Boston Children's Hospital, Department of Urology, Harvard Medical School, Boston, MA, USA.
Boston Children's Hospital, Department of Urology, Harvard Medical School, Boston, MA, USA.
J Pediatr Urol. 2018 Apr;14(2):182.e1-182.e8. doi: 10.1016/j.jpurol.2018.01.003. Epub 2018 Mar 2.
In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions.
To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children's hospital.
We retrospectively reviewed all robotic cases performed at our institution from 2014 to 2016 for patients with a GU malignancy or a suspicious mass. The surgeries were performed by a pediatric urologist with robotic experience and a fellowship-trained MIS adult urologist specializing in oncology. Perioperative and oncologic outcomes were recorded.
A total of eight robotic cases were performed: four partial nephrectomies (PN) with retroperitoneal lymph node dissection (LND) (OT 269-338 min, EBL 5-300 mL, LOS 3-6 days), one adrenalectomy with LND (6.4 cm mass; OT 172 min, EBL 5 mL, LOS 3 days), one nephrectomy with pericaval LND (9.8 cm mass; 234 min, EBL 25 mL, LOS 3 days), and two retroperitoneal LNDs (OT 572 and 508 min, EBL 250 and 100, LOS 3 and 4 days). Patient weights ranged from 14 to 79 kg (mean 53.4 kg). There were no major complications (Clavien 3-5). Pathology results for PN included papillary RCC (AJCC pT1aNx) and two cases of segmental cystic renal dysplasia with nephrogenic rests. Bilateral template RPLNDs yielded paratesticular rhabdomyosarcoma (43 nodes; COG low risk group II stage I) and mixed non-seminomatous germ cell tumor (74 nodes; COG stage III). The nephrectomy yielded an undifferentiated sarcoma, low grade; the adrenalectomy favorable-type ganglioneuroma.
In pediatrics, urologic oncology cases are often managed with open surgery. Our series demonstrates the feasibility of using the robotic approach in carefully selected cases. In doing so, the patient benefits from a minimally invasive surgery, while the surgeon benefits from robotic surgical dexterity. We seamlessly advanced these new techniques through a step-wise collaboration between an adult urologist who routinely performs robotic oncology procedures and a pediatric urologist experienced in robotics for benign conditions.
In this small series, we safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults.
在成人泌尿科肿瘤学中，机器人的使用已经很普遍；而在小儿泌尿科，机器人的使用则很少见。本文描述了一位成人泌尿科医生和一位小儿泌尿科医生之间的合作，他们共同为患有可疑或癌症性泌尿生殖系统（GU）病变的儿童和年轻人进行机器人手术。
评估儿童和年轻人接受机器人手术治疗 GU 道可疑或癌症性病变的临床和肿瘤学结果；描述我们在一家独立的儿童医院中，成人泌尿科医生和小儿泌尿科医生之间的合作模式。
我们回顾性分析了 2014 年至 2016 年间，我们机构为 GU 恶性肿瘤或可疑肿块患者进行的所有机器人手术病例。手术由一位有机器人手术经验的小儿泌尿科医生和一位专门从事肿瘤学的 MIS 成人泌尿科医生（接受过 fellowship 培训）共同完成。记录围手术期和肿瘤学结果。
共完成了 8 例机器人手术：4 例部分肾切除术（PN）伴腹膜后淋巴结清扫术（OT 269-338 分钟，EBL 5-300 毫升， LOS 3-6 天），1 例肾上腺切除术伴淋巴结清扫术（6.4 厘米肿块；OT 172 分钟，EBL 5 毫升， LOS 3 天），1 例肾切除术伴腔静脉旁淋巴结清扫术（9.8 厘米肿块；OT 234 分钟，EBL 25 毫升， LOS 3 天）和 2 例腹膜后淋巴结清扫术（OT 572 和 508 分钟，EBL 250 和 100 毫升， LOS 3 和 4 天）。患者体重 14-79 公斤（平均 53.4 公斤）。无严重并发症（Clavien 3-5 级）。PN 的病理结果包括乳头状肾细胞癌（AJCC pT1aNx）和 2 例节段性囊性肾发育不良伴肾源性遗迹。双侧模板性腹膜后淋巴结清扫术得到了睾丸旁横纹肌肉瘤（43 个淋巴结；COG 低危组 II 期 I 期）和混合非精原细胞瘤生殖细胞肿瘤（74 个淋巴结；COG 期 III 期）。肾切除术得到了未分化的肉瘤，低度恶性；肾上腺切除术为良性神经节细胞瘤。
在儿科，泌尿科肿瘤病例通常采用开放手术治疗。我们的系列研究表明，在精心选择的病例中，使用机器人方法是可行的。这样，患者可以从微创手术中获益，而外科医生可以从机器人手术的灵巧性中获益。我们通过成人泌尿科医生（他常规进行机器人肿瘤手术）和小儿泌尿科医生（在机器人治疗良性疾病方面经验丰富）之间的逐步合作，安全有效地将这些新技术应用于儿童和年轻人的泌尿生殖系统肿瘤病例中。
在这项小系列研究中，我们安全有效地将成人机器人技术应用于儿童和年轻人的泌尿生殖系统肿瘤病例。
