机器人单孔腹腔镜下行猪肾部分切除术及肾盂输尿管成形术的初步尝试

Robotic single-site surgery:laparoscopic partial nephrectomy and ureteropelvic angioplasty in pigs

目的初步尝试机器人单孔腹腔镜下行猪肾部分切除术及肾盂输尿管成形术,评估机器人单孔腹腔镜下行泌尿外科重建手术的可行性和不同通道技术的人机工程学效果,总结操作经验。方法猪肾部分切除术:完全侧卧位,平脐水平,沿腹直肌外缘切开4 cm长皮肤切口,钝性分离皮下脂肪,以气腹针建立气腹。按菱形将4个套管置入腹腔,其中左右为8mm的达芬奇机器人金属套管,上下为Surgiquest 10 mm无阀套管。安装机器人臂后,按常规完成肾部分切除术,肾脏缺损采用"滑夹"的无结技术进行全层水平褥式缝合关闭。肾盂输尿管成形术(UPJ):改用Surgiquest新型无阀单孔通道,切口两侧置入8 mm的机器人金属套管。观察镜接12 mm普通腹腔镜套管后,置入单孔通道内,按常规完成UPJ成形术。结果完成肾部分切除术2例,通道建立时间分别为5、8 min,机器人系统安装时间为11、9 min,手术操作时间为55、42 min,温缺血时间23、18min,出血50、20 ml。完成肾盂输尿管成形术2例,通道建立时间为17、12 min,机器人安装时间为5、4 min,手术操作时间为32、25 min,出血均为0 ml。结论机器人单孔腹腔镜手术在合理安置通道后,能顺利完成泌尿外科高难度重建手术;专用机器人单孔通道可获得更理想的人机工程学效果。

Objective To make an initial attempt to use robotic single-site surgery for laparoscopic partial nephrectomy and ureteropelvic angioplasty in pigs,so as to assess the feasibility and ergonomics of the robotic single-site surgery in laparoscopic urological reconstruction surgery and to summarize the manipulation experience.Methods Partial nephrectomy： at a lateral position,a 4 cm incision was made at the level of hilum on the lateral border of the rectus muscle,and the subcutaneous tissue layer was dissected bluntly with the Kelly clamp.After pneumoperitoneum was established by the veress needle,four trocars were introduced in the shape of diamond,including two 8 mm robotic trocars on the left and right sides and two 10 mm surgiquest trocars on the upper and lower sides.After the robotic tower was docked,the procedure of nephrectomy was performed routinely.And the renal defect was closed by a horizontal mattress suture with ＂sliding-clip technique＂.Pyeloplasty： all trocars were removed and a 4 cm long incision was made;the novel suriquest robotic port was introduced into the abdominal cavity.Two 8 mm robotic metal trocars were introduced from two sides of the surgiquest port in the way of ＂1＋1＂.After the robotic arm was docked,the pyeloplasty was performed.Results Partial nephrectomy were successfully performed in two cases,with the time for establishing access being 5 min and 8 min,time for docking the robotic system being 11 min and 9 min,time for operation being 55 min and 42 min, and time of warm ischemia being 23 min and 18 min,and with the blood loss being 50 ml and 20 ml.Pyeloplasty were successfully performed in two cases,with the time for establishing access being 17 min and 12 min,time for docking the robotic system being 5 min and 4 min,and time of operation being 32 min and 25 min,and with no blood loss.Conclusion After proper setup of trocars,the roboic single-site operation under laparoscope can complete the complex urological reconstructive surgery.And the novel surgiquest port can obtain more ideal ergonomics outcomes.