Masterson John M, Zhao Hanson, Taich Lior, Naser-Tavakolian Aurash, Johnson Hayley, Najjar Reiad, Kim Irene K, Gupta Amit
Division of Urology Cedars-Sinai Medical Center Los Angeles California USA.
Hoag Urology Hoag Hospital Newport Beach California USA.
BJUI Compass. 2023 Jun 24;4(6):701-708. doi: 10.1002/bco2.263. eCollection 2023 Nov.
This study aims to describe our technique and review our experience with synchronous robotic bilateral nephrectomy for large kidneys in ADPKD with the da Vinci XI and da Vinci Single Port platforms (Intuitive Surgical, Sunnyvale, CA).
We performed a retrospective review of all robotic bilateral nephrectomy cases from January 2020 to present at a high-volume robotic single centre. Demographic data and perioperative details including preoperative CT scans, indication for nephrectomy and renal function were collected. We also collected post-op course data and final specimen data details.
Fourteen cases were included. Patient demographics, indications for surgery and specimen data are outlined in Table 1. The largest kidney removed has a measurement of 32 cm in the largest dimension on preoperative imaging. Median operating time from incision to closure was 299 min (IQR 260, 339). Median estimated blood loss was 75 cc (IQR 50, 187.5). Two patients were transfused intraoperatively. Median pre- and post-operative Hgb was 11.0 and 9.6, respectively. Median length of stay was 3 days (IQR 2, 3.5). There were no intraoperative complications and no open conversions. Post-operative complications included one incisional hematoma and one superficial wound infection. One patient was admitted to the surgical ICU post operatively for ventilatory support. Two patients were readmitted within 30 days of surgery.
The robotic approach to bilateral native nephrectomy for ADPKD should be considered when native nephrectomies are indicated. The operative times and outcomes are favourable compared with prior series, and this technique works even for very large kidneys.
本研究旨在描述我们的技术，并回顾我们使用达芬奇XI和达芬奇单孔平台（直观外科公司，加利福尼亚州桑尼维尔）对常染色体显性多囊肾病（ADPKD）患者的大肾脏进行同步机器人双侧肾切除术的经验。
我们对2020年1月至今在一个高容量机器人单中心进行的所有机器人双侧肾切除术病例进行了回顾性研究。收集了人口统计学数据和围手术期细节，包括术前CT扫描、肾切除术指征和肾功能。我们还收集了术后病程数据和最终标本数据细节。
共纳入14例病例。患者人口统计学、手术指征和标本数据见表1。术前影像学检查中切除的最大肾脏最大径为32厘米。从切口到缝合的中位手术时间为299分钟（四分位间距260，339）。中位估计失血量为75毫升（四分位间距50，187.5）。2例患者术中输血。术前和术后血红蛋白中位数分别为11.0和9.6。中位住院时间为3天（四分位间距2，3.5）。无术中并发症，无中转开放手术。术后并发症包括1例切口血肿和1例浅表伤口感染。1例患者术后因呼吸支持入住外科重症监护病房。2例患者在术后30天内再次入院。
当需要进行双侧自体肾切除术时，应考虑采用机器人技术治疗ADPKD。与先前的系列研究相比，手术时间和结果良好，该技术甚至适用于非常大的肾脏。
