Xu JinBin, Deng GengGuo, Huang ZhanSen, Cheong Sam Un, Xu Zifeng, Ye Yuedian, Liu Weihao, Li Xiaoming, Li Jiang, Huang Qunxiong, Li Tengcheng, Di Jinming
Department of Urology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Int J Med Robot. 2025 Oct;21(5):e70110. doi: 10.1002/rcs.70110.
To evaluate the feasibility of a novel robotic-assisted laparoscopic technique-side clamp two-step vascular method-for left renal vein (LRV) transposition in nutcracker syndrome (NCS).
Between May and December 2023, three male NCS patients (median age: 14 years) underwent robot-assisted LRV transposition using the Di's technique. The key procedure included a side clamp two-step technique to selectively occlude the infrarenal inferior vena cava and LRV without right renal vein manipulation. Surgical outcomes, including operative time, blood loss, anastomosis duration, and postoperative complications, were retrospectively analysed.
All procedures were successfully completed. Median operative time was 125 min, with LRV anastomosis completed in 23 min. Postoperative imaging confirmed the resolution of LRV compression, with pressure gradients reduced to < 3 mmHg. Symptoms resolved completely within 4 weeks.
The robotic-assisted side clamp two-step technique offers a minimally invasive alternative for LRV transposition in NCS, minimising vascular dissection and preserving right renal venous flow.
This clinical trial has been registered in the Chinese Clinical Trial Registry (ChiCTR, registration number: ChiCTR2500099335).
评估一种新型机器人辅助腹腔镜技术——侧钳两步血管法——用于胡桃夹综合征（NCS）中左肾静脉（LRV）转位的可行性。
2023年5月至12月期间，3例男性NCS患者（中位年龄：14岁）采用狄氏技术接受了机器人辅助LRV转位手术。关键步骤包括侧钳两步技术，以选择性阻断肾下下腔静脉和LRV，而不涉及右肾静脉操作。回顾性分析手术结果，包括手术时间、失血量、吻合时间和术后并发症。
所有手术均成功完成。中位手术时间为125分钟，LRV吻合在23分钟内完成。术后影像学检查证实LRV压迫解除，压力梯度降至<3 mmHg。症状在4周内完全缓解。
机器人辅助侧钳两步技术为NCS中LRV转位提供了一种微创替代方法，可最大限度减少血管解剖并保留右肾静脉血流。
本临床试验已在中国临床试验注册中心注册（ChiCTR，注册号：ChiCTR2500099335）。
