Wenning Lu, Xiangfei Meng, Rong Wang, Liping Zhang, Chaoyang Liu, Rui Cheng
Department of Comprehensive Surgery, The Second Medical Center & National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital, Beijing, 100853, China.
Department of Hepatobiliary, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Ann Med Surg (Lond). 2021 Aug 5;69:102669. doi: 10.1016/j.amsu.2021.102669. eCollection 2021 Sep.
and Importance: There have been few studies in the literature that report patient have triple combined procedures done via minimally invasive approaches. We report a co-management SMC intervention helped an 88-years-old patient with multiple surgery risk factors have combined procedures done via robotic-assisted approaches at one sitting with excellent surgical outcomes.
We describe the surgical and medical co-management (SMC) intervention of a 88-year-old male patient who was found to have colonic carcinoma, right renal carcinoma, gall bladder stones, hypertension, plumonary interstital fibrosis, atrioventricular block. The patient underwent simultaneous triple robotic-assisted laparoscopic surgery procedure consisting of right partial nephrectomy, right hemicolecomy and cholecystectomy using robot. Perioperative optimization approach was recommended and planned after consultation with group comprises internists and surgeons. The internists rounds on the patient daily and helps to manage all chronic medical comorbidities. He was discharged without any severe complications.
This case shows the feasibility and safety of the synchronously triple robotic surgical treatments, with clinic outcomes that is better with that of the separately. SMC approach may maximize therapy efficiency and patient recovery in elder patients with chronic disease who has significantly higher postoperative complications.
及其重要性：文献中鲜有研究报道患者通过微创方法进行三联联合手术。我们报告了一种联合管理的同步多器官协作（SMC）干预措施，该措施帮助一名患有多种手术风险因素的88岁患者通过机器人辅助方法一次性完成联合手术，手术效果极佳。
我们描述了一名88岁男性患者的手术和医疗联合管理（SMC）干预情况，该患者被发现患有结肠癌、右肾癌、胆结石、高血压、肺间质纤维化、房室传导阻滞。患者接受了同步三联机器人辅助腹腔镜手术，包括右半肾切除术、右半结肠切除术和机器人辅助胆囊切除术。在与由内科医生和外科医生组成的团队协商后，推荐并制定了围手术期优化方案。内科医生每天查房并帮助管理所有慢性合并症。患者出院时无任何严重并发症。
本病例显示了同步三联机器人手术治疗的可行性和安全性，临床结果优于单独手术。SMC方法可能会使患有明显更高术后并发症的老年慢性病患者的治疗效率和患者恢复最大化。
