隐蔽切口法在机器人辅助腹腔镜下儿童肾肿瘤根治术标本取出中的应用体会

Application of hidden incision for specimen extraction during robot-assisted laparoscopic pediatric radical nephrectomy

目的 初步探讨隐蔽切口法(Hidden Incision)在机器人辅助腹腔镜下儿童肾肿瘤根治术(Robot-assisted laparoscopic radical nephrectomy,RAL-RN)标本取出中应用的价值。方法 回顾性分析2015年8月至2019年2月收治的6例机器人辅助腹腔镜下肾肿瘤根治性切除患儿的临床资料。其中男4例,女2例;平均年龄3岁11个月;肾母细胞瘤3例,Xp11.2易位/TFE3基因融合相关肾癌2例,后肾腺瘤1例;肿瘤位于左肾3例,右肾3例。术中均采取健侧60°卧位,目镜Trocar位于脐缘(病灶对侧缘),操作孔1位于前正中线脐上6~7 cm(具体取决于患儿腹壁空间),操作孔2进皮点位于前正中线与下腹部腹横纹交点,进腹腔点在进皮点上方约1.5 cm处(Trocar于皮下潜行)。如需辅助孔,则辅助孔Trocar置于患侧下腹部腹横纹延长线上。所有患儿均实施根治性切除术,标本切除后完整置入标本袋,延长下腹部切口(切口长度大于等于瘤肾最小径),标本袋经下腹部腹横纹切口完整取出。结果 6例患儿中,采用辅助孔3例,未采用辅助孔3例。切口长度5~8 cm,平均6.5 cm。所有标本均经下腹部腹横纹切口通道完整取出,无一例术中中转开放。术后住院4~7 d,平均4.5 d。术后伤口无活动性出血、裂开、感染等情况发生。术后随访4~46个月,平均25个月。术后伤口恢复可,未见明显瘢痕增生。结论 隐蔽切口法可安全、有效地应用于儿童RAL-RN术中标本的取出。

Objective To explore the value of hidden incision for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy.Methods The clinical data of robotic-assisted laparoscopic radical nephrectomy were retrospectively analyzed.Six patients undergoing robot-assisted laparoscopic radical nephrectomy were recruited from August 2015 to February 2019.There were 4 boys and 2 girls with a mean age of 47 months.There were Wilms'tumor(n=3),Xp11.2 translocation renal cell carcinoma(n=2)and metanephric adenoma(n=1).The involved side was left(n=3)and right(n=3).With a 60°lateral position,eyepiece Trocar was located at umbilical contralateral margin.The operation hole 1 was located at 6-7 cm above anterior median line(depending upon abdominal wall space)and operation hole 2 at the intersection of anterior median line and lower transverse Pfannenstiel incision.Trocar was sneaked under skin and then inserted into abdominal cavity(1.5 cm above operation hole 2)if auxiliary hole was needed.Auxiliary hole Trocar was placed on the affected side of lower abdominal transverse line.All children underwent radical resection.After removal,specimen was placed into a specimen bag.Then lower abdominal transverse incision(length of incision equal to the minimal renal diameter)was extended.The specimen bag was extracted through the Pfannenstiel incision.Results Auxiliary hole was applied in 3 cases with an average length of incision at 6.5(5-8)cm.All specimens were intactly extracted.The average postoperative hospital stay was 4.5(4-7)days.No active bleeding,splitting or infection of wounds occurred postoperatively.During an average follow-up period of 25(4-46)months,postoperative wound recovery was excellent and there was no scar hyperplasia.Conclusions The hidden Pfannenstiel incision may be safely and effectively applied for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy.