Uwaydah Nabeel I, Jones Alex, Elkaissi Mahmoud, Yu Zhongxin, Palmer Blake W
Department of Pediatric Urology, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd., WP 3150, Oklahoma City, OK, 73104, USA.
Department of Radiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
J Robot Surg. 2014 Sep;8(3):289-93. doi: 10.1007/s11701-013-0441-0. Epub 2013 Dec 5.
Neuroblastoma (NB) is the most common extra-cranial solid tumor in children and the most common malignancy in infants, with complete resection being curative in low-stage disease. The previous standard of treatment for many abdominal NBs involving the adrenal gland had been open surgery; however, there have been numerous descriptions of the safety and feasibility of a laparoscopic approach to resect adrenal masses in the pediatric population in benign and malignant disease, including improved cosmetic results, decreased length of stay, decreased surgical morbidity, and comparable oncological outcomes to open surgery. Despite these reported advantages over open surgery, the newer robot-assisted laparoscopy (RAL) offers benefits over the conventional laparoscopic approach that could further improve outcomes and expand the use of minimally invasive surgical approaches for pediatric adrenal masses. RAL offers many additional advantages over conventional laparoscopy, such as 3D visualization, increased range of motion of surgical instruments, tremor control, and a shorter learning curve compared with traditional laparoscopic surgery, while still maintaining the advantages of minimally invasive surgery. The body of literature concerning robot-assisted oncological surgery involving the adrenal gland in children is quite small, and to our knowledge no case reports have been published describing robot-assisted removal of an adrenal NB in a pediatric patient. We present our experience and technique of an RAL approach for lymph-node dissection and radical resection of a low-stage NB involving the adrenal gland with no image-defined risk factors in a 15-month-old infant.
神经母细胞瘤（NB）是儿童最常见的颅外实体瘤，也是婴儿最常见的恶性肿瘤，低分期疾病通过完整切除可治愈。以往，许多累及肾上腺的腹部NB的标准治疗方法是开放手术；然而，已有大量文献描述了在儿科人群中，无论是良性还是恶性疾病，采用腹腔镜方法切除肾上腺肿块的安全性和可行性，包括改善美容效果、缩短住院时间、降低手术发病率以及与开放手术相当的肿瘤学结局。尽管与开放手术相比有这些已报道的优势，但更新的机器人辅助腹腔镜手术（RAL）比传统腹腔镜手术方法具有更多优势，这可能进一步改善结局并扩大微创外科手术方法在儿科肾上腺肿块治疗中的应用。与传统腹腔镜手术相比，RAL具有许多额外优势，如三维可视化、手术器械活动范围增加、震颤控制以及学习曲线更短，同时仍保持微创手术的优势。关于儿童肾上腺的机器人辅助肿瘤手术的文献数量相当少，据我们所知，尚无病例报告描述在儿科患者中机器人辅助切除肾上腺NB。我们介绍了在一名15个月大婴儿中，采用RAL方法进行淋巴结清扫和根治性切除累及肾上腺的低分期NB且无影像学定义的风险因素的经验和技术。
