Tobis Scott, Houman Justin, Thomer Marguerite, Rashid Hani, Wu Guan
Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA.
J Laparoendosc Adv Surg Tech A. 2013 Aug;23(8):702-6. doi: 10.1089/lap.2012.0577. Epub 2013 Jul 19.
Transumbilical laparoendoscopic single-site (U-LESS) pyeloplasty may provide improved cosmesis compared with conventional laparoscopic pyeloplasty. However, U-LESS pyeloplasty can be challenging because of the need for extensive suturing. The wristed instrumentation of robot-assisted laparoendoscopic single-site (R-LESS) pyeloplasty provides improved dexterity to facilitate intracorporeal suturing. We therefore present our technique and experience with R-LESS pyeloplasty for ureteropelvic junction obstruction (UPJO).
The da Vinci(®) S or Si Surgical System (Intuitive Surgical, Sunnyvale, CA) was used in all cases. Ureteral stents were placed cystoscopically at the start of each case. A 3-cm skin incision was made adjacent to the umbilicus. Three ports (12 mm, 8 mm, and 5 mm) were placed either through separate fascial incisions or into a GelPort(®) (Applied Medical, Rancho Santa Margarita, CA). Key techniques included port staggering, a "chopstick" arrangement of the instruments, and use of a 30° lens in an upward configuration. Traditional dismembered pyeloplasty procedures were performed in all cases. Patients less than 45 years of age with no prior abdominal surgery were offered this approach.
Eight patients (4 female; 5 right-sided; median age, 22 years) underwent R-LESS pyeloplasty without the need for additional ports. All patients were discharged by the third postoperative day, and 5 were discharged on Day 1. One patient experienced urine leakage, which was managed with a temporary nephrostomy tube. Length of follow-up ranged from 29 to 46 months. No patients have developed symptoms or radiographic evidence of recurrent UPJO.
R-LESS pyeloplasty can be safely performed for selected patients with currently available robotic equipment. Careful patient selection and case setup are key to successfully performing these procedures.
与传统腹腔镜肾盂成形术相比，经脐单孔腹腔镜（U-LESS）肾盂成形术可能具有更好的美容效果。然而，由于需要进行广泛的缝合，U-LESS肾盂成形术具有挑战性。机器人辅助单孔腹腔镜（R-LESS）肾盂成形术的腕式器械提供了更好的灵活性，便于体内缝合。因此，我们介绍我们使用R-LESS肾盂成形术治疗输尿管肾盂连接部梗阻（UPJO）的技术和经验。
所有病例均使用达芬奇S或Si手术系统（直观外科公司，加利福尼亚州桑尼维尔）。在每个病例开始时经膀胱镜放置输尿管支架。在脐旁做一个3厘米的皮肤切口。通过单独的筋膜切口或插入GelPort（应用医疗公司，加利福尼亚州兰乔圣玛格丽塔）放置三个端口（12毫米、8毫米和5毫米）。关键技术包括端口交错、器械的“筷子”式排列以及向上配置使用30°镜头。所有病例均采用传统的离断性肾盂成形术。年龄小于45岁且既往无腹部手术史的患者采用此方法。
8例患者（4例女性；5例右侧；中位年龄22岁）接受了R-LESS肾盂成形术，无需额外端口。所有患者术后第3天出院，5例患者术后第1天出院。1例患者出现尿漏，通过临时肾造瘘管处理。随访时间为29至46个月。没有患者出现复发性UPJO的症状或影像学证据。
使用现有的机器人设备，R-LESS肾盂成形术可以安全地用于选定的患者。仔细的患者选择和病例设置是成功进行这些手术的关键。
