Yu S C, Zhu S B, Hu H Y, Ding G Q
Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
Zhonghua Wai Ke Za Zhi. 2021 Jun 1;59(6):530-534. doi: 10.3760/cma.j.cn112139-20200814-00643.
To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning. Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient's side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A "W"-shape, three robotic-arm configurations was used for port placement. The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57). Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.
探讨一种无需机器人重新对接或患者重新定位的机器人辅助肾输尿管切除术新技术。纳入2015年11月至2019年1月在浙江大学医学院附属邵逸夫医院泌尿外科接受该术式治疗的上尿路尿路上皮癌患者进行分析。在获得机构审查委员会批准后，通过回顾性病历审查收集包括患者人口统计学、手术过程和术后并发症等数据。62例患者（35例男性和27例女性）接受了单次对接机器人辅助肾输尿管切除术且未重新定位，中位年龄为70岁（范围：30至91岁）。62例患者中，37例为肾盂癌，25例为输尿管癌（上段12例，中段5例，下段8例）。患者取60至80度改良侧卧位，头低脚高15度。对侧手臂置于臂板上与躯干垂直，同侧手臂用充足衬垫固定于患者身侧。然后将机器人手术台车以90度角对接，垂直于患者。采用“W”形三臂机器人配置进行端口置入。62例患者手术均成功完成。手术时间为（171.6±54.7）分钟（范围：60至370分钟）。术中估计失血量为50（50）毫升（范围：20至400毫升），4例患者接受输血。未发生围手术期死亡。11例患者出现术后并发症（Clavien-Dindo 2级），包括3例出血和8例乳糜漏。所有病例均定期随访，中位随访时间为37个月（范围：17至55个月）。分别有8、30、19、4和1例患者随访48、36、24、18和不到18个月。3例患者出现局部复发，11例发生远处转移，5例患者死于癌症。估计24个月内生存率为75.4%（43/57）。无需机器人重新对接或患者重新定位的机器人辅助肾输尿管切除术可安全重复进行，手术效果与其他成熟技术相当。
