Kubota Risa, Araki Motoo, Wada Koichiro, Kawamura Kasumi, Maruyama Yuki, Mitsui Yosuke, Sadahira Takuya, Ariyoshi Yuichi, Iwata Takehiro, Nishimura Shingo, Takamoto Atsushi, Sako Tomoko, Edamura Kohei, Kobayashi Yasuyuki, Kano Yuzuki, Kitagawa Masashi, Tanabe Katsuyuki, Sugiyama Hitoshi, Wada Jun, Watanabe Masami, Watanabe Toyohiko, Nasu Yasutomo
Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Acta Med Okayama. 2020 Feb;74(1):53-58. doi: 10.18926/AMO/57953.
We investigated the feasibility of robotic renal autotransplantation (RAT) in a porcine model to reduce invasiveness of RAT. Five pigs underwent robotic RAT using the da Vinci® robotic system. A robotic left nephrectomy was performed in all cases. Robotic RAT was performed on the left side in all but one case. Four ports were used. In 3 cases, the kidney was taken out through the GelPort® and irrigated on ice with Ringer's solution. In 2 cases, a complete intracorporeal robotic RAT was performed. An end-to-side anastomosis was performed between the renal vein and the external iliac vein and between the renal artery and the external iliac artery. Ureteroneocystostomy was also performed in 2 cases. All cases were performed robotically without open conversion. The median (IQR) console time was 3.1 (0.7) h, and the operative time was 3.8 (1.1) h. The estimated blood loss was 30 (0) ml. The warm ischemia time was 4.0 (0.2) min, and the cold ischemia time was 97 (17) min. Intracorporeal transarterial hypothermic renal perfusion was feasible in the 2 complete intracorporeal robotic RAT cases by using a perfusion catheter through a laparoscopic port. Robotic RAT has the potential to be a new minimally invasive substitute for conventional open surgery.
我们在猪模型中研究了机器人辅助肾自体移植（RAT）以降低其侵袭性的可行性。五只猪使用达芬奇®机器人系统接受了机器人辅助RAT。所有病例均进行了机器人辅助左肾切除术。除1例病例外，所有病例均在左侧进行机器人辅助RAT。使用了四个端口。3例中，肾脏通过GelPort®取出，并用林格氏液在冰上冲洗。2例进行了完全体内机器人辅助RAT。在肾静脉与髂外静脉之间以及肾动脉与髂外动脉之间进行了端侧吻合。2例还进行了输尿管膀胱吻合术。所有病例均通过机器人完成，未转为开放手术。中位（四分位间距）控制台时间为3.1（0.7）小时，手术时间为3.8（1.1）小时。估计失血量为30（0）毫升。热缺血时间为4.0（0.2）分钟，冷缺血时间为97（17）分钟。在2例完全体内机器人辅助RAT病例中，通过腹腔镜端口使用灌注导管进行体内经动脉低温肾灌注是可行的。机器人辅助RAT有可能成为传统开放手术的一种新的微创替代方法。
