腎結核に対するロボット支援腹腔鏡的腎部分切除術における改良戦略：「屋根開け・基部切除」手技と臨床的転帰

Renal tuberculosis is one of the main reasons for nephrectomy. Early removal of tuberculous lesions can preserve the remaining functional renal tissue and help avoid nephrectomy. Robotic-assisted surgery significantly improves the success rate of partial nephrectomy. The present study aims to introduce a modified robotic surgical approach, the 'unroofing and base excision' technique, for treating localized renal tuberculosis. Four patients with localized renal tuberculosis underwent our modified robot-assisted laparoscopic partial nephrectomy. In traditional approaches, lesions were excised at least 0.5 cm from the margin, and the lesion cavity was left intact. In the current procedure, surgery begins with opening the lesion cavity, and the cavity wall is then lifted to identify the boundary between the lesions and the surrounding normal tissue, allowing excision of the lesions approximately 0.2 cm from the cavity wall. The lesion base is removed from the interior to the exterior of the cavity. The operative times were 130, 120, 145, and 160 minutes, with corresponding warm ischemia times of 27, 25, 35, and 45 minutes. The abdominal drainage tube remained in place for 8, 7, 9, and 5 days, respectively. None of the patients experienced postoperative urine leakage, bleeding, or intraperitoneal infection. The median follow-up was 23.5 months. The preoperative serum creatinine levels were 45, 88, 130, and 55 µmol/L, which changed to 57, 83, 161, and 64 µmol/L at the last follow-up visit. The preoperative glomerular filtration rates of the affected kidneys were 28.3, 20.2, 28.1, and 29.6 mL/min, which declined to 20.5, 16.6, 26.6, and 24.9 mL/min at the last follow-up visit. Radiological imaging showed that the remaining renal tissue on the affected side retained normal morphology and structure at the last follow-up visit. Overall, our 'unroofing and base excision' technique enables the complete removal of tuberculous lesions while maximizing the preservation of functional renal tissue.