Abstract：
To assess the efficacy of routine use of intraoperative ultrasonography (IOUS) in improving perioperative outcomes in patients undergoing IOUS-guided laparoscopic nephrectomy (IOUS-LN) and conventional laparoscopic nephrectomy (C-LN).
This was a parallel-arm, single-blinded, randomised controlled trial (CTRI/2021/12/038906). All patients undergoing LN, either for benign or malignant causes, were included. Patients undergoing partial/cytoreductive nephrectomy, with venous thrombus were excluded. In the study arm, IOUS-guided renal vascular assessment was performed after colon mobilisation and a standard LN was performed in the control arm. The primary outcome was intraoperative duration. The secondary outcomes were blood loss, need for open conversion, blood transfusion, perioperative complications, duration of Intensive Care Unit (ICU) stay and length of hospitalisation (LOH). The patients were followed for 3 months after surgery.
A total of 104 patients were included, with 52 in each arm. Demographic characteristics were comparable in both arms. A significant reduction in the operative duration (mean [sd] 181.69 [40.8] vs 199.7 [41.8] min, P = 0.02) was seen in the IOUS-LN group. The difference in blood loss showed no significant difference when compared between both groups (median [interquartile range] 84.55 [74-105.5] vs 99.95 [78.5-111] mL, P = 0.08). On subgroup analysis, the reduction in the operative duration was significant in patients who underwent laparoscopic simple nephrectomy (LSN; mean [sd] 194.4 [42.5] vs 221.2 [36.4] min, P = 0.01), whereas comparable operative durations were seen in patients undergoing laparoscopic radical nephrectomy (LRN; mean [sd] 168.96 [35.3] vs 178.3 [35.9] min, P = 0.34). Similar conversion rates were seen in both groups (P = 0.98) along with blood transfusions (P = 0.78). The LOH, ICU stay, and complications were similar in both groups. Significantly less blood loss (P = 0.03) was noted with IOUS in patients undergoing LSN. IOUS did not influence any outcomes in patients undergoing LRN.
Intraoperative ultrasonography significantly reduced the operative duration in LN, but with no significant reduction in the volume of blood loss. Significant reduction in intraoperative duration and blood loss was seen in patients who underwent LSN on subgroup analysis.
This was a parallel-arm, single-blinded, randomised controlled trial (CTRI/2021/12/038906). All patients undergoing LN, either for benign or malignant causes, were included. Patients undergoing partial/cytoreductive nephrectomy, with venous thrombus were excluded. In the study arm, IOUS-guided renal vascular assessment was performed after colon mobilisation and a standard LN was performed in the control arm. The primary outcome was intraoperative duration. The secondary outcomes were blood loss, need for open conversion, blood transfusion, perioperative complications, duration of Intensive Care Unit (ICU) stay and length of hospitalisation (LOH). The patients were followed for 3 months after surgery.
A total of 104 patients were included, with 52 in each arm. Demographic characteristics were comparable in both arms. A significant reduction in the operative duration (mean [sd] 181.69 [40.8] vs 199.7 [41.8] min, P = 0.02) was seen in the IOUS-LN group. The difference in blood loss showed no significant difference when compared between both groups (median [interquartile range] 84.55 [74-105.5] vs 99.95 [78.5-111] mL, P = 0.08). On subgroup analysis, the reduction in the operative duration was significant in patients who underwent laparoscopic simple nephrectomy (LSN; mean [sd] 194.4 [42.5] vs 221.2 [36.4] min, P = 0.01), whereas comparable operative durations were seen in patients undergoing laparoscopic radical nephrectomy (LRN; mean [sd] 168.96 [35.3] vs 178.3 [35.9] min, P = 0.34). Similar conversion rates were seen in both groups (P = 0.98) along with blood transfusions (P = 0.78). The LOH, ICU stay, and complications were similar in both groups. Significantly less blood loss (P = 0.03) was noted with IOUS in patients undergoing LSN. IOUS did not influence any outcomes in patients undergoing LRN.
Intraoperative ultrasonography significantly reduced the operative duration in LN, but with no significant reduction in the volume of blood loss. Significant reduction in intraoperative duration and blood loss was seen in patients who underwent LSN on subgroup analysis.
摘要：
目的：评估常规使用术中超声（IOUS）改善IOUS引导下LN（IOUS-LN）和常规LN（C-LN）患者围手术期预后的疗效。
方法：这是一个平行臂，单盲,随机对照试验（CTRI/2021/12/038906）。所有接受LN的患者,无论是良性还是恶性原因，包括在内。接受部分/细胞减灭术肾切除术的患者，排除静脉血栓。在研究臂中，结肠动员后进行IOUS指导的肾血管评估，并在对照组中进行标准LN。主要结果是术中持续时间。次要结果是失血，需要开放转换，输血,围手术期并发症,ICU住院时间和住院时间（LOH）。术后随访3个月。
结果：纳入了104名患者，每个手臂都有52个。两组的人口统计学特征具有可比性。IOUS-LN组手术时间显着减少（181.69/-40.8vs199.7/-41.8；p=0.02），两组之间比较，失血量差异无统计学意义（84.55（74-105.5）vs99.95（78.5-111）；p=0.08）。在分组分析中，在接受腹腔镜单纯肾切除术（LSN）的患者中，手术时间显着减少（194.4/-42.5vs221.2/-36.4；p=0.01），而腹腔镜下根治性肾切除术患者的手术持续时间相当(168.96+/-35.3vs178.3+/-35.9;p=0.34)。在两组（p=0.98）和输血（p=0.78）中观察到相似的转化率。LOH,两组的ICU住院时间和并发症相似。在接受LSN的患者中，IOUS的失血量明显减少（p=0.03）。IOUS不影响接受LRN的患者的任何结局。
结论：IOUS显著缩短了LN的手术时间，但失血量没有显著减少。在亚组分析中，接受LSN的患者的术中持续时间和失血量显着减少。
方法：这是一个平行臂，单盲,随机对照试验（CTRI/2021/12/038906）。所有接受LN的患者,无论是良性还是恶性原因，包括在内。接受部分/细胞减灭术肾切除术的患者，排除静脉血栓。在研究臂中，结肠动员后进行IOUS指导的肾血管评估，并在对照组中进行标准LN。主要结果是术中持续时间。次要结果是失血，需要开放转换，输血,围手术期并发症,ICU住院时间和住院时间（LOH）。术后随访3个月。
结果：纳入了104名患者，每个手臂都有52个。两组的人口统计学特征具有可比性。IOUS-LN组手术时间显着减少（181.69/-40.8vs199.7/-41.8；p=0.02），两组之间比较，失血量差异无统计学意义（84.55（74-105.5）vs99.95（78.5-111）；p=0.08）。在分组分析中，在接受腹腔镜单纯肾切除术（LSN）的患者中，手术时间显着减少（194.4/-42.5vs221.2/-36.4；p=0.01），而腹腔镜下根治性肾切除术患者的手术持续时间相当(168.96+/-35.3vs178.3+/-35.9;p=0.34)。在两组（p=0.98）和输血（p=0.78）中观察到相似的转化率。LOH,两组的ICU住院时间和并发症相似。在接受LSN的患者中，IOUS的失血量明显减少（p=0.03）。IOUS不影响接受LRN的患者的任何结局。
结论：IOUS显著缩短了LN的手术时间，但失血量没有显著减少。在亚组分析中，接受LSN的患者的术中持续时间和失血量显着减少。
