Gunelli Roberta, Fiori Massimo, Salaris Cristiano, Salomone Umberto, Urbinati Marco, Vici Alexia, Zenico Teo, Bertocco Mauro
Urology Unit, Forlì Hospital, Romagna Local Health Service.
Arch Ital Urol Androl. 2016 Dec 30;88(4):311-313. doi: 10.4081/aiua.2016.4.311.
As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass.
A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826).
Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed.
The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.
鉴于文献中关于肿瘤根治性切除的证据越来越多，单纯剜除术已成为机器人手术治疗肾肿瘤的最佳技术之一，因为它保证了微创性并最大程度地保留了肾组织，便于在切除过程中使用减少或零缺血技术。使用机器人超声探头是检测和确定肿瘤位置的有用工具，特别是对于外生性较差的小肾肿块。
使用12-5MHz机器人超声探头（BK Drop-In 8826）对＜3cm的肾肿瘤（帕多瓦评分18分，Pz 6/7，4例Pz 8）进行了22例机器人剜除术。
一旦在肿瘤部位将肾脏从脂肪囊分离（2例），借助通过辅助端口插入的超声探头，在所有病例（22/22）中都能轻松确定病变的确切位置，即使对于大多数内生性病变也是如此。外科医生使用达芬奇手术系统的TilePro功能生成图像并在控制台屏幕上进行可视化，以产生画中画图像。然后用电灼标记切除边缘，从而实现快速解剖分离。这将缺血时间缩短至8分钟（6-13分钟），并在不夹闭肾蒂的情况下进行剜除术时（6/22）便于操作。未观察到因使用超声探头引起的并发症。
术中使用机器人超声探头有助于更轻松地识别小的、大多为内生性的肿瘤，实现更好的解剖入路，缩短缺血时间，降低解剖过程中假包膜破裂的风险，并且在不夹闭的情况下更易于剜除。值得注意的是，术中使用超声探头可通过手术解剖过程中对隐藏区域的精确三维视觉实现对肿瘤的心理重建。
