Comparison Of Robot-Assisted,3D And Traditional Laparoscopic Nephron Sparing Surgery

Objective To compare clinical outcomes of robot-assisted laparoscopic,3D laparoscopic and traditional laparoscopic nephron sparing surgery(NSS).Methods From March 2012 to April 2015,90 patients underwent laparoscopic nephron sparing surgery in our hospital due to renal carcinoma, including robot-assisted laparoscopic NSS in 21 patients, 3D laparoscopic NSS in 30 patients and traditional laparoscopic NSS in 39 patients.Their data were retrospectively reviewed. The operation time, renal warm ischemia time(WIT),the estimated blood loss,volune of drainage,postoperative hospital stay and total hospitalization charge,post-operative complications between the three groups were observed and compared.Results The surgery was successfully completed in all cases.The operative time were(129.0±13.9)min 、(123.9±18.7)min and(137.0±22.1)min, respectively.There was significant difference between 3D group and LPN group,while no significant difference was found between RAPN group,3D group and LPN group(P >0.05).The renal warm ischemia time was(18.1±5.1) min,(22.2±6.5) min and(25.7±5.4) min,respectively. There was significant difference between each group(P<0.05). The total hospitalization charge was(46858.3±3057.2),(21904.8±2404.3) and(21019.7±1478.9),respectively. There was significant difference between RARP group, 3D group and LPN group,while no significant difference was found between 3D group and LPN group(P >0.05).However,the estimated blood loss,volune of drainage and postoperative hospital stay were similar between the 3 groups(P >0.05).Each 1 case of 3D and LPN group was found delayed wound healing,and another 2 cases of perirenal hematoma were also noticed in LPN group.All complications were cured;In RAPN group,14 cases were clear-cell carcinoma,3 cases were angioleiomyolipoma,2 cases were cystic renal cell carcinoma,1 case was chromophobe cell carcinoma,1 case was oxyphil cell tumor;In 3D group,22 cases were clear-cell carcinoma,6 cases were angioleiomyolipoma,2 cases were papillary cell carcinoma;In LPN group,27 cases were clear-cell carcinoma,7 cases were angioleiomyolipoma,2 cases were cystic renal cell carcinoma,2 cases were papillary cell carcinoma,1 case was chromophobe cell carcinoma.Follow-up ranged from 1 to 32 months,no tumor recurred and/or metastasis developed.All resection margins were negative.Conclusion Three groups of surgical procedures are quite effective,safe and minimally invasive surgicai management for NSS.Traditional laparoscopy was easy to apply and economic; 3D three-dimensional vision in spatial location and the sense of depth and low price has broad application prospects in 3D laparoscopic;And robot assisted laparoscopic have the shortest renal warm ischemia time, although the maintenance cost and treatment cost is hard to be widely spread,but with the accumulation of operation experience as well as the development of medical science and technology,the flexible surgical action of robot-assisted laparoscopic NSS make it the main method in the future of medical development.