Giberti Claudio, Gallo Fabrizio, Schenone Maurizio, Cortese Pierluigi
Claudio Giberti, Fabrizio Gallo, Maurizio Schenone, Pierluigi Cortese, Department of Urology, San Paolo Hospital, 17100 Savona, Italy.
World J Clin Cases. 2014 Jun 16;2(6):224-7. doi: 10.12998/wjcc.v2.i6.224.
We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.
我们报告首例同期双侧机器人辅助部分肾切除术（RAPN），以展示并深入讨论该手术的可行性。材料与方法：一名69岁男性患者因偶然发现双侧肾旁小肿块（右侧2.5 cm，左侧3.5 cm）怀疑为恶性肿瘤而就诊于我院。患者取侧卧位，先从右侧开始手术。端口放置：脐周12 mm摄像端口，两个呈宽“V”形配置的8 mm机器人端口，在脐与耻骨联合之间的中线处额外设置一个12 mm辅助端口。实施了右侧夹闭松开式RAPN并采用滑动夹肾缝合术。移除套管针并将机器人脱开。在不中断麻醉程序的情况下，将患者报告为仰卧位，手术床旋转180度后，重新置于对侧侧卧位。利用先前的脐周和中线端口，再放置两个8 mm机器人套管针。然后重新对接机器人，采用与先前报告相同的技术对左侧也实施了RAPN。结果：总时间：285分钟。估计失血量：150 cc。术后过程：平稳。病理检查：双侧肾细胞癌，手术切缘阴性。结论：我们的经验令人鼓舞，证实了该手术的可行性和安全性。我们技术的规划具有时间和成本效益，对患者有美容益处。然而，我们认为在开展这类手术之前，对患者进行适当选择以及具备机器人肾脏手术技能是明智的。
