Comparison Of Short-term Efficacy Of Three Types Of Laparoscopic Partial Nephrectomy In The Treatment Of Renal Tumors

Objective:Through comparing the clinical data of suprapulic robot-assisted laparoendoscopic single-site surgery partial nephrectomy（SRA-LESS-PN）,suprapublic-assisted laparoendoscopic single-site surgery partial nephrectomy（SA-LESS-PN）and retroperitoneal laparoscopic partial nephrectomy（RLPN）for renal tumors,we investigated the efficacy and safety of SRA-LESS-PN and SA-LESS-PN,and comprehensively evaluated the clinical application value of SRA-LESS-PN and SA-LESS-PN.Methods:We retrospectively analyzed the clinical data of 96 cases of SRA-LESS-PN,SA-LESS-PN,and RLPN performed between December 2016 and December 2021 in the Department of Urology,First Affiliated Hospital of Gannan Medical College.Among them,26 cases of SRA-LESS-PN,29 cases of SA-LESS-PN,and 41 cases of RLPN were performed.The three groups of patients were compared and analyzed for intraoperative and postoperative complications,preoperative general clinical data,operation time,intraoperative bleeding,thermal ischemia time,postoperative hospitalization time,postoperative gastrointestinal function recovery time,postoperative drainage tube retention time,pathological type,positive incisional margin rate,renal function change index,tumor control,postoperative pain,postoperative cosmetic effect evaluation,and postoperative quality of life evaluation.All data were statistically analyzed using SPSS 21.0 statistical software.Results:In the present study,96 patients were successfully operated under general anesthesia,and no serious complications occurred intraoperatively or postoperatively.Preoperative general data of patients:in the SRA-LESS-PN group,among 26 cases,10were male and 16 were female,with a body mass index（BMI）of 24.06±3.51 kg/m²and an age of 50.58±13.63 years at the time of surgery;in the SA-LESS-PN group,among 29 cases,18 were male and 11 were female,with a BMI of 22.69±3.12 kg/m²and an age of 52.79±13.63 years at the time of surgery.In the SA-LESS-PN group,out of 29 cases,18 were male and 11 were female,with a BMI of 22.69±3.12 kg/m² and an age of 52.79±9.52 years at the time of surgery;in the RLPN group,out of 41 cases,19 were male and 22 were female,with a BMI of 23.38±3.17 kg/m2 and an age of50.88±9.40 years at the time of surgery.15 cases in the SRA-LESS-PN group were located on the left side and 11 cases on the right side,with a mean maximum tumor diameter of 4.39 mm.The mean maximum tumor diameter was 4.39±1.62 cm,with 16cases of T_1aN₀M₀,7 cases of T_1bN₀M₀,and 3 cases of T_2aN₀M₀;the SA-LESS-PN group was located on the left side in 13 cases and on the right side in 16 cases,with a mean maximum tumor diameter of 3.98±1.44 cm,with 21 cases of T_1aN₀M₀,7 cases of T_1bN₀M₀,and 1 case of T_2aN₀M₀.In the RLPN group,there were 24 cases on the left side and 17 cases on the right side,with a mean maximum tumor diameter of 3.73±1.49cm,29 cases of T_1aN₀M₀,1 case of T_1bN₀M₀,and 1 case of T_2aN₀M₀.The differences between the three groups were not statistically significant（P>0.05）.1.The general intraoperative and postoperative data of the three groups:the mean thermal ischemia time was 19.65±5.08 min,23.93±4.63 min,and 23.00±4.34 min in the SRA-LESS-PN,SA-LESS-PN,and RLPN groups,respectively,and the mean bleeding volume was 121.54±58.29 ml,166.55±69.78 ml,154.88±58.10 ml,visual analogue scales（VAS）24 hours after surgery were 2.96±1.11,2.90±1.17,3.56±1.18,and the mean gastrointestinal recovery time was 1.92±0.62 d,2.26±0.82 d,1.20±0.65d.The SRA-LESS-PN group had a significant advantage over the SA-LESS-PN and RLPN groups in terms of thermal ischemia time and intraoperative bleeding（P<0.05）,and the SRA-LESS-PN and SA-LESS-PN groups had less postoperative pain,but the RLPN group had a shorter recovery time of gastrointestinal function（P<0.05）.the SRA-LESS-PN group,SA-LESS-PN group,and RLPN group had a mean operative time of120.50±43.29 min,136.72±33.89 min,and 128.90±42.21 min,respectively,and a mean postoperative drainage tube retention time of 5.07±1.73 d,4.83±2.03 d,and4.55±1.85 d.The mean postoperative hospitalization days were 7.46±2.50 d,7.24±2.06 d,and 7.10±2.7 d,respectively;one case of secondary anemia and one case of postoperative fever in the SRA-LESS-PN group;one case of postoperative fever and one case of urinary tract infection in the SA-LESS-PN group;and one case of secondary anemia and one case of urinary tract infection in the RLPN group.The differences in the above perioperative data and complication rates were not statistically significant（P>0.05）.2.Changes in renal function:the mean values of preoperative and postoperative e GFR in the SRA-LESS-PN group were 107.49±29.47 and 94.19±38.68ml/min·1.73m²;the mean values of preoperative and postoperative e GFR in the SA-LESS-PN group were 107.90±22.98 and 90.34±25.02 ml/min·1.73m²,and the mean values of preoperative and postoperative e GFR in the RLPN group were 105.17±17.48and 88.27±21.48 ml/min·1.73m².The differences were not statistically significant when comparing the preoperative e GFR,postoperative e GFR and the percentage decrease in postoperative e GFR between the different surgical procedures（P>0.05）.3.Postoperative follow-up:Post-operative follow-up 3-12 months.The SRA-LESS-PN and SA-LESS-PN groups were significantly better than the RLPN group in terms of total PSAQ scores,with statistically significant differences（P<0.05）;there were no statistically significant differences in terms of postoperative quality of life scores,tumor pathology type,and positive margin rate（P>0.05）.One patient in the SRA-LESS-PN group had local recurrence of tumor（chromophobe cell carcinoma with sarcomatoid degeneration）and secondary lung metastases 6 months after surgery and died after surviving with tumor for 2 months;none of the patients in the SA-LESS-PN and RLPN groups had tumor recurrence,metastasis or death.Conclusion:1.SRA-LESS-PN,SA-LESS-PN and RLPN are safe,feasible and effective.2.SRA-LESS-PN is worthy of clinical application since its advantages are greater than those of single-port laparoscopic techniques.