Robotic Urologic Surgery, Department of Urology, Ohio State University Medical Center & James Cancer Hospital, 503 Doan Hall, 410W. 10th Avenue, Columbus, OH 43210, USA.
Eur Urol. 2011 Apr;59(4):652-6. doi: 10.1016/j.eururo.2010.08.038. Epub 2010 Sep 16.
Laparoscopy has become a standard modality for most renal tumors but not as yet for renal cell carcinoma (RCC) involving the inferior vena cava (IVC). Robotic technology may facilitate such complex procedures. We report the first series of robotic nephrectomy with IVC tumor thrombectomy including the first cases requiring cross-clamping of the IVC in a minimally invasive fashion. Five patients underwent robotic nephrectomy with IVC tumor thrombectomy including one patient having two renal veins, each with an IVC thrombus, for a total of six IVC thrombi. The IVC was opened in all patients, and tumor thrombi were delivered intact, followed by sutured closure. The mean patient age was 64 yr (53-70 yr) with a mean body mass index of 36.6 kg/m(2) (22-43 kg/m(2)). Thrombi protruded 1 cm, 2 cm, 4 cm, and 5 cm into the IVC in five patients and 3 cm and 2 cm in the patient with two thrombi. The mean estimated blood loss was 170 ml (50-400 ml). Mean operative time was 327 min (240-411 min). Mean length of stay was 1.2 d. There were no complications, transfusions, or readmissions. This early series represents a limited experience by a single surgeon with a new procedure and may not be reproducible in larger numbers or by all surgeons. Further experience is necessary to validate this application.
腹腔镜已成为大多数肾肿瘤的标准治疗方式，但对于累及下腔静脉（IVC）的肾细胞癌（RCC）尚未如此。机器人技术可能有助于此类复杂手术。我们报告了首例机器人肾切除术和 IVC 肿瘤血栓切除术，包括首例以微创方式对 IVC 进行交叉夹闭的病例。五例患者接受了机器人肾切除术和 IVC 肿瘤血栓切除术，其中一例患者有两条肾静脉，每条静脉均有 IVC 血栓，共计有 6 个 IVC 血栓。所有患者均切开 IVC，完整取出肿瘤血栓，然后缝合关闭。患者平均年龄为 64 岁（53-70 岁），平均体重指数为 36.6 kg/m2（22-43 kg/m2）。血栓突入 IVC 的长度分别为 5 例患者的 1cm、2cm、4cm 和 5cm，2 例患者的血栓突入 IVC 的长度为 3cm 和 2cm。估计出血量平均为 170ml（50-400ml）。手术时间平均为 327min（240-411min）。平均住院时间为 1.2 天。无并发症、输血或再入院。这组早期病例代表了一位经验有限的外科医生在一项新手术上的有限经验，可能无法在更大数量或所有外科医生中复制。需要进一步的经验来验证这种应用。
