单一机位机器人辅助腹腔镜顺行双侧腹股沟淋巴结清扫术的可行性和安全性

The feasibility and safety of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer

目的探讨单一机位机器人辅助腹腔镜顺行双侧腹股沟淋巴结清扫术的可行性和安全性。方法回顾性分析2019年1月至2020年1月浙江省人民医院收治的6例阴茎癌患者的病例资料,年龄(52.0±8.6)岁。6例均为阴茎癌术后,原发灶病理诊断均为鳞状细胞癌,其中高分化2例,中分化4例。术前查体以及相关辅助检查均提示双侧腹股沟淋巴结肿大,6例均无远处转移。6例均接受单一机位机器人辅助腹腔镜顺行双侧腹股沟淋巴结清扫术。患者取平卧位,头低足高约15°,双腿伸直呈"八"字尽量分开。可视下建立皮下空间,置入套管后将达芬奇机器人床旁机械臂定泊于两腿间,连接机械臂和套管后开始淋巴结清扫。清扫范围以外环上缘与髂前上棘的连线为上界,以髂前上棘与其下20 cm处的连线为外界,以耻骨结节及其下15 cm处的股内侧为内界,内界和外界下缘的连线为下界。结果本组6例手术均顺利完成,无中转开放手术,均同期行双侧腹股沟淋巴结清扫,均一次成功建立皮下空间并置入套管,术中均无需移动机械臂系统。平均手术时间(105.0±20.5)min,术中出血量均<50 ml。单侧平均清扫淋巴结(15.0±2.5)枚,术中冰冻病理检查示2例单枚淋巴结转移,4例无淋巴结转移。平均住院时间(7±3)d。6例均未发生皮肤坏死,其中1例因为局部小面积切口感染,换药1周后愈合;2例出现淋巴瘘,保守治疗后治愈。6例术后随访12~14个月,原发灶与腹股沟淋巴结均无复发、转移。结论单一机位机器人辅助腹腔镜顺行双侧腹股沟淋巴结清扫术的安全性和有效性良好,围手术期并发症较少。

Objective To investigate the feasibility and safety of single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy for penile cancer.Methods The clinical data of 6 patients with penile cancer admitted to our hospital from January 2019 to January 2020 were retrospectively analyzed.The mean age was(52.0±8.6)years old.The pathology was primary focal squamous cell carcinoma,with 2 cases of high differentiation,and 4 cases of medium differentiation.All the 6 patients underwent single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy.Preoperative physical and imaging examinations indicated bilateral inguinal lymph node enlargement,and no distant metastasis was found in all of the 6 patients.The supine position was taken,with the head low and feet high about 15°,the legs straight and separated as far as possible in the shape of"Chinese eight".The da Vinci robotic patient cart was placed between legs of the patient,after inserting the trocars.The external boundary of bilateral inguinal lymph node dissection was the line between the anterior superior iliac spine and 20 cm lower,the inner boundary was the pubic tubercle and its 15cm medial lower measurement,and the line between the inner boundary and the external lower edge was the lower boundary.Results All the 6 operations were successfully completed without transfer to open surgery.Both sides of the inguinal lymph nodes were dissected at the same time.The space establishment and trocar insertion were performed simultaneously.There was no need for mobile robotic arm system during the operation.The average operative time was(105.0±20.5)min,and the amount of intraoperative blood loss was less than 50ml,the average hospital stay was(7±3)days.An average of(15.0±2.5)lymph nodes were dissected on each side.Intraoperative freezing suggested single positive lymph nodein 2 patients and no positive lymph node in 4 patients.There was no skin necrosis,1 case of delayed wound healing,and 2 cases of lymphatic leakage.All patients were cured by conservative treatment.The 6 patients were followed up for 12-14 months,and there was no recurrence or metastasis.Conclusions Single-position robotic assisted laparoscopic anterograde bilateral inguinal lymphadenectomy can achieve the expected surgical outcome,and has fewer perioperative complications.The surgery is safe and effective.