Gurung Pratik M S, Frye Thomas P, Rashid Hani H, Joseph Jean V, Wu Guan
Department of Urology, University of Rochester Medical Center (URMC), Rochester, NY.
Department of Urology, University of Rochester Medical Center (URMC), Rochester, NY.
Urology. 2021 Jul;153:333-338. doi: 10.1016/j.urology.2020.05.069. Epub 2020 Jun 17.
To describe our technique of robot-assisted synchronous bilateral nephrectomy (RASBN) for autosomal dominant polycystic kidney disease (ADPKD).
Given prior abdominal surgery/transplant in most patients, we prefer an open cut-down access to place a 12 mm port 10 cm infraumbilically. Four (8 mm) robotic ports are then placed under vision in a fan distribution along the umbilical level. The operating table is placed in reverse Trendelenburg and tilted opposite to the targeted side. Provided there are no concerns for malignancy, some cysts encountered in large kidneys (>2.5 L) may require puncture, to facilitate access and mobilization. The resected kidney is placed in a large bag and tucked in the pelvis. A similar procedure is carried out on the contralateral side after redocking the robot and tilting the table in the opposite direction. The specimen bags are extracted by elongating the lower midline 12 mm port site.
Seven cases of RASBN performed for ADPKD were identified (December 2015 to December 2018). Median (interquartile range, IQR) values for patient demographics were: Age = 59 years (47-63), body mass index = 29 (26-32), and American Society of Anaesthesiology grade = 3. Three patients had prior deceased- and 4 had prior living- donor transplants. Indication for nephrectomy were: pain (5), hemorrhage into cysts (3), and renal masses (2). Perioperative outcomes were: operating room time = 388 minutes, estimated blood loss = 200 mL, hemoglobin change = 1.3 g/dL, transfusion = 0, length of hospital stay = 3 days, Grade I Clavien-Dindo complications = 2 cases. All patients were alive at a median follow-up of 3.8 years.
RASBN is safe and effective in ADPKD even in the context of prior renal transplant patients with attendant comorbidities.
描述我们用于常染色体显性多囊肾病（ADPKD）的机器人辅助同步双侧肾切除术（RASBN）技术。
鉴于大多数患者既往有腹部手术/移植史，我们更倾向于采用开放切口入路，在脐下10 cm处放置一个12 mm的端口。然后在直视下沿脐水平呈扇形分布放置四个（8 mm）机器人端口。手术台置于头低脚高位，并向与目标侧相反的方向倾斜。如果不存在恶性肿瘤担忧，对于大肾脏（>2.5 L）中遇到的一些囊肿可能需要穿刺，以利于暴露和游离。切除的肾脏放入一个大袋子中并置于盆腔内。重新对接机器人并将手术台向相反方向倾斜后，对侧进行类似操作。通过延长下中线12 mm端口部位取出标本袋。
确定了7例因ADPKD进行RASBN的病例（2015年12月至2018年12月）。患者人口统计学特征的中位数（四分位间距，IQR）值为：年龄=59岁（47 - 63岁），体重指数=29（26 - 32），美国麻醉医师协会分级=3级。3例患者既往接受过尸体供肾移植，4例患者既往接受过活体供肾移植。肾切除的指征为：疼痛（5例）、囊肿内出血（3例）和肾肿物（2例）。围手术期结果为：手术时间=388分钟，估计失血量=200 mL，血红蛋白变化=1.3 g/dL，输血=0例，住院时间=3天，Clavien-Dindo I级并发症=2例。所有患者在中位随访3.8年时均存活。
即使在有合并症的既往肾移植患者中，RASBN对于ADPKD也是安全有效的。
