General Surgery Department, Madrid Norte Sanchinarro San Pablo University Hospital, Calle Oña 10, 28050, Madrid, Spain.
Surg Endosc. 2018 Feb;32(2):1072. doi: 10.1007/s00464-017-5738-z. Epub 2017 Aug 4.
Leiomyosarcomas present high postoperative morbidity and poor prognosis [1]. In the literature, only few cases of localized small leiomyosarcoma have been described [2, 3]. These cases might benefit from a minimally invasive approach. Robotic surgery has been claimed to have several advantages over laparoscopy such as enhanced vision and instruments movements which might make more feasible the execution of this type of surgery where partial renal resection is required.
A 53-year-old female with a medical history of myeloid leukemia and with chronic renal failure (creatinine: 2.6) was referred to our hospital for an incidental finding of right perirenal tumor of almost 3 cm compatible with leiomyosarcoma arising from the right renal vein.
The operation was performed using a Da Vinci Robotic Surgical System model Si (Intuitive Surgical, Sunnyvale, CA, USA).Robotic ports were placed in a standard configuration for minimally invasive right nephrectomy. The dissection started with the partial mobilization of the right liver and Kocher maneuver. After the identification of the inferior vena cava the tumor was finally localized and dissected. Resection ended with a partial right vein resection and suture. Pathological final exam confirmed the diagnosis with margins free from tumor.
In selected cases, robotic resection of leiomyosarcoma might be a safe and feasible procedure in experienced hands.
平滑肌肉瘤术后发病率高，预后差[1]。文献中仅少数局部小平滑肌肉瘤病例被描述[2,3]。这些病例可能受益于微创方法。机器人手术被认为比腹腔镜具有多项优势，例如增强的视野和器械运动，这可能使需要部分肾切除术的手术更可行。
一名 53 岁女性，有髓样白血病病史和慢性肾功能衰竭（肌酐：2.6），因右侧腹膜后肿瘤被转诊至我院，肿瘤大小约 3cm，符合源自右肾静脉的平滑肌肉瘤。
手术采用达芬奇机器人手术系统 Si 模型（直觉外科公司，加利福尼亚州森尼韦尔）进行。机器人端口按微创右肾切除术的标准配置放置。手术开始时进行右肝部分游离和 Kocher 操作。在下腔静脉识别后，最终定位并解剖肿瘤。切除结束时进行部分右静脉切除和缝合。病理最终检查证实诊断，切缘无肿瘤。
在选择的病例中，机器人平滑肌肉瘤切除术在有经验的手中可能是一种安全可行的手术。
