Böbrek Tümörlerinde Laparoskopik ve Robotik Cerrahi Tedavi Yöntemleri
Özet
Bu yazı, böbrek tümörlerinin tedavisinde kullanılan minimal invaziv (laparoskopik ve robotik) cerrahi yöntemleri, anatomik temelleri, hasta hazırlık süreçlerini ve klinik sonuçları incelemektedir. Böbrek anatomisinde üç boyutlu görüntülemenin önemi vurgulanarak, transperitoneal ve retroperitoneal gibi farklı cerrahi yaklaşımların avantaj ve dezavantajları karşılaştırılmaktadır. İlk kez 1991'de uygulanan laparoskopik nefrektomi ve ardından gelişen robotik teknoloji, açık cerrahiye kıyasla daha az ağrı, hızlı iyileşme ve benzer onkolojik sağkalım oranları sunarak yaygınlaşmıştır. Radikal nefrektomide büyük tümörler temizlenebilirken, parsiyel nefrektomide nefron koruyucu yaklaşımla tümörün kompleksliğine göre RENAL skoru kullanılmaktadır. Laparoskopik tek bölge cerrahisi (LESS) ve el destekli yöntemler de kozmetik ve kontrol avantajlarıyla öne çıkmaktadır. Cerrahi deneyim arttıkça majör vasküler yaralanma ve kanama gibi intraoperatif komplikasyon riskleri azalmakta, gelişen komplikasyonlar ise anjiyografi veya embolizasyon gibi konservatif yöntemlerle yönetilebilmektedir. Son yıllarda, özellikle robotik parsiyel ve radikal nefrektomi kullanımı dünya genelinde cerrahi standartları değiştirerek hızla artmıştır.
This text examines the minimal invasive (laparoscopic and robotic) surgical methods, anatomical foundations, patient preparation processes, and clinical outcomes used in the treatment of renal tumors. Emphasizing the importance of three-dimensional imaging in renal anatomy, it compares the advantages and disadvantages of different surgical approaches such as transperitoneal and retroperitoneal. Laparoscopic nephrectomy, first performed in 1991, and the subsequently developed robotic technology have become widespread by offering less pain, rapid recovery, and similar oncological survival rates compared to open surgery. While large tumors can be removed in radical nephrectomy, the RENAL score is used according to the complexity of the tumor in partial nephrectomy with a nephron-sparing approach. Laparoendoscopic single-site surgery (LESS) and hand-assisted methods also stand out with their cosmetic and control advantages. As surgical experience increases, the risks of intraoperative complications such as major vascular injury and bleeding decrease, and developing complications can be managed with conservative methods like angiography or embolization. In recent years, the use of robotic partial and radical nephrectomy in particular has increased rapidly, changing surgical standards worldwide.
Referanslar
Kerbl DC, McDougall EM, Clayman RV, et al: A history and evolution of laparoscopic nephrectomy: perspectives from the past and future directionsin the surgical management of renal tumors, J Urol 185(3):1150–1154, 2011
Gill IS, Kavoussi LR, Lane BR, et al: Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors, J Urol 178(1):41–46, 2007.
Lane BR, Novick AC, Babineau D, et al: Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney, J Urol 179(3):847– 851, discussion 852, 2008
Tan HJ, Wolf JS Jr, Ye Z, et al: Complications and failure to rescue after laparoscopic versus open radical nephrectomy, J Urol 186(4):1254–1260, 2011.
Cadeddu JA, Chan DY, Hedican SP, et al: Retroperitoneal access for transperitoneal laparoscopy in patients at high risk for intra-abdominal scarring,J Endourol 13(8):567–570, 1999.
Whalley DG, Berrigan MJ: Anesthesia for radical prostatectomy, cystectomy, nephrectomy, pheochromocytoma, and laparoscopic procedures, Anesthesiol Clin North America 18(4):899–917, x, 2000.
Fan X, Xu K, Lin T, et al: Comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy for renal cell carcinoma: a systematic review and meta-analysis, BJU Int 111(4):611–621, 2013.
Box G, Averch T, Cadeddu J, et al: Nomenclature of natural orifice translumenal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) procedures in urology, J Endourol 22(11):2575–2581, 2008.
Monga M, Premoli J, Skemp N, et al: Forearm compression by laparoscopic hand-assist devices, J Endourol 18(7):654–656, 2004.
Ost MC, VanderBrink BA, Rastinehad AR, et al: Hand pain during hand assisted laparoscopic nephrectomy–an ischemic event?, J Urol 176(1):149–154, 2006.
Berger A, Brandina R, Atalla MA, et al: Laparoscopic radical nephrectomy for renal cell carcinoma: oncological outcomes at 10 years or more, J Urol 182(5):2172–2176, 2009.
Simmons MN, Kaouk J, Gill IS, et al: Laparoscopic radical nephrectomy with hilar lymph node dissection in patients with advanced renal cell carcinoma, Urology 70(1):43–46, 2007.
Steinnerd LE, Vardi IY, Bhayani SB: Laparoscopic radical nephrectomy for renal carcinoma with known level I renal vein tumor thrombus, Urology 69(4):662–665, 2007.
Regan JP, Cho ES, Flowers JL: Small bowel obstruction after laparoscopic donor nephrectomy, Surg Endosc 17(1):108–110, 2003.
Molina WR, Desai MM, Ng CS, et al: Retroperitoneoscopic radical nephrectomy with concomitant distal pancreatectomy: case report, J Endourol 18(7):665–667, 2004.
O’Malley RL, Godoy G, Kanofsky JA, et al: The necessity of adrenalectomy at the time of radical nephrectomy: a systematic review, J Urol 181(5):2009–2017, 2009.
Fornara P, Doehn C, Friedrich HJ, et al: Nonrandomized comparison of open flank versus laparoscopic nephrectomy in 249 patients with benign renal disease, Eur Urol 40(1):24–31, 2001.
Tan HJ, Wolf JS Jr, Ye Z, et al: Population-level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer, Cancer 117(18):4184–4193, 2011.
Wolf JS Jr, Merion RM, Leichtman AB, et al: Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy, Transplantation 72(2):284–290, 2001.
Liu G, Ma Y, Wang S, et al: Laparoscopic versus open radical nephrectomy for renal cell carcinoma: a systematic review and meta-analysis, Transl Oncol 10(4):501–510, 2017.
Nambirajan T, Jeschke S, Al-Zahrani H, et al: Prospective, randomized controlled study: transperitoneal laparoscopic versus retroperitoneoscopic radical nephrectomy, Urology 64(5):919–924, 2004.
Desai MM, Strzempkowski B, Matin SF, et al: Prospective randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy, J Urol 173(1):38–41, 2005.
Garg M, Singh V, Sinha RJ, et al: Prospective randomized comparison of transperitoneal vs retroperitoneal laparoscopic simple nephrectomy, Urology 84(2):335–339, 2014.
Chen YT, Yang SS, Hsieh CH, et al: Hand port-site metastasis of renal-cell carcinoma following hand-assisted laparoscopic radical nephrectomy: case report, J Endourol 17(9):771–775, 2003.
Nelson CP, Wolf JS Jr: Comparison of hand assisted versus standard laparoscopic radical nephrectomy for suspected renal cell carcinoma, J Urol 167(5):1989–1994, 2002
Nadler RB, Loeb S, Clemens JQ, et al: A prospective study of laparoscopic radical nephrectomy for T1 tumors–is transperitoneal, retroperitoneal or hand assisted the best approach?, J Urol 175(4):1230–1233, discussion 1234, 2006.
Okeke AA, Timoney AG, Keeley FX: Hand-assisted laparoscopic nephrectomy: complications related to the hand-port site, BJU Int 90(4):364–367, 2002.
Chung SD, Huang KH, Lai MK, et al: Long-term follow-up of hand-assisted laparoscopic radical nephrectomy for organ-confined renal cell carcinoma, Urology 69(4):652–655, 2007.
Gabr AH, Gdor Y, Strope SA, et al: Approach and specimen handling do not influence oncological perioperative and long-term outcomes after laparoscopic radical nephrectomy, J Urol 182(3):874–880, 2009.
Gill IS, Delworth MG, Munch LC: Laparoscopic retroperitoneal partial nephrectomy, J Urol 152(5 Pt 1):1539–1542, 1994.
Kutikov A, Uzzo RG: The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth, J Urol 182(3):844–853, 2009.
Hayn MH, Schwaab T, Underwood W, et al: RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy, BJU Int 108(6):876– 881, 2011.
Nagahara A, Uemura M, Kawashima A, et al: R.E.N.A.L. nephrometry score predicts postoperative recurrence of localized renal cell carcinoma treated by radical nephrectomy, Int J Clin Oncol 21(2):367–372, 2016.
Watts KL, Ghosh P, Stein S, et al: Value of nephrometry score constituents on perioperative outcomes and split renal function in patients undergoing minimally invasive partial nephrectomy, Urology 99:112–117, 2017.
Johnson A, Sudarshan S, Liu J, et al: Feasibility and outcomes of repeat partial nephrectomy, J Urol 180(1):89–93, discussion 93, 2008.
Watson MJ, Sidana A, Diaz AW, et al: Repeat robotic partial nephrectomy: characteristics, complications, and renal functional outcomes, J Endourol 30(11):1219–1226, 2016.
Huang WC, Levey AS, Serio AM, et al: Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study, Lancet Oncol 7(9):735–740, 2006.
Thompson RH, Boorjian SA, Lohse CM, et al: Radical nephrectomy for pT1 renal masses may be associated with decreased overall survival compared with partial nephrectomy, J Urol 179(2):468–471, discussion 472–463, 2008
Kara O, Maurice MJ, Malkoc E, et al: Comparison of robot-assisted and open partial nephrectomy for completely endophytic renal tumours: a single centre experience, BJU Int 118(6):946–951, 2016.
Wang Y, Shao J, Ma X, et al: Robotic and open partial nephrectomy for complex renal tumors: a matched-pair comparison with a long-term followup, World J Urol 35(1):73–80, 2017.
Shen Z, Xie L, Xie W, et al: The comparison of perioperative outcomes of robot-assisted and open partial nephrectomy: a systematic review and meta-analysis, World J Surg Oncol 14(1):220, 2016.
Wu Z, Li M, Liu B, et al: Robotic versus open partial nephrectomy: a systematic review and meta-analysis, PLoS ONE 9(4):e94878, 2014.
Kaouk JH, Autorino R, Kim FJ, et al: Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases, Eur Urol 60(5):998–1005, 2011.
Abdel-Karim AM, El Tayeb MM, Yahia E, et al: Evaluation of the role of laparoendoscopic single-site surgery vs minilaparoscopy for treatment of upper urinary tract pathologies: prospective randomized comparative study, J Endourol 31(12):1237–1242, 2017.
Gupta A, Ahmed K, Kynaston HG, et al: Laparoendoscopic single-site donör nephrectomy (LESS-DN) versus standard laparoscopic donor nephrectomy, Cochrane Database Syst Rev (5):CD010850, 2016.
Komninos C, Shin TY, Tuliao P, et al: R-LESS partial nephrectomy trifecta outcome is inferior to multiport robotic partial nephrectomy: comparative analysis, Eur Urol 66(3):512–517, 2014.
Choi JE, You JH, Kim DK, et al: Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis, Eur Urol 67(5):891–901, 2015.
Zaid HB, Parker WP, Lohse CM, et al: Patient factors associated with 30-day complications after partial nephrectomy: a contemporary update, Urol Oncol 35(4):153 e151–153 e156, 2017.
Simhan J, Smaldone MC, Tsai KJ, et al: Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy, Eur Urol 60(4):724–730, 2011.
Permpongkosol S, Link RE, Su LM, et al: Complications of 2,775 urological laparoscopic procedures: 1993 to 2005, J Urol 177(2):580–585, 2007.
Simforoosh N, Basiri A, Ziaee SA, et al: Major vascular injury in laparoscopic urology, JSLS 18(3):2014
Hsi RS, Saint-Elie DT, Zimmerman GJ, et al: Mechanisms of hemostatic failure during laparoscopic nephrectomy: review of Food and Drug Administration database, Urology 70(5):888–892, 2007.
Jeon CH, Seong NJ, Yoon CJ, et al: Clinical results of renal artery embolization to control postoperative hemorrhage after partial nephrectomy, Acta Radiol Open 5(8):2016. 2058460116655833.
Jain S, Nyirenda T, Yates J, et al: Incidence of renal artery pseudoaneurysm following open and minimally invasive partial nephrectomy: a systematic review and comparative analysis, J Urol 189(5):1643–1648, 2013.
Filson CP, Banerjee M, Wolf JS Jr, et al: Surgeon characteristics and long-term trends in the adoption of laparoscopic radical nephrectomy, J Urol 185(6):2072–2077, 2011.
Banegas MP, Harlan LC, Mann B, et al: Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States, Urol Oncol 34(10):433 e439–433 e417, 2016.
Jeong IG, Khandwala YS, Kim JH, et al: Association of robotic-assisted vs laparoscopic radical nephrectomy with perioperative outcomes and health care costs, 2003 to 2015, J Am Med Assoc 318(16):1561–1568, 2017.
Alameddine M, Koru-Sengul T, Moore KJ, et al: Trends in utilization of robotic and open partial nephrectomy for management of cT1 renal masses, Eur Urol Focus 2018. S2405_4569(17), Jan 8, 2018.
