Argun Omer Burak, Mourmouris Panagiotis, Tufek Ilter, Tuna Mustafa Bilal, Keskin Selcuk, Obek Can, Kural Ali Riza
Department of Urology, Acibadem University, Istanbul, Turkey.
Department of Urology, Acibadem University, Istanbul, Turkey.
Urology. 2016 Jun;92:136-9. doi: 10.1016/j.urology.2016.02.047. Epub 2016 Mar 9.
To report our initial experience on robot-assisted radical nephroureterectomy, using the da Vinci Xi robotic system without patient or port repositioning.
The patients were in a modified flank position. A Bugbee electrode was used to cauterize and mark the ureteral orifice, aiding in the final robotic excision of the distal ureter. For the first step of the procedure, the second robotic arm holds the scope, the fourth robotic arm holds Port #1 (monopolar curved scissors), the first robotic arm holds Port #2 (Fenestrated bipolar forceps), and the third robotic arm holds Port #4 (Prograsp forceps). After completion of nephrectomy, all robotic arms were released and reconfigured. In the new setting, the third robotic arm and second robotic arm were switched between the camera port and the fourth port. The first port remained working with the monopolar curved scissors whereas Prograsp forceps was moved to the second port and fenestrated bipolar forceps was moved to the third port.
Two patients underwent 2 successful radical nephroureterectomies with the above-mentioned technique. The console time for the first patient was 150 minutes whereas the estimated blood loss was 200 mL. The console time and blood loss for the second patient were 140 minutes and 300 mL, respectively. The hospitalization time and catheter removal time were 3 days for both patients and no complications were observed.
The use of the da Vinci Xi robotic system enabled us to perform both nephrectomy and distal ureterectomy and/or bladder cuff excision without any repositioning of the patient or trocars.
报告我们使用达芬奇Xi机器人系统在不重新安置患者或端口的情况下进行机器人辅助根治性肾输尿管切除术的初步经验。
患者采用改良侧卧位。使用Bugbee电极烧灼并标记输尿管口，以辅助机器人最终切除远端输尿管。在手术的第一步，第二个机器人手臂握持摄像头，第四个机器人手臂握持端口1（单极弯剪刀），第一个机器人手臂握持端口2（带孔双极钳），第三个机器人手臂握持端口4（抓持钳）。肾切除完成后，松开并重新配置所有机器人手臂。在新的设置中，第三个机器人手臂和第二个机器人手臂在摄像头端口和第四个端口之间切换。第一个端口仍使用单极弯剪刀，而抓持钳移至第二个端口，带孔双极钳移至第三个端口。
两名患者采用上述技术成功进行了2例根治性肾输尿管切除术。第一位患者的控制台时间为150分钟，估计失血量为200毫升。第二位患者的控制台时间和失血量分别为140分钟和300毫升。两名患者的住院时间和拔管时间均为3天，未观察到并发症。
使用达芬奇Xi机器人系统使我们能够在不重新安置患者或套管针的情况下进行肾切除术和远端输尿管切除术及/或膀胱袖口切除术。
