Cheng Gong, Ruan Hailong, Yang Chao, Cao Qi, Liang Huageng, Yang Xiong, Jiang Guosong, Zhang Xiaoping
Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Urologic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Transl Androl Urol. 2021 May;10(5):2133-2139. doi: 10.21037/tau-20-1523.
The aim of the present study was to report the initial clinical experience of robot-assisted laparoscopic retroperitoneal leiomyosarcoma resection with inferior vena cava graft replacement. The patient was a 45-year-old female with abdominal pain. She was referred to our hospital and found to be with a retroperitoneal mass (46 mm × 45 mm). The inferior vena cava and the distal part of left renal vein were invaded by the tumor and compression was obviously seen from magnetic resonance imaging. The serum level of potassium, epinephrine, norepinephrine, cortisol, adrenocorticotropic hormone and renin angiotensin aldosterone system were all in normal ranges before the surgery. The operation was performed via a six port, robot assisted, transperitoneal laparoscopic approach. The tumor was completely resected and adherent part of inferior vena cava (approximately 5 cm) was dissected. Considering severe impairment of the great vessel, we decided to replace excised caval segment with an extended polytetrafluoroethylene graft and undertook the inferior vena cava reconstruction. The patient was discharged 11 days postoperatively with embolus in the graft. Anticoagulants were routinely administrated and the thrombus seemed to be smaller 3 months after operation. Abdominal pain was resolved and pathological examination finally confirmed that the tumor was leiomyosarcoma with negative margins free from tumor. Leiomyosarcoma of inferior vena cava present a technical challenge to surgeons. Comprehensive preparation should be made preoperatively to facilitate tumor resection and vascular management. In specific cases, robotic resection of leiomyosarcoma from great vessels and vascular repairment might be feasible options in experienced hands.
本研究的目的是报告机器人辅助腹腔镜下后腹膜平滑肌肉瘤切除并下腔静脉移植置换术的初步临床经验。患者为一名45岁女性，有腹痛症状。她被转诊至我院，检查发现后腹膜有一肿块（46毫米×45毫米）。肿瘤侵犯了下腔静脉和左肾静脉远端，磁共振成像显示有明显压迫。术前血清钾、肾上腺素、去甲肾上腺素、皮质醇、促肾上腺皮质激素和肾素-血管紧张素-醛固酮系统水平均在正常范围内。手术通过六孔机器人辅助经腹腹腔镜入路进行。肿瘤被完整切除，下腔静脉的粘连部分（约5厘米）被分离。考虑到大血管严重受损，我们决定用一段延长的聚四氟乙烯移植物置换切除的腔静脉段，并进行下腔静脉重建。患者术后11天出院，移植物中有栓子。常规给予抗凝剂，术后3个月血栓似乎变小。腹痛缓解，病理检查最终证实肿瘤为平滑肌肉瘤，切缘阴性，无肿瘤残留。下腔静脉平滑肌肉瘤对外科医生来说是一项技术挑战。术前应进行全面准备，以利于肿瘤切除和血管处理。在特定情况下，对于经验丰富的医生，机器人辅助从大血管切除平滑肌肉瘤并进行血管修复可能是可行的选择。
