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首页> 外文期刊>BJU international >Early unclamping technique during robot-assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity
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Early unclamping technique during robot-assisted laparoscopic partial nephrectomy can minimise warm ischaemia without increasing morbidity

机译：机器人辅助腹腔镜部分肾切除术中的早期松开术可以最大程度地减少局部缺血，而不会增加发病率

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Objective To compare perioperative outcomes of early unclamping (EUC) vs standard unclamping (SUC) during robot-assisted partial nephrectomy (RAPN), as early unclamping of the renal pedicle has been reported to decrease warm ischaemia time (WIT) during laparoscopic PN. Patients and Methods A retrospective multi-institutional study was conducted at eight French academic centres between 2009 and 2013. Patients who underwent RAPN for a renal mass were included in the study. Patients without vascular clamping or for whom the decision to perform a radical nephrectomy was taken before unclamping were excluded. Perioperative outcomes were compared using the chi-squared and Fisher's exact tests for discrete variables and the Mann-Whitney test for continuous variables. Predictors of WIT and estimated blood loss (EBL) were assessed using multiple linear regression analysis. Results In all, there were 430 patients: 222 in the EUC group and 208 in the SUC group. Tumours were larger (35.8 vs 32.3 mm, P = 0.02) and more complex (R.E.N.A.L. nephrometry score 6.9 vs 6.1, P < 0.001) in the EUC group but surgeons were more experienced (>50 procedures 12.2% vs 1.4%, P < 0.001). The mean WIT was shorter (16.7 vs 22.3 min, P < 0.001) and EBL was higher (369.5 vs 240 mL, P = 0.001) in the EUC group with no significant difference in complications or transfusion rates. The results remained the same when analysing subgroups of complex renal tumours (R.E.N.A.L. nephrometry score ≥7) or RAPN performed by less experienced surgeons (<20 procedures). In multivariable analysis, EUC was predictive of decreased WIT (β -0.34; P < 0.001) but was not associated with EBL (β -0.09, P = 0.16). Conclusions EUC can reduce WIT during RAPN without increasing morbidity even for complex renal tumours or when being performed by less experienced surgeons.
机译：目的比较机器人辅助部分肾切除术（RAPN）期间早期松开（EUC）与标准松开（SUC）的围手术期结局，因为据报道，肾蒂的早期松开可减少腹腔镜PN期间的温暖缺血时间（WIT）。患者与方法2009年至2013年间，在法国的8个学术中心进行了一项回顾性多机构研究。该研究包括接受RAPN肾肿块治疗的患者。没有血管夹紧或在松开之前已决定行根治性肾切除术的患者被排除在外。使用卡方检验和Fisher精确检验（离散变量）和Mann-Whitney检验（连续变量）比较围手术期结局。使用多元线性回归分析评估WIT的预测因子和估计的失血量（EBL）。结果总共有430例患者：EUC组222例，SUC组208例。 EUC组的肿瘤更大（35.8 vs 32.3 mm，P = 0.02）和更复杂（RENAL肾病得分6.9 vs 6.1，P <0.001），但外科医生经验更丰富（> 50例手术，12.2％vs 1.4％，P <0.001 ）。 EUC组的平均WIT较短（16.7 vs 22.3 min，P <0.001），EBL较高（369.5 vs 240 mL，P = 0.001），并发症或输血率无明显差异。分析复杂肾脏肿瘤的亚组（R.E.N.A.L.肾功能检查得分≥7）或经验不足的外科医生进行的RAPN（<20程序）时，结果仍然相同。在多变量分析中，EUC可以预测WIT降低（β-0.34; P <0.001），但与EBL无关（β-0.09，P = 0.16）。结论EUC可以降低RAPN期间的WIT，而不会增加发病率，即使是复杂的肾肿瘤或由经验不足的外科医生进行时也是如此。

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