Cong Rong, Xue Yan, Li Yaling, Li Qiling, Zhao Lanbo
The Second Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.
Department of Obstetrics and Gynecology, The First Affilitated Hospital of Xi'an Jiaotong University, Xi'an, China.
Ann Med Surg (Lond). 2025 Jan 21;87(4):2358-2361. doi: 10.1097/MS9.0000000000002862. eCollection 2025 Apr.
Robotic laparo-endoscopic single-site (R-LESS) surgery is a potential advancement from the conventional single-site surgery in minimally invasive surgery (MIS) management for early ovarian cancer including granulosa cell tumors. This case report details the use of a novel robotic surgical system for a trans-umbilical single-site re-staging procedure to assess its feasibility and safety. It also discusses the technical challenges encountered during omentectomy, one of the most challenging steps of the surgery, since it requires changing of instrument direction from pelvic to abdominal area.
We presented a case of a female in 40 years old who came to our hospital for a re-staging surgery. She underwent open abdominal right ovarian and fallopian tube resection in local hospital, and post-operative pathology reported ovarian granulosa cell tumor. Since she insisted to have MIS, robotic laparo-endoscopic trans-umbilical single-site re-staging surgery was planned for her. The scope of the surgery was total hysterectomy, left ovarian and fallopian tube resection, and omentectomy. The whole surgery took 240 min. Console time was 173 min. Intra-operative bleeding was 50 mL. The patient left our hospital 3 days after surgery with no complications.
Ovarian granulosa cell tumor is not common. Staging can be performed under MIS in highly selected patients. During infra-colic omentectomy, spaces were rather narrow for valid movement of robotic arms. To solve this problem, assistant played crucial role for traction and exposure.
To conclude, single-site robotic surgery was feasible for staging of ovarian granulosa cell tumor with highly selected patients.
机器人腹腔镜单孔手术（R-LESS）是微创外科（MIS）治疗早期卵巢癌（包括颗粒细胞瘤）的传统单孔手术的潜在进展。本病例报告详细介绍了一种新型机器人手术系统用于经脐单孔再分期手术以评估其可行性和安全性。它还讨论了在网膜切除术中遇到的技术挑战，网膜切除术是手术中最具挑战性的步骤之一，因为它需要将器械方向从盆腔改变到腹部区域。
我们报告了一例40岁女性来我院进行再分期手术的病例。她在当地医院接受了开放性右卵巢和输卵管切除术，术后病理报告为卵巢颗粒细胞瘤。由于她坚持进行微创治疗，因此为她计划了机器人腹腔镜经脐单孔再分期手术。手术范围包括全子宫切除术、左卵巢和输卵管切除术以及网膜切除术。整个手术耗时240分钟。控制台操作时间为173分钟。术中出血50毫升。患者术后3天出院，无并发症。
卵巢颗粒细胞瘤并不常见。在经过严格筛选的患者中，可以在微创条件下进行分期。在结肠下网膜切除术中，机器人手臂有效移动的空间相当狭窄。为了解决这个问题，助手在牵引和暴露方面发挥了关键作用。
总之，对于经过严格筛选的患者，单孔机器人手术用于卵巢颗粒细胞瘤分期是可行的。
