当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術ICUD (回腸導管) の初期経験
【はじめに】当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術 (ICUD) の初期経験を報告する. ICUDを行っている施設は多くないが, 当院では, RARC初回症例から尿路変向術はICUDで開始した.【対象】当院でRARCを施行した14例のうち, 尿路変向術が尿管皮膚瘻となった1例を除く, ICUDで回腸導管造設術を施行した13例. 平均年齢 : 73.7歳. 男女比10 : 3.【結果】総手術時間中央値536分, コンソール時間中央値445分. コンソール時間のうち, 郭清-膀胱遊離時間中央値212分, 回腸導管造設時間中央値183分. 出血量中央値150 mL,...
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| Published in | Japanese Journal of Endourology and Robotics Vol. 35; no. 1; pp. 133 - 142 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本泌尿器内視鏡・ロボティクス学会
2022
Japanese Society of Endourology and Robotics |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2436-875X |
| DOI | 10.11302/jserjje.35.1_133 |
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| Abstract | 【はじめに】当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術 (ICUD) の初期経験を報告する. ICUDを行っている施設は多くないが, 当院では, RARC初回症例から尿路変向術はICUDで開始した.【対象】当院でRARCを施行した14例のうち, 尿路変向術が尿管皮膚瘻となった1例を除く, ICUDで回腸導管造設術を施行した13例. 平均年齢 : 73.7歳. 男女比10 : 3.【結果】総手術時間中央値536分, コンソール時間中央値445分. コンソール時間のうち, 郭清-膀胱遊離時間中央値212分, 回腸導管造設時間中央値183分. 出血量中央値150 mL, 2例で輸血が必要. 合併症は, Clavien-Dindo分類にて麻痺性イレウス : 2例 (I, IIIa), 深部静脈血栓症 (DVT) : 1例 (II), 尿路感染症 : 4例 (全てII) を認めた.【結論】ICUDをRARC初回症例から導入可能であった. 一方で手術時間が長くなることや86歳の症例にDVTを認めており, 高齢者に対する適応は慎重に考慮すべき等, 今後の課題も挙げられた. |
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| AbstractList | 【はじめに】当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術 (ICUD) の初期経験を報告する. ICUDを行っている施設は多くないが, 当院では, RARC初回症例から尿路変向術はICUDで開始した.【対象】当院でRARCを施行した14例のうち, 尿路変向術が尿管皮膚瘻となった1例を除く, ICUDで回腸導管造設術を施行した13例. 平均年齢 : 73.7歳. 男女比10 : 3.【結果】総手術時間中央値536分, コンソール時間中央値445分. コンソール時間のうち, 郭清-膀胱遊離時間中央値212分, 回腸導管造設時間中央値183分. 出血量中央値150 mL, 2例で輸血が必要. 合併症は, Clavien-Dindo分類にて麻痺性イレウス : 2例 (I, IIIa), 深部静脈血栓症 (DVT) : 1例 (II), 尿路感染症 : 4例 (全てII) を認めた.【結論】ICUDをRARC初回症例から導入可能であった. 一方で手術時間が長くなることや86歳の症例にDVTを認めており, 高齢者に対する適応は慎重に考慮すべき等, 今後の課題も挙げられた. ［Introduction］ Robot-assisted radical cystectomy (RARC) has been covered by the National Health Insurance in Japan since 2018. However, not many medical institutions perform intracorporeal urinary diversion (ICUD). In our hospital, RARC was introduced in July 2018, and urinary diversion by ICUD has been performed since then.［Subjects］ Of the 14 patients who underwent RARC between July 2018 and October 2020, 1 patient was excluded due to the use of a ureterocutaneous fistula for urinary diversion, and the remaining 13 patients were selected as study subjects. Urinary diversion by ICUD was performed from the first RARC case. The mean age of the subjects was 73.7 years (67-86 years), and the male to female ratio was 10 : 3.［Results］ The median total surgical time was 536 minutes (443-609 minutes), and the median console time was 445 minutes (365-507 minutes). When the console time was divided into 1) from dissection to bladder removal and 2) ileal conduit procedure, the median time of the former was 212 minutes (160-282 minutes), and the median time of the latter was 183 minutes (138-226 minutes) (Table 1). The median amount of blood loss was 150 mL (40-670 mL). Blood transfusion was required in 2 patients, 1 of whom had renal anemia prior to the surgery. The complications observed were as follows (the grades are according to the Clavien-Dindo classification) : ileus paralytic in 2 patients (grade I and IIIa), deep vein thrombosis (DVT) in 1 patient (grade II), and urinary tract infection in 4 patients (all grade II).［Conclusions］ Although we have been able to perform ICUD since the first RARC case, there have been some challenges. For example, the surgical time required for urinary diversion is too long and needs to be further reduced through the accumulation of more cases. Additionally, since DVT was observed in an 86-year-old patient, careful consideration should be given to the indication for the procedure in elderly patients. 【はじめに】当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術 (ICUD) の初期経験を報告する. ICUDを行っている施設は多くないが, 当院では, RARC初回症例から尿路変向術はICUDで開始した.【対象】当院でRARCを施行した14例のうち, 尿路変向術が尿管皮膚瘻となった1例を除く, ICUDで回腸導管造設術を施行した13例. 平均年齢 : 73.7歳. 男女比10 : 3.【結果】総手術時間中央値536分, コンソール時間中央値445分. コンソール時間のうち, 郭清-膀胱遊離時間中央値212分, 回腸導管造設時間中央値183分. 出血量中央値150 mL, 2例で輸血が必要. 合併症は, Clavien-Dindo分類にて麻痺性イレウス : 2例 (I, IIIa), 深部静脈血栓症 (DVT) : 1例 (II), 尿路感染症 : 4例 (全てII) を認めた.【結論】ICUDをRARC初回症例から導入可能であった. 一方で手術時間が長くなることや86歳の症例にDVTを認めており, 高齢者に対する適応は慎重に考慮すべき等, 今後の課題も挙げられた. |
| Author | 川喜田, 睦司 山内, 裕士 大橋, 朋悦 山田, 浩史 錦見, 俊徳 水野, 秀紀 |
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| References | 3) Zhang JJH, Ericson KJ, Thomas LJ, et al. (2019) Large single-institution comparison of perioperative outcomes and complications in open radical cystectomy, intracorporeal robot-assisted radical cystectomy, and robotic extracorporeal approach. J Urol 203 : 512-521 6) Tan WS, Kelly JD (2018) Is experience with extracorporeal urinary diversion following robotic assisted radical cystectomy necessary before transitioning to intracorporeal urinary diversion? Trans Androl Urol 7 : 735-737 9) 鈴木敦人, 槙山和秀, 蓼沼知之, 他 (2020) ロボット支援腹腔鏡下膀胱全摘と体腔内尿路変向術の導入期における周術期成績. Jpn J Endourol 33 : 318-324 8) 岩本秀人, 森實修一, 本田 正, 他 (2020) 特集 ロボット支援膀胱全摘除術のすべて 尿路変向術 ―回腸導管造設術―. 泌外 33 : 230-235 7) Hussein AA, May PR, Jing Z, et al. (2018) Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy : Results from the International Robotic Cystectomy Consortium. J Urol 199 : 1302-1311 2) Bassetti A, Cacciamani G, Anceschi U, et al. (2019) Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) : a multi-center study. World J Urol 38 : 837-843 1) Ahmed K, Khan SA, Hayn MH, et al. (2014) Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy : Results from the International Robotic Cystectomy Consortium. Eur Urol 65 : 340-347 4) 大山 力, 盛 和行, 畠山真吾, 他 (2020) 特集 ロボット支援膀胱全摘除術のすべて 回腸新膀胱造設術―ECUDとICUD―. 泌外 33 : 236-240 5) Bertolo R, Agudelo J, Garisto J, et al. (2019) Perioperative outcomes and complications after robotic radical cystectomy with intracorporeal or extracorporeal ileal conduit urinary diversion : Head-to-head comparison from a single-institutional prospective study. Urology 129 : 98-105 |
| References_xml | – reference: 2) Bassetti A, Cacciamani G, Anceschi U, et al. (2019) Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD) : a multi-center study. World J Urol 38 : 837-843 – reference: 1) Ahmed K, Khan SA, Hayn MH, et al. (2014) Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy : Results from the International Robotic Cystectomy Consortium. Eur Urol 65 : 340-347 – reference: 4) 大山 力, 盛 和行, 畠山真吾, 他 (2020) 特集 ロボット支援膀胱全摘除術のすべて 回腸新膀胱造設術―ECUDとICUD―. 泌外 33 : 236-240 – reference: 5) Bertolo R, Agudelo J, Garisto J, et al. (2019) Perioperative outcomes and complications after robotic radical cystectomy with intracorporeal or extracorporeal ileal conduit urinary diversion : Head-to-head comparison from a single-institutional prospective study. Urology 129 : 98-105 – reference: 3) Zhang JJH, Ericson KJ, Thomas LJ, et al. (2019) Large single-institution comparison of perioperative outcomes and complications in open radical cystectomy, intracorporeal robot-assisted radical cystectomy, and robotic extracorporeal approach. J Urol 203 : 512-521 – reference: 7) Hussein AA, May PR, Jing Z, et al. (2018) Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy : Results from the International Robotic Cystectomy Consortium. J Urol 199 : 1302-1311 – reference: 9) 鈴木敦人, 槙山和秀, 蓼沼知之, 他 (2020) ロボット支援腹腔鏡下膀胱全摘と体腔内尿路変向術の導入期における周術期成績. Jpn J Endourol 33 : 318-324 – reference: 6) Tan WS, Kelly JD (2018) Is experience with extracorporeal urinary diversion following robotic assisted radical cystectomy necessary before transitioning to intracorporeal urinary diversion? Trans Androl Urol 7 : 735-737 – reference: 8) 岩本秀人, 森實修一, 本田 正, 他 (2020) 特集 ロボット支援膀胱全摘除術のすべて 尿路変向術 ―回腸導管造設術―. 泌外 33 : 230-235 |
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| Snippet | 【はじめに】当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術 (ICUD) の初期経験を報告する. ICUDを行っている施設は多くないが, 当院では, RARC初回症... ［Introduction］ Robot-assisted radical cystectomy (RARC) has been covered by the National Health Insurance in Japan since 2018. However, not many medical... |
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| Title | 当院におけるロボット支援下膀胱全摘除術 (RARC) ＋体腔内尿路変向術ICUD (回腸導管) の初期経験 |
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