Vattikuti Urology Institute, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
J Robot Surg. 2009 Mar;3(1):1. doi: 10.1007/s11701-009-0123-0. Epub 2009 Jan 29.
We describe a robotic retroperitoneal approach to renal surgery, optimized in porcine and cadaveric models, and applied to human patients. A retroperitoneal approach for robotic kidney surgery was developed in nonsurvival porcine and a fresh cadaver models, and then utilized in ten patients (three partial nephrectomy, three radical nephrectomy, two simple nephrectomy, one pyeloplasty, one cryoablation). Retroperitoneal access was successfully achieved for robotic renal procedures in six pigs and a human cadaver. Ten human patients (mean age 56 years, range 36-72 years) then underwent a successful retroperitoneal approach for robotic renal surgery. Mean console time was 166 (120-300) min. Mean blood loss was 82 (50-100) ml and average hospital stay was 2.6 (1-5) days. Pathology demonstrated clear cell renal cell carcinoma (four), papillary renal cell carcinoma (two), and xanthogranulomatous pyelonephritis (two). One patient with xanthogranulomatous pyelonephritis required open conversion for failure to progress due to dense adhesions. A retroperitoneal approach is a safe and feasible alternative to a transperitoneal approach for robotic renal surgery, including radical nephrectomy, partial nephrectomy, pyeloplasty, and cryoablation.
我们描述了一种经优化的机器人腹膜后入路肾手术，该方法在猪和尸体模型中进行了优化，并应用于人类患者。我们在非存活猪和新鲜尸体模型中开发了一种用于机器人肾脏手术的腹膜后入路，然后在 10 名患者（3 名部分肾切除术、3 名根治性肾切除术、2 名单纯肾切除术、1 名肾盂成形术、1 名冷冻消融术）中应用了该方法。我们在 6 头猪和 1 具人体尸体中成功地完成了机器人肾脏手术的腹膜后入路。随后，10 名患者（平均年龄 56 岁，范围 36-72 岁）接受了成功的机器人腹膜后肾手术。控制台平均用时 166 分钟（120-300 分钟）。平均失血量为 82 毫升（50-100 毫升），平均住院时间为 2.6 天（1-5 天）。病理检查显示透明细胞肾细胞癌（4 例）、乳头状肾细胞癌（2 例）和黄肉芽肿性肾盂肾炎（2 例）。1 例黄肉芽肿性肾盂肾炎患者由于致密粘连导致手术无法进展，需要转为开放手术。腹膜后入路是机器人肾脏手术（包括根治性肾切除术、部分肾切除术、肾盂成形术和冷冻消融术）的一种安全可行的经腹腔入路替代方法。
