Ball Mark W, Gorin Michael A, Jayram Gautam, Pierorazio Phillip M, Allaf Mohamad E
The Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Can J Urol. 2015 Feb;22(1):7666-70.
To describe our technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) tumor thrombectomy and to present initial results for our first two patients.
Two patients with renal masses with infrahepatic IVC extension underwent RARN with IVC tumor thrombectomy using a four-arm configuration. Both cases were right-sided tumors. Vascular control was obtained with complete cross-clamping of the vena cava with robotic bulldog clamps. Intraoperative ultrasound was used to delineate extent of tumor extension. Specimens were removed en-bloc, and the IVC was closed with 2-layers of 4-0 Prolene. The specimen is extracted through a lower midline incision.
Two robotic IVC thrombectomies were successfully completed. There were no conversions, intraoperative or postoperative complications. Median operative time was 243 minutes with a median estimated blood loss of 150 mL. Both patients were able to ambulate independently free of intravenous opioids on postoperate day 1. Median length of stay was 4.5 (range 3-6) days. Final pathology revealed clear cell RCC in both cases with negative surgical margins.
Robotic technology may facilitate RN and IVC thrombectomy in the well selected patient and appears to be a safe and feasible approach.
描述我们采用机器人辅助根治性肾切除术（RARN）联合下腔静脉（IVC）肿瘤血栓切除术的技术，并展示我们前两名患者的初步结果。
两名肾肿物累及肝下下腔静脉的患者接受了采用四臂配置的机器人辅助根治性肾切除术联合下腔静脉肿瘤血栓切除术。两例均为右侧肿瘤。使用机器人牛头夹完全夹闭腔静脉以控制血管。术中超声用于确定肿瘤延伸范围。标本整块切除，下腔静脉用两层4-0普理灵缝线缝合。标本通过下腹部正中切口取出。
成功完成了两例机器人辅助下腔静脉血栓切除术。无中转手术情况，无术中或术后并发症。中位手术时间为243分钟，中位估计失血量为150毫升。两名患者均在术后第1天能够独立行走，无需静脉注射阿片类药物。中位住院时间为4.5天（范围3 - 6天）。最终病理显示两例均为透明细胞肾细胞癌，手术切缘阴性。
对于精心挑选的患者，机器人技术可能有助于根治性肾切除术和下腔静脉血栓切除术，似乎是一种安全可行的方法。
