Centro de Cirurgia Robótica do Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil.
Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil.
Int Braz J Urol. 2018 Jan-Feb;44(1):202-203. doi: 10.1590/S1677-5538.IBJU.2016.0560.
Robot-Assisted Single Site Radical Nephrectomy (RASS-RN) has been reported by surgeons in Europe and United States (1-3). To our best knowledge this video presents the first RASS-RN with concomitant cholecystectomy performed in Latin America.
A 66 year-old renal transplant male due to chronic renal failure presented with an incidental 1.3cm nodule in the upper pole of the right kidney. In addition, symptomatic gallbladder stones were detected.
Patient was placed in modified flank position. Multichannel single port device was placed using Hassan's technique through a 3cm supra-umbilical incision. Standard radical nephrectomy and cholecystectomy were made using na 8.5mm camera, two 5mm robotic arms and an assistant 5mm access. Surgery time and estimated blood loss were 208 minutes and 100mL, respectively. Patient did well and was discharged within less than 48 hours, without complications. Pathology report showed benign renomedullary tumor of interstitial cells and chronic cholecystitis.
Robotic technology improves ergonomics, gives better precision and enhances ability to approach complex surgeries. Robot-assisted Single Port aims to reduce the morbidity of multiple trocar placements while maintaining the advantages of robotic surgery (2). Limitations include the use of semi-rigid instruments providing less degree of motion and limited space leading to crash between instruments. On the other hand, it is possible to perform complex and concomitant surgeries with just one incision.
RASS-RN seems to be safe and feasible option for selected cases. Studies should be performed to better understand the results using single port technique in Urology.
机器人辅助单部位根治性肾切除术（RASS-RN）已在欧洲和美国的外科医生中报道（1-3）。据我们所知，这段视频展示了拉丁美洲首例同时行胆囊切除术的机器人辅助单部位根治性肾切除术。
一名 66 岁男性肾移植患者，因慢性肾衰竭导致右肾上极出现 1.3cm 小结节，此外还发现有症状性胆囊结石。
患者采用改良侧卧位，通过脐上 3cm 的切口，采用 Hassan 技术置入多通道单端口装置。采用 8.5mm 摄像头、两个 5mm 机器人臂和一个助手 5mm 通道进行标准根治性肾切除术和胆囊切除术。手术时间和估计失血量分别为 208 分钟和 100mL。患者恢复良好，不到 48 小时内出院，无并发症。病理报告显示良性肾髓质间质细胞瘤和慢性胆囊炎。
机器人技术改善了手术的人体工程学，提高了手术的精确性，并增强了处理复杂手术的能力。机器人辅助单端口手术旨在减少多个套管针放置的发病率，同时保持机器人手术的优势（2）。其局限性包括使用半刚性器械，提供的运动自由度较小，并且空间有限，导致器械之间发生碰撞。另一方面，可以通过一个切口进行复杂的同时手术。
对于选定的病例，RASS-RN 似乎是一种安全可行的选择。应该进行研究，以更好地了解单端口技术在泌尿外科中的应用结果。
