经腹膜入路与后腹膜入路在机器人辅助肾部分切除术围手术期预后的比较

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery Pub Date : 2025-05-19 DOI:10.1111/ases.70086

Naoki Akagi, Riki Obayashi, Akihiro Yamamoto, Akihiko Nagoshi, Tasuku Fujiwara, Atsushi Igarashi, Yuto Hattori, Noboru Shibasaki, Mutsushi Kawakita, Toshinari Yamasaki

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引用次数: 0

摘要

机器人辅助部分肾切除术是治疗小肾肿瘤的常用手术技术，并已扩展到包括大或复杂肿瘤在内的具有挑战性的病例。然而，没有先前的报道比较腹膜后入路和经腹膜入路对不同肾肿瘤部位的手术结果。我们的目的是比较基于肿瘤位置的机器人辅助部分肾切除术的围手术期结果。方法系统分析2015年2月至2023年4月在我院施行的380例机器人辅助部分肾切除术的围手术期结果。经腹膜前部和后腹膜后部的病例被定义为典型病例，而经腹膜后部和前腹膜后部的病例被定义为非典型病例。记录病例和患者特征并用于倾向评分匹配。结果经腹膜/后腹膜病例的总体分布为154/226。经配对，鉴定出37例前侧，15例后侧，26例外侧，89例典型，39例非典型。总的来说，腹膜后入路在缓解时间和三直肠成功率方面优于经腹膜入路；在非典型病例中，腹膜后切口在手术时间、坐位时间和三节直肠成就方面优于腹膜后切口。在腹膜后入路的非典型病例中，腹部手术史和肾脏解剖是选择入路的主要决定因素。位于肾门后部的肿瘤不是向背侧而是向腹侧突入肾窦，是非典型病例选择经腹膜入路的常见原因。结论腹膜后入路除肝门前肿瘤外，其他任何部位均可获得较短的手术时间。这两种方法都是安全可行的。

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Comparison of Perioperative Outcomes Between Transperitoneal and Retroperitoneal Approaches for Robot-Assisted Partial Nephrectomy by Tumor Locations

Introduction

Robot-assisted partial nephrectomy is a common surgical technique for the management of small renal tumors and has extended its utility to challenging cases, including large or complex tumors. However, no previous reports have compared the surgical outcomes of the retroperitoneal and transperitoneal approaches for different renal tumor sites. We aimed to compare the perioperative outcomes between these approaches in robot-assisted partial nephrectomy based on tumor location.

Methods

Perioperative outcomes were systematically analyzed in 380 robot-assisted partial nephrectomy procedures performed at our institution between February 2015 and April 2023. Transperitoneal for anterior and retroperitoneal for posterior cases were defined as typical cases, whereas transperitoneal for posterior/lateral cases and retroperitoneal for anterior/lateral cases were defined as atypical. Case and patient characteristics were recorded and used for propensity score matching.

Results

The overall distribution of the transperitoneal/retroperitoneal cases was 154/226. After matching, 37 anterior, 15 posterior, 26 lateral, 89 typical, and 39 atypical cases were identified. The retroperitoneal approach was superior to transperitoneal in terms of console time and trifecta achievement rate in the overall patient; retroperitoneal was superior in terms of operative time, console time, and trifecta achievement in atypical cases. In atypical cases of the retroperitoneal approach, a history of abdominal surgery and renal anatomy were the predominant determinants of approach selection. Posterior tumors located in the renal hilum, which protruded not dorsally but ventrally into the renal sinus, were a common reason to select the transperitoneal approach in atypical cases.