Steinberg Ryan L, Johnson Brett A, Garbens Alaina, Cadeddu Jeffrey A
Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
UT Southwestern Department of Urology, 2001 Inwood Dr. Urology 4th Floor, MC 9164, Dallas, TX, 75390, USA.
J Robot Surg. 2020 Oct;14(5):781-788. doi: 10.1007/s11701-020-01054-x. Epub 2020 Feb 14.
Nutcracker phenomenon of the left renal vein is a rare anatomic anomaly that can present with chronic flank/pelvic pain, pelvic congestion, and hematuria. Conventional treatment options (superior mesenteric artery transposition, endovascular stent placement, auto-transplantation) involve substantial risk, morbidity, or the need for chronic anti-coagulation. We now report our institution's robotic experience with extravascular left renal vein stent placement. A retrospective, single surgeon series from December 2016 to May 2019 was reviewed. After positioning and port placement (three robotic ports, one assistant), the left renal vein was exposed and dissected free circumferentially down to the inferior vena cava insertion. The distance between the renal vein ostium and adrenal vein was measured and a 1 cm-diameter ringed polytetrafluoroethylene vascular stent of this length placed. The stent edges were secured to itself with 3-0 polyglactin sutures. Demographics, surgical, and functional outcomes were collected. Six patients with mean age of 45 ± 6 years and body mass index of 20.3 ± 3.3 g underwent the procedure. Mean operative time was 143 ± 20 min. Estimated blood loss was minimal. Mean graft length utilized was 2.25 ± 0.3 cm. Median day of discharge was 1.5 days (range 1-3). No high-grade complications occurred. All patients received immediate pain relief and 50% also saw other symptomatic improvements. Robotic assisted extravascular left renal vein stent placement appears safe and effective in a small cohort with short follow-up. Further long-term follow-up for pain relief and graft-related complications are needed.
左肾静脉胡桃夹现象是一种罕见的解剖学异常，可表现为慢性胁腹/盆腔疼痛、盆腔充血和血尿。传统的治疗选择（肠系膜上动脉移位、血管内支架置入、自体肾移植）存在较大风险、发病率高或需要长期抗凝。我们现在报告我们机构在血管外左肾静脉支架置入方面的机器人手术经验。回顾了2016年12月至2019年5月由单一外科医生进行的回顾性系列病例。在定位和放置端口（三个机器人端口，一个助手端口）后，暴露左肾静脉并沿圆周方向游离解剖至下腔静脉汇入处。测量肾静脉开口与肾上腺静脉之间的距离，并放置一个直径1厘米、长度合适的带环聚四氟乙烯血管支架。用3-0聚乙醇酸缝线将支架边缘固定在自身上。收集患者的人口统计学、手术和功能结果。6例患者平均年龄45±6岁，体重指数20.3±3.3，接受了该手术。平均手术时间为143±20分钟。估计失血量极少。平均使用的移植物长度为2.25±0.3厘米。中位出院天数为1.5天（范围1-3天）。未发生严重并发症。所有患者的疼痛均立即缓解，50%的患者其他症状也有所改善。在随访时间较短的一小群患者中，机器人辅助血管外左肾静脉支架置入术似乎安全有效。需要进一步进行长期随访，以观察疼痛缓解情况和与移植物相关的并发症。
