Estébanez Zarranz J, Belloso Loidi J, Gutierrez García M A, Rubio Calaveras V, Morales Higelmo G, Melendo Tercilla P, Busto Leis L, Sanz Jaka J P
Servicio de Urología, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España.
Servicio de Urología, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, España.
Actas Urol Esp (Engl Ed). 2018 Oct;42(8):538-541. doi: 10.1016/j.acuro.2018.02.008. Epub 2018 Apr 24.
Renal cell carcinoma has a natural tendency to extend through the renal vein. When the thrombus reaches the vena cava, thrombectomy and the necessary reconstruction of the vena cava are typically performed by open pathway. Robot-assisted technology provides advantages for performing this complex technique, using a minimally invasive access.
We present the technique we employed in the first case performed in our department. After performing renal artery embolisation, we conducted the surgery with the Vinci S robotic system. The main steps of the surgery are as follows: detachment and Kocher manoeuvre; release of the lower renal pole; clamping and sectioning of the renal artery; endocavitary ultrasound to locate the thrombus; placement of tourniquets in the vena cava below and above the renal veins and in the left renal vein; closure of the 3 tourniquets; opening of the vena cava; resection and extraction of the thrombus; suture of the vena cava; opening of the tourniquets; complete release of the kidney; bagging and extraction of the specimen.
The surgery was performed without complications. The patient required a transfusion of 2 units of packed red blood cells and was discharged with modest renal failure (creatinine level of 1.60mg/dl).
Radical nephrectomy with thrombectomy in the vena cava is a technique susceptible to severe complications and has, to date, been performed in few centres. We believe that the technique is reproducible and has clear advantages for our patients.
肾细胞癌有自然延伸至肾静脉的倾向。当血栓到达腔静脉时，通常通过开放手术途径进行血栓切除术及必要的腔静脉重建。机器人辅助技术利用微创入路为实施这项复杂技术提供了优势。
我们介绍了在本科室完成的首例手术中所采用的技术。在进行肾动脉栓塞后，我们使用达芬奇S机器人系统进行手术。手术的主要步骤如下：游离与科赫尔操作；松解肾下极；钳夹并切断肾动脉；腔内超声定位血栓；在肾静脉下方和上方的腔静脉以及左肾静脉中放置止血带；收紧3条止血带；切开腔静脉；切除并取出血栓；缝合腔静脉；松开止血带；完全游离肾脏；装入标本袋并取出标本。
手术无并发症发生。患者需要输注2单位浓缩红细胞，出院时伴有轻度肾衰竭（肌酐水平为1.60mg/dl）。
根治性肾切除术加腔静脉血栓切除术是一项易引发严重并发症的技术，迄今为止仅在少数中心开展。我们认为该技术具有可重复性，对我们的患者具有明显优势。
