Aster Medcity, Kochi, Kerala, India.
Int Braz J Urol. 2018 Nov-Dec;44(6):1261. doi: 10.1590/S1677-5538.IBJU.2017.0384.
The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active component. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma.
Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota's fascia. Mass was dissected completely and removed through Pfan-nensteil incision.
Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-operative renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examination of specimen revealed ganglioneuroma arising from adrenal gland.
Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles.
本视频旨在演示一例 16 岁男孩右侧肾上腺复杂肿块的机器人切除术，该肿块向后延伸至下腔静脉并包裹肾门。生化筛选结果为无代谢活性成分。增强 CT 扫描显示右侧肾上腺区有一个约 10.8cmx6.2cmx4.2cm 的均质肿块，向后延伸至下腔静脉后方并包裹肾门血管。影像学表现为典型的神经节细胞瘤。
采用机器人辅助腹腔镜肾上腺切除术，保留肾门血管。患者取侧卧位，使用五个端口，其中一个用于肝牵拉。达芬奇®系统的四个臂从右肩上方对接。打开肾筋膜后识别移位的肾门结构。完全分离肿块并通过潘氏切口取出。
手术时间为 345 分钟，控制台时间为 290 分钟。出血量为 250ml。术后肾多普勒显示血流正常。他在术后第三天出院。标本的组织病理学检查显示源自肾上腺的神经节细胞瘤。
神经节细胞瘤是一种罕见的肾上腺肿瘤，手术切除后预后良好。机器人手术的出现使得涉及下腔静脉等重要结构的复杂手术能够通过微创技术进行，而不影响肿瘤学原则。
