerrahi tedavidir. Ek olarak, açık cerrahiye olan üstün yanlarından dolayı minimal invaziv PN yöntemleri daha fazla tercih edilmektedir. Bu çalışmanın amacı, tek cerrah tarafından gerçekleştirilmiş olan robotik parsiyel nefrektomi (RPN) ve laparoskopik parsiyel nefrektomi (LPN)lerde, cerrahi yöntem ve RENAL nefrometri skoru (RNS)'na göre perioperatif sonuçları karşılaştırmaktır. Gereç ve Yöntemler: Çalışmamızda, hastanemizde Ağustos 2009-Aralık 2016 tarihleri arasında PN yapılan hastaların kayıtları retrospektif olarak incelenmiştir. Sıcak iskemi zamanı [warm ischemia time (WIT)], operasyon zamanı [operative time (OT)] ve tahmini kan kaybı [estimated blood loss (EBL)] perioperatif parametreler olarak değerlendirilmiştir. Hastalar, cerrahi yönteme göre LPN grubu (n=30) ve RPN grubu (n=30) ve ayrıca cerrahi yönteme bakılmaksızın RNS'ye göre Grup A (RNS<7, n=44) ve Grup B (RNS≥7, n=16) olarak ayrılmış, perioperatif değerler karşılaştırılmıştır. Bulgular: Hasta ve tümör özellikleri açısından gruplar arasında istatistiksel farklılık gözlenmemiştir. LPN ve RPN grupları arasında RNS açısından istatistiksel farklılık gözlenmemiştir. WIT, OT ve EBL parametreleri, LPN grubuna göre RPN grubunda ve Grup A'ya göre Grup B'de istatistiksel olarak daha düşük saptanmıştır. Sonuç: PN'de robot yardımlı cerrahi yaklaşım, perioperatif sonuçlar açısından pür laparoskopiye alternatif olan etkili bir yöntemdir. Bununla birlikte, cerrahların tecrübeli oldukları cerrahi yöntemi seçmeleri, klinik olarak tatmin edici sonuçlar elde etmeyi sağlayacaktır. RNS'de düşük tümör kompleksliği, PN'lerde daha az EBL, daha kısa OT ve WIT ile ilişkilidir.
Anahtar Kelimeler: Nefrektomi; laparoskopi; robotik cerrahi prosedürler
Amaç: Lokalize böbrek tümörlerinde parsiyel nefrektomi (PN) ideal cerrahi tedavidir. Ek olarak, açık cerrahiye olan üstün yanlarından dolayı minimal invaziv PN yöntemleri daha fazla tercih edilmektedir. Bu çalışmanın amacı, tek cerrah tarafından gerçekleştirilmiş olan robotik parsiyel nefrektomi (RPN) ve laparoskopik parsiyel nefrektomi (LPN)lerde, cerrahi yöntem ve RENAL nefrometri skoru (RNS)'na göre perioperatif sonuçları karşılaştırmaktır. Gereç ve Yöntemler: Çalışmamızda, hastanemizde Ağustos 2009-Aralık 2016 tarihleri arasında PN yapılan hastaların kayıtları retrospektif olarak incelenmiştir. Sıcak iskemi zamanı [warm ischemia time (WIT)], operasyon zamanı [operative time (OT)] ve tahmini kan kaybı [estimated blood loss (EBL)] perioperatif parametreler olarak değerlendirilmiştir. Hastalar, cerrahi yönteme göre LPN grubu (n=30) ve RPN grubu (n=30) ve ayrıca cerrahi yönteme bakılmaksızın RNS'ye göre Grup A (RNS<7, n=44) ve Grup B (RNS≥7, n=16) olarak ayrılmış, perioperatif değerler karşılaştırılmıştır. Bulgular: Hasta ve tümör özellikleri açısından gruplar arasında istatistiksel farklılık gözlenmemiştir. LPN ve RPN grupları arasında RNS açısından istatistiksel farklılık gözlenmemiştir. WIT, OT ve EBL parametreleri, LPN grubuna göre RPN grubunda ve Grup A'ya göre Grup B'de istatistiksel olarak daha düşük saptanmıştır. Sonuç: PN'de robot yardımlı cerrahi yaklaşım, perioperatif sonuçlar açısından pür laparoskopiye alternatif olan etkili bir yöntemdir. Bununla birlikte, cerrahların tecrübeli oldukları cerrahi yöntemi seçmeleri, klinik olarak tatmin edici sonuçlar elde etmeyi sağlayacaktır. RNS'de düşük tümör kompleksliği, PN'lerde daha az EBL, daha kısa OT ve WIT ile ilişkilidir.
Anahtar Kelimeler: Nefrektomi; laparoskopi; robotik cerrahi prosedürler
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