Ipsilateral retroperitoneal papillary renal cell carcinoma 27 years after simple nephrectomy for a renal abscess:A case report

BACKGROUND Cases of severe inflammatory renal disease and renal cell carcinoma(RCC)that occur simultaneously in the same kidney have been occasionally reported.However,extrarenal RCC that does not originate from the native kidney has rarely been reported.To our knowledge,this is the first reported case of RCC developing in the ipsilateral retroperitoneal space after a simple nephrectomy(SN)for inflammatory renal disease.CASE SUMMARY A 63-year-old woman was referred to our hospital following the incidental discovery of a left retroperitoneal mass without specific symptoms.Her medical history revealed a left SN 27 years ago due to a renal abscess.Magnetic resonance imaging of the abdomen revealed three oval masses in the left retroperitoneum.The masses were successfully excised,and subsequent pathology confirmed papillary RCC.After surgery,the patient remained disease-free for 11 years without adjuvant therapy.CONCLUSION Clinicians should be vigilant of RCC in patients with retroperitoneal masses,especially after SN for inflammatory renal disease.

“A stitch in time”: Intraoperative diaphragmatic injury during laparoscopic nephrectomy - A case of immediate recognition and expert management

Laparoscopy within the urology field has undergone a noteworthy surge in popularity over the past decade,with particular importance given to renal surgeries such as simple nephrectomy,radical nephrectomy,donor nephrectomy,nephroureterectomy,and partial nephrectomy.1 This shift toward laparoscopic procedures among urologists can be attributed to the many benefits of these procedures,including reduced postoperative pain,shorter hospital stays,and faster recovery times.2 However,as with any evolving surgical technique,laparoscopic procedures in renal surgery bring forth their own set of distinctive challenges and complications.

Incidental renal cell carcinoma post bilateral nephrectomy in autosomal dominant polycystic kidney disease

BACKGROUND Renal cell carcinoma(RCC)is more common in patients with autosomal dominant polycystic kidney disease(ADPKD)than in the general population.Diagnosing RCC in ADPKD is challenging due to the presence of multiple renal cysts,often leading to delays and difficulties in distinguishing RCC from cyst infection or hemorrhage.A total of 38 kidneys were excised from 19 patients,with a mean age of 56.8 years and an average hemodialysis duration of 84.2 months.Eight patients underwent open nephrectomies,and 11 underwent hand-assisted laparoscopic nephrec-tomies.RCC was detected in 15.8%of kidneys,affecting 21.1%of patients.Two patients had multifocal RCC in both kidneys.All RCC cases were pT1 stage,with the largest lesion averaging 16.5 mm in diameter.The average operative duration was 120 minutes,with intraoperative blood loss averaging 184.2 mL.Five patients required blood transfusions.Postoperative complications occurred in five patients,with a mean hospital stay of 17.1 days.The mean follow-up period was 28.1 months.CONCLUSION The prevalence of RCC is higher in patients with ADPKD with ESRD than in those with ESRD alone.Thus,clinicians should be cautious and implement surveillance programs to monitor the development of RCC in patients with ADPKD,particularly those on dialysis.

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

Clinical Nursing for Patients Undergoing Prone-Position Laparoscopic Partial Nephrectomy

Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were selected,with hospital admission spanning from January 2024 to June 2024.Patients were randomly divided into the study group(n=10)and the control group(n=9).The control group received basic nursing care,while the study group received comprehensive high-quality nursing care.The recovery period,length of hospital stay,complication rates,SCL-90 scores,and nursing quality scores were compared between the two groups.Results:The recovery period and hospital stay were significantly shorter in the study group compared to the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).After the nursing intervention,the SCL-90 scores of the study group were lower than those of the control group(P<0.05).Nursing quality scores were higher in the study group than in the control group(P<0.05).Conclusion:Comprehensive high-quality nursing intervention for patients undergoing prone-position laparoscopic partial nephrectomy can shorten the recovery period and hospital stay,reduce the complication rate,improve mental health,and enhance nursing quality,making it suitable for wider application in medical institutions.

Right versus left fully robotic live donor nephrectomy and open kidney transplantation:Does the laterality of the donor kidney really matter?

Objective Robotic-assisted live donor nephrectomy(LDN)is being gradually adopted across transplant centers.The left donor kidney is preferred over right due to anatomical factors and ease of procurement.We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys.Methods All fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed.Results Out of 196 robotic LDN(49[right]vs.147[left]),10(5.1%)donors had intra-operative events(6.1%[right]vs.4.8%[left],p=0.71).None of the LDN required conversion to open surgery.The operative times were comparable for the two groups.Nausea(13.3%)was the most common post-operative complication.There was no mortality in either LDN group.Herein,we report our outcomes on 156 recipients(39 right and 117 left allografts)excluding robotic implants,exports,and pediatric recipients.There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival(100.0%vs.98.1%,p=0.45)or graft survival(93.9%vs.97.1%,p=0.11),or delayed graft function(7.7%vs.5.1%,p=0.55).Conclusion Non-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes.Right LDN was not associated with higher incidence of complications compared to left LDN.Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.

Can preoperative planning using IRIS™three-dimensional anatomical virtual models predict operative findings during robot-assisted partial nephrectomy?

Objective To evaluate the predictive validity of IRIS™(Intuitive Surgical®,Sunnyvale,CA,USA)as a planning tool for robot-assisted partial nephrectomy(RAPN)by assessing the degree of overlap with intraoperative execution.Methods Thirty-one patients scheduled for RAPN by four experienced urologists were enrolled in a prospective study.Prior to surgery,urologists reviewed the IRIS™three-dimensional model on an iphone Operating System(iOS)app and completed a questionnaire outlining their surgical plan including surgical approach,and ischemia technique as well as confidence in executing this plan.Postoperatively,questionnaires assessing the procedural approach,clinical utility,efficiency,and effectiveness of IRIS™were completed.The degree of overlap between the preoperative and intraoperative questionnaires and between the planned approach and actual execution of the procedure was analyzed.Questionnaires were answered on a 5-point Likert scale and scores of 4 or greater were considered positive.Results Mean age was 65.1 years with a mean tumor size of 27.7 mm(interquartile range 17.5-44.0 mm).Hilar tumors consisted of 32.3%;48.4%of patients had R.E.N.A.L.nephrometry scores of 7-9.On preoperative questionnaires,the surgeons reported that in 67.7%cases they were confident that they can perform the procedure successfully,and on intraoperative questionnaires,the surgeons reported that in 96.8%cases IRIS™helped achieve good spatial sensation of the anatomy.There was a high degree of overlap between preoperative and intraoperative questionnaires for the surgical approach,interpreting anatomical details and clinical utility.When comparing plans for selective or off-clamp,the preoperative plan was executed in 90.0%of cases intraoperatively.Conclusion A high degree of overlap between the preoperative surgical approach and intraoperative RAPN execution was found using IRIS™.This is the first study to evaluate the predictive accuracy of IRIS™during RAPN by comparing preoperative plan and intraoperative execution.

The application of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy with a new robotic system KangDuo Surgical Robot-01:Initial experience

Objective To assess the feasibility of internal suspension technique in retroperitoneal robot-assisted laparoscopic partial nephrectomy(rRAPN)with a new robotic platform called KangDuo Surgical Robot-01(KD-SR-01)system(Suzhou KangDuo Robot Co.,Ltd.,Suzhou,China)and discuss its surgical technique.Methods A 44-year-old male patient was admitted with a 2.5 cm tumor on dorsolateral upper pole of the left kidney.The R.E.N.A.L.nephrometry score of this patient was 4x.This patient underwent rRAPN with KD-SR-01.The perinephric fat between the tumor and Gerota's fascia was preserved,which was used for internal suspension traction during tumor resection.Postoperative follow-up data were collected.Results The surgery was successfully carried out with a duration of 127 min,in which the docking time was 6 min 25 s and console time was 60 min.The warm ischemia time was 19 min 53 s,and the estimated blood loss was 0 mL.The pathological histology showed a pathological tumor stage 1a clear cell renal cell carcinoma,with a negative surgical margin.The World Health Organization/International Society of Urological Pathology(WHO/ISUP)grade of this patient was Grade 2.No recurrence was observed during the 6-month follow-up.Conclusion Internal suspension in rRAPN is feasible and effective with use of the new robotic system KD-SR-01.

Surgical Video Review of Warm Ischemia Time during Laparoscopic Partial Nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications

Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning.

Single omental metastasis of renal cell carcinoma after radical nephrectomy:A case report

BACKGROUND Renal cell carcinoma(RCC)is the third most common malignancy in the genitourinary tract.The lungs,bone,lymph nodes,liver,and brain are common metastatic sites of RCC.However,there is limited literature on single omental metastasis of RCC.CASE SUMMARY We present the case of a 44-year-old man with single omental metastasis of RCC after laparoscopic radical nephrectomy.Pathological diagnosis of the resected left kidney revealed pT3a clear cell RCC(Fuhrman grade III).At 6 mo postoperatively,abdominal computed tomography revealed a 12-mm enhancing nodule in the left lower peritoneum.At 7 mo after initial operation,laparoscopic removal of the left omental nodule was performed.The pathological results indicated metastatic clear cell RCC.Currently,the patient is being treated with adjuvant pembrolizumab.CONCLUSION Omental metastasis of RCC owing to laparoscopic radical nephrectomy is rare.Urologists should be aware of the diverse nature of RCC.

Transcatheter embolization for hemorrhage from aberrant testicular artery after partial nephrectomy:A case report

BACKGROUND Arterial bleeding typically involves the renal artery following partial nephrectomy;in this study,we present a case of bleeding originating from the testicular artery that has not been reported in previous studies.CASE SUMMARY A 52-year-old man suffered hemorrhage from a perinephric branch of the aberrant left testicular artery after an open nephron-sparing surgery for renal cell carcinoma.Clinical signs of bleeding were manifested by the patient,such as fresh blood drainage from the catheter,decreased hemoglobin levels,and significant vital sign changes.Since computed tomography did not show evidence of active bleeding,transcatheter angiography was conducted to identify the bleeding site.Fluoroscopic spot images confirmed bleeding derived from a perinephric branch of the testicular artery originating from the segmental artery of the left renal artery.Using n-butyl-2-cyanoacrylate,successful transcatheter arterial embolization of the affected branch was performed.Immediately after the embolization procedure,the bleeding ceased,and the patient experienced complete recovery devoid of complications.CONCLUSION In patients with postoperative arterial hemorrhage after partial nephrectomy,the testicular artery can be a rare but notable source of bleeding.Accurate bleeding site localization via angiographic evaluation,followed by transcatheter arterial embolization,can be instrumental for safe,prompt,and effective hemostasis.

A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

经食管超声心动图在肾切除术联合MayoⅢ~Ⅳ级静脉瘤栓取栓术不同手术方式中的临床作用

目的:比较经食管超声心动图(transesophageal echocardiography,TEE)在肾切除术联合下腔静脉MayoⅢ~Ⅳ级瘤栓取栓术不同手术方式中的临床作用。方法:纳入2022年1月至2024年2月在北京大学第三医院行根治性肾切除联合MayoⅢ~Ⅳ级瘤栓取栓手术的患者28例,其中,机器人手术16例,腹腔镜手术2例,开腹手术10例,收集患者的各项临床资料进行分析比较。结果:机器人手术的患者中有9例采用TEE,其中7例术中TEE影像结果较术前发生变化,包括2例术中TEE提示瘤栓进入右心房,2例显示下腔静脉瘤栓由MayoⅢ级升至Ⅳ级,3例提示瘤栓与下腔静脉粘连,及时调整了手术方案;开腹手术的患者中有6例采用TEE,其中4例术中TEE提示Mayo分级较术前发生变化,包括3例提示瘤栓与下腔静脉粘连,1例提示瘤栓伴血栓形成,调整了手术方案,旷置或节段性切除瘤栓;腹腔镜手术的2例患者未采用术中TEE。术中采用TEE的作用包括开腹手术术中探查结合TEE监测瘤栓切除过程,机器人手术完全通过TEE监测瘤栓脱出,术中TEE还实时监测患者循环状态和心脏功能变化。结论:肾切除术联合MayoⅢ~Ⅳ级瘤栓取栓术的不同术式中,术中TEE均可再次确定瘤栓分级、粘连程度,并实时动态跟踪取栓过程,监测患者循环状态和心脏功能变化,具有重要的辅助作用,但其临床应用仍不足,建议这类手术均采用术中TEE。

右美托咪定对腹腔镜肾部分切除术患者远期肾功能的保护作用

目的观察右美托咪定(DEX)对腹腔镜肾部分切除术(LPN)患者术后远期肾功能的保护作用。方法选取2021年5月至2022年12月安徽医科大学第二附属医院择期行LPN患者80例,根据随机对照表法将患者随机分为右美托咪定组和对照组,每组40例。右美托咪定组在肾动脉阻断前30 min给予DEX负荷量0.6 mg/kg,之后改为维持剂量0.5μg/(kg·h)并持续到手术结束前30 min。对照组静脉泵注相同剂量和时间的生理盐水。记录患者麻醉诱导前(T_(0))、插管即刻(T_(1))、肾动脉阻断即刻(T_(2))、肾动脉开放即刻(T_(3))和拔管即刻(T_(4))的平均动脉压(MAP)和心率(HR)。监测患者术前以及术后1、6个月^(99m)Tc-DTPA肾小球滤过率(GFR)、血清胱抑素C(Cys-C)和血清肌酐(SCr),并根据公式计算出基于SCr的估计GFR(eGFRcr)、基于SCr和Cys-C的估计GFR(eGFRcr-cys)和基于Cys-C的估计GFR(eGFRcys)。观察患者术前以及术后24 h和48 h血清中性粒细胞明胶酶相关载脂蛋白(NGAL)和尿肾损伤分子-1(KIM-1)含量。结果T_(1)、T_(4)时,右美托咪定组MAP低于对照组(P<0.05),T_(2)时,MAP高于对照组(P<0.05);T_(1)时,右美托咪定组HR低于对照组(P<0.05)。术后24 h和48 h,右美托咪定组血清NGAL和尿KIM-1低于对照组(P<0.05)。术后1、6个月,右美托咪定组手术侧^(99m)Tc-DTPA GFR值高于对照组(P<0.05),而两组对侧^(99m)Tc-DTPA GFR和总^(99m)Tc-DTPA GFR值比较,差异无统计学意义(P>0.05)。术后1、6个月,右美托咪定组eGFRcr-cys和eGFRcys值高于对照组(P<0.05),但两组eGFRcr值比较,差异无统计学意义(P>0.05)。结论DEX可对LPN术后远期肾功能产生保护作用,是防治LPN术后慢性肾脏病发生和发展的潜在治疗药物。

后腹腔镜供肾取肾术与开放取肾术式临床效果对比分析

目的探讨后腹腔镜供肾取肾术与开放取肾术式临床效果优劣。方法回顾性分析2023年1月至2024年4月亲属供肾者的临床资料,男性46例,女性93例,平均年龄为(54.21±6.52)岁。采用后腹腔镜取肾术式99例,采用开放取肾术式40例。收集供肾者既往史、肾脏位置、供肾动脉长度、肾脏维度、动脉支数、手术时间、术中出血量、手术切口长度、术后最高肌酐、术后最高尿素氮、术后住院天数、术后总引流量、供肾取下后动脉长度、热缺血时间、术中腹膜破损及脂肪粘连、并发症情况资料进行分析。结果腹腔镜组手术切口较开放术式组明显缩小、出血量及术后引流量明显减少、供者住院天数明显缩短(P<0.05),热缺血时间较开放术式组明显延长(P<0.05)。男性、体质量指数大、既往吸烟史、外伤史、肾脏维度大、术中出血多、腹膜破损及脂肪粘连会显著增加手术时间(P<0.05)。结论腹腔镜术式在亲属活体供肾取肾术中,在保证肾脏质量前提下,没有延长手术时间,同时具有切口小、出血少、供者恢复快等优点。

改良铆钉缝合法在后腹腔镜下肾部分切除术中的应用

目的探讨改良铆钉缝合法在后腹腔镜下肾部分切除术中的临床效果。方法选取2019年3月至2022年3月因肾细胞癌于郑州人民医院泌尿外科接受后腹腔镜下肾部分切除术的患者,共81例,回顾其临床资料,根据缝合方法分为研究组(改良铆钉缝合,41例)和对照组(倒刺线连续缝合,40例),总结临床资料,比较两组患者的热缺血时间、术中出血量、术后引流量、术后尿漏发生率、术后肾周血肿发生率、术前术后血红蛋白下降情况。结果研究组热缺血时间短于对照组,术中出血量、术后引流量、术后尿漏及肾周血肿发生率均低于对照组(P<0.05)。术后研究组血红蛋白水平高于对照组,差异有统计学意义(P<0.05)。对照组中出现1例术后尿瘘和2例术后肾周血肿,经过治疗后好转,研究组未出现并发症。结论改良铆钉缝合法在后腹腔镜下肾部分切除术中效果确切,可缩短肾脏热缺血时间,减少术中出血量及术后并发症,值得在临床推广。

达芬奇Xi手术机器人在肾部分切除术中手术入路选择的应用研究(附手术视频)

目的:探讨达芬奇手术机器人辅助腹腔镜下肾部分切除术中不同手术入路选择的临床疗效及安全性,并为其临床应用提供经验。方法:回顾性分析2020年11月—2021年5月于新疆维吾尔自治区人民医院泌尿中心采用达芬奇Xi手术机器人行机器人辅助腹腔镜下T1期肾肿瘤肾部分切除术的23例患者临床资料。根据肿瘤部位与肾蒂的关系、腹部手术史、肥胖等因素,将所有患者分为经腹入路组(10例)和后腹膜入路组(13例),比较两种不同入路对围手术期的影响。结果:23例患者手术均顺利完成,术中未出现周围脏器及大血管损伤,无中转开放。比较不同手术入路发现,采用经后腹膜入路手术的装机速度及手术时间比经腹腔入路手术的时间显著缩短。结论:采用达芬奇Xi手术机器人行机器人辅助腹腔镜下肾部分切除术治疗肾肿瘤的疗效及安全性良好,且经后腹膜入路的手术方式效果更佳。

基层泌尿外科医生掌握经后腹腔镜下根治性肾切除术的学习曲线分析

目的 分析基层泌尿外科医生掌握经后腹腔镜下根治性肾切除术(RLRN)的学习曲线。方法 回顾性分析2020年1月至2022年12月于我院就诊并由同一术者进行RLRN的40例肾细胞癌(RCC)患者的临床资料。依据手术开展先后次序将患者分为A组(第1~10例)、B组(第11~20例)、C组(第21~30例)、D组(第31~40例)。比较四组的手术时间、术中出血量及术后住院时间,并分析其学习曲线。结果 40例患者中,2例中转开放手术,其中A组和B组各1例。四组的手术时间、术中出血量及术后住院时间比较,差异具有统计学意义(P<0.05);C组、D组的手术时间、术后住院时间短于A组、B组,术中出血量少于A组、B组(P<0.05);A组与B组的术后住院时间比较,差异无统计学意义(P>0.05);C组与D组的手术时间、术中出血量、术后住院时间比较,差异无统计学意义(P>0.05)。学习曲线分析发现,该基层泌尿外科医生通过24例左右的学习后就可达到RLRN熟练掌握、相对稳定的程度。结论 基层泌尿外科医生掌握RLRN的学习曲线为24例左右。

国产Agibot^(■)腔镜机器人首次人体试验手术3例报道

本文回顾性分析了我院2023年12月实施国产Agibot^(■)腔镜机器人人体试验的患者3例,均为男性,前列腺癌2例,肾癌1例。年龄44.8~75.4岁,其中根治性前列腺切除术2例(受试者编号Y01001、Y01002)、肾部分切除术1例(受试者编号Y01003)。手术均顺利完成,无中转开放或普通腹腔镜手术,无术中及术后并发症,无输血。2例根治性前列腺切除术的术前机器安装时间4~8 min,手术时间132~141 min,引流管引流时间3d,术后住院时间3~5 d,术后病理诊断为前列腺腺癌,术后30 d随访前列腺特异性抗原(PSA)均<0.1μg/L。1例肾部分切除术的术前机器安装时间6min,手术时间87 min,热缺血时间24 min,引流管引流时间3 d,术后住院时间7 d,术后病理诊断为肾透明细胞癌,切缘阴性。术中指标及术后结果表明国产Agibot^(■)腔镜机器人手术效果良好,患者康复顺利。长期影响有待通过大样本、多中心、长期随访研究进一步验证。

机器人辅助腹腔镜处理肾门部肿瘤的有效性以及安全性分析

目的:探讨机器人辅助腹腔镜手术在治疗肾门部肿瘤的安全性以及有效性。方法:回顾性分析2020年1月至2023年12月在重庆医科大学附属第一医院治疗的肾门部恶性肿瘤患者,其中普通腹腔镜23例,机器人辅助患者26例,比较2组患者的年龄、性别、肿瘤侧别、肿瘤直径、R.E.N.A.L评分差异无统计学意义;比较2组患者的手术时间,热缺血时间、肿瘤切缘阴性、有无Clavien-DindoⅢ级以上严重并发症、术后住院时间。结果:2组手术均顺利完成,腔镜组1例改开放肾部分切除手术。2组患者在术前患者资料方面无明显差异。2组患者在手术时间、术后血红蛋白下降值、术后输血率(0/22∶0/26)、术中出血量、肿瘤切缘阳性率(0/22∶0/26)、Clavien-DindoⅢ级以上并发症发生率(0/22∶0/26)等方面比较差异均无统计学意义(P>0.05)。2组患者在术中肾脏热缺血时间[(29.3±3.7)min和(21.3±3.3)min],术后住院天数[(6.0±1.2)d和(3.9±1.3)d]差异有统计学意义(P<0.01)。结论:机器人辅助腹腔镜在处理肾门部肾肿瘤的安全性以及有效性比较确切。