“一步法”机器人辅助腹腔镜下肾输尿管全长切除术

The“one-step”robot-assisted laparoscopic nephroureterectomy

目的探讨"一步法"机器人辅助腹腔镜行肾输尿管全长切除术在发挥微创技术优势,优化手术操作方面的作用。方法选择2017年1月至2017年12月在中国人民解放军兰州总医院行"一步法"机器人辅助腹腔镜下肾输尿管全长切除术的患者7例。手术体位取60°健侧卧位、整体15°头低脚高位;所有套管孔设计于患侧腹直肌旁一条直线上;在不更换患者体位、不重新连接机械臂的情况下顺利完成手术,肿瘤患者并完成区域淋巴结清扫。结果 7例患者中肾盂尿路上皮癌2例、输尿管尿路上皮癌3例、单侧肾输尿管结核2例,均成功完成手术治疗,无中转开放,病理明确诊断,术中估计出血量50~500mL,均痊愈出院,未发生严重并发症。结论 "一步法"机器人辅助腹腔镜下肾输尿管全长切除术,可使各手术器械间无干扰,不需调整体位或增加套管,也不用重新连接机械臂,可常规应用。

Objective To explore the minimally invasive advantage of＂one-step＂robot-assisted laparoscopic nephroureterectomy.Methods The clinical data of 7 patients undergoing robot-assisted laparoscopic nephroureterectomy during Jan.and Dec.2017 were retrospectively analyzed.The patients lay in a 60°flank position with a 15°Trendelenburg tilt.All ports were placed along the lateral rectus muscle in a straight line.The operation was performed successfully without repositioning patients or redocking the robot.Regional lymph node dissection was performed in all tumor patients.Results In all of the 7 cases,2 were renal pelvis urothelial carcinoma,3 were ureteral urothelial carcinoma,and2 were unilateral renal ureteral tuberculosis.All operations were completed successfully without conversion to open surgery.The intraoperative blood loss was 50-500 ml.All patients were cured without severe complications.Conclusion The＂one-step＂robot-assisted laparoscopic nephroureterectomy can be used routinely.It causes no interference among various surgical instruments.There is no need to reposition the patients or redock the robot.