Robot Yardımlı Parsiyel Nefrektomi: İlk 56 Hastamızda Cerrahi Teknik ve Onkolojik Sonuçların Değerlendirilmesi

Year 2019, Volume: 26 Issue: 1, 72 - 79, 04.03.2019

Ekrem İslamoğlu , Çağatay Özsoy , Kaan Karamık İbrahim Erol , Mutlu Ateş , Murat Savaş

https://doi.org/10.17343/sdutfd.441442

Abstract

Amaç: Kliniğimizde böbrek
tümörü nedeniyle robot yardımlı  parsiyel
nefrektomi (RYPN) yapılan ilk 56 hastamızda cerrahi teknik ve onkolojik
sonuçların değerlendirilmesi.

Materyal ve metod: Mart
2015 ile Şubat 2018 tarihleri arasında RYPN yapılan 56 hastanın  prospektif olarak toplanan verileri geriye
dönük olarak analiz edildi. Preoperatif kan parametrelerinde hemoglobin, serum
üre/kreatinin ve karaciğer fonksiyon testleri bakıldı. Perioperatif
parametrelerde; ameliyat ve iskemi süreleri ile kan transfüzyonları kaydedildi.
Postoperatif olarak hemoglobin değerleri ve patolojik sonuçlar incelendi.

Bulgular: Yaşları
ortalama 59 yıl (32-84) olan 44 erkek ve 12 kadın hastaya transperitoneal
yaklaşınla RYPN uygulandı. Ortalama tümör çapı 3.8 cm (1.5-8) olan 27 sağ, 29 sol
renal ünite opere edildi. Ortalama operasyon süresi 151 dk  (90-250), ortalama sıcak iskemi süresi 24.5
dk (18-35), ortalama kan kaybı 63 ml
(25-100) idi. Bir hastada (% 1.7) transfüzyon gerektiren perirenal hematom
gözlendi. Hiçbir hastada açık cerrahiye dönülme ihtiyacı olmadı ve hiçbir
hastada nefrektomi gerekmedi. Sekiz hastada pelvikaliksiyel sistem açıldığı
için onarım yapıldı ancak hiçbirisine üreteral stent yerleştirme ihtiyacı
duyulmadı. Böbrekteki kitlelerin % 78.5’i primer renal hücreli karsinom olarak
raporlandı ve 4 hastada (% 9.0) cerrahi sınır pozitif olarak belirtildi.
Hastaların ortalama takip süresi 13(4-36) aydı ve hiçbir hastada lokal
rekürrens ya da uzak metastaz görülmedi. Hiçbir hastada insizyonel herni gibi
geç dönem komplikasyon izlenmedi.

Sonuç: RYPN, iyi seçilmiş evre
1 böbrek tümörlerinde güvenle uygulanabilen bir cerrahi yöntemdir. Cerraha
sağladığı sütür atma kolaylığı ve hareket serbestliği sayesinde sıcak iskemi
süresini makul düzeylerde tutarak,  öngörülen
onkolojik ve fonksiyonel sonuçlara, düşük morbidite ile ulaşılmasını sağlar.

Keywords

böbrek tümörü, robotik cerrahi, parsiyel nefrektomi

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