Canda Abdullah Erdem, Çakıcı Özer Ural, Ener Kemal, Atmaca Ali Fuat
Department of Urology, Yıldırım Beyazıt University Faculty of Medicine, Atatürk Training and Research Hospital, Ankara, Turkey.
Clinic of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
Turk J Urol. 2015 Sep;41(3):159-63. doi: 10.5152/tud.2015.21298. Epub 2015 Feb 18.
Currently, most renal masses are detected incidentally while still small in size because of the widespread use of radiological imaging, and most pheochromocytomas are localized in the adrenal glands as unilateral lesions. A 5 × 4-cm right adrenal mass and a 19 × 13-mm exophytic left renal mass were synchronously detected by contrast enhancement on computed tomography and magnetic resonance imaging in a 47-year-old male with hypertension. The patient's preoperative serum and 24-h urine catecholamine levels were elevated. Initially, robotic transperitoneal right adrenalectomy was performed, and histopathology confirmed a 4 cm pheochromocytoma. After 3 months, transperitoneal zero ischemia robotic left partial nephrectomy was performed, and histopathology demonstrated clear cell renal cell carcinoma, Fuhrman grade II, 17 mm in size with clear surgical margins. This case indicates that sequential robotic surgery is feasible and safe as a minimally invasive approach to remove bilateral renal and adrenal masses. Zero ischemia robotic partial nephrectomy is also feasible and safe for selected small renal masses.
目前，由于放射影像学的广泛应用，大多数肾肿物在体积尚小时就被偶然发现，且大多数嗜铬细胞瘤局限于肾上腺，表现为单侧病变。一名47岁高血压男性患者，通过计算机断层扫描和磁共振成像的对比增强同步检测到一个5×4 cm的右肾上腺肿物和一个19×13 mm的左肾外生性肿物。患者术前血清和24小时尿儿茶酚胺水平升高。最初，实施了机器人经腹右肾上腺切除术，组织病理学证实为4 cm嗜铬细胞瘤。3个月后，实施了经腹零缺血机器人左肾部分切除术，组织病理学显示为透明细胞肾细胞癌，Fuhrman分级II级，大小为17 mm，手术切缘清晰。该病例表明，作为一种微创方法，序贯机器人手术对于切除双侧肾和肾上腺肿物是可行且安全的。零缺血机器人肾部分切除术对于选定的小肾肿物也是可行且安全的。
