切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 151 -155. doi: 10.3877/cma.j.issn.1674-3253.2022.02.013

临床研究

达芬奇Xi系统在单一体位经腹腔肾输尿管切除术中的应用
翁博文1, 邱志磊1, 孙发林1, 高健刚1, 贾勇1, 梁鑫1, 吕海涛2, 侯四川1,()   
  1. 1. 266071 山东,青岛市市立医院东院区泌尿外科
    2. 66071 山东,青岛市市立医院东院区麻醉手术科
  • 收稿日期:2021-01-04 出版日期:2022-04-01
  • 通信作者: 侯四川

Single-position transperitoneal robot-assisted nephroureterectomy with the da Vinci Xi robotic system

Bowen Weng1, Zhilei Qiu1, Falin Sun1, Jiangang Gao1, Yong Jia1, Xin Liang1, Haitao Lv2, Sichuan Hou1,()   

  1. 1. Department of Urology, the East Campus of Qingdao Municipal Hospital, Shandong 266071, China
    2. Department of Anaesthesiology and Operating, the East Campus of Qingdao Municipal Hospital, Shandong 266071, China
  • Received:2021-01-04 Published:2022-04-01
  • Corresponding author: Sichuan Hou
引用本文:

翁博文, 邱志磊, 孙发林, 高健刚, 贾勇, 梁鑫, 吕海涛, 侯四川. 达芬奇Xi系统在单一体位经腹腔肾输尿管切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(02): 151-155.

Bowen Weng, Zhilei Qiu, Falin Sun, Jiangang Gao, Yong Jia, Xin Liang, Haitao Lv, Sichuan Hou. Single-position transperitoneal robot-assisted nephroureterectomy with the da Vinci Xi robotic system[J]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(02): 151-155.

目的

探讨达芬奇Xi系统单一体位经腹腔肾输尿管全长切除术在治疗上尿路尿路上皮癌中的可行性及安全性。

方法

回顾性分析青岛市市立医院东院区2019年11月至2020年11月收治的11例患者资料。其中男7例,女4例,年龄50~77岁。肾盂癌5例,输尿管癌5例,肾盂癌合并输尿管癌1例。肿瘤位于左侧6例,右侧5例。应用达芬奇Xi系统,术中不变换体位。

结果

11台手术均顺利应用达芬奇Xi系统完成,无中转开放或腹腔镜手术。术中出血量30~300 ml。手术时间110~210 min。术后住院时间8~13 d。术后无ClavienⅡ级以上并发症。术后随访时间0~12个月,失访2例,无死亡及肿瘤复发病例。

结论

单一体位经腹腔肾输尿管切除术能较好地发挥达芬奇Xi系统的优势,手术时间明显较短,术后恢复快,肿瘤切除效果较好,短期随访结果满意。

Objective

To investigate and evaluate the safety and effect of single-position transperitoneal robotic-assisted nephroureterectomy with the da Vinci Xi robotic system.

Methods

A total of 11 patients' clinical data from November 2019 to November 2020 in our hospital was retrospectively analyzed, including 7 males and 4 females. The age was 50-77 years. Of the 11 localized upper tract urothelial carcinoma (UTUC) patients including, 5 renal pelvic tumors, 5 ureter tumors, 1 ureter tumors combined with renal pelvic tumor. There were 6 cases on the left side, and 5 cases on the right. Single-position transperitoneal robot-assisted nephroureterectomy with the da Vinci Xi robotic system was performed on all the patients.

Results

All procedures were successful.The median operation time was 155(110-210) min, and the median estimated blood loss of 92(30-300) ml. The median length of stay was 10.5(8-13) d. None Clavien grade Ⅱ-Ⅴ complications was occurred after surgery. The median length of follow-up was 4.3(0-12) months. None recurrence and died case until November 2020.

Conclusions

The single-position transperitoneal robotic-assisted nephroureterectomy with the da Vinci Xi robotic system is a safe and efficacious procedure. The postoperative recover time is reduced. Short-term follow-up results prompt good tumor control effect.

图1 达芬奇Xi系统径腹腔肾输尿管切处术中套管穿刺位置分布图注:图1a病变位于右侧;A、B、C、D均为8 mm机械臂套管,分别对应1、2、3、4号机械臂;E为12 mm第一助手套管,F为5 mm第二助手套管;图1b病变位于左侧;A、B、C、D均为8 mm机械臂套管,分别对应1、2、3、4号机械臂;E为12 mm第一助手套管
图2 膀胱袖状切除步骤注:图2a为游离输尿管远端至膀胱壁内段;图2b为于输尿管膨大处预缝膀胱壁;图2c为切除输尿管壁内段及管口周围部分膀胱壁;图2d为连续缝合膀胱残端
[1]
Roupret M, Babjuk M, Burger M, et al. European association of urology guidelines on upper urinary tract urothelial carcinoma: 2020 update[J]. Eur Urol, 2021, 79(1): 62-79.
[2]
中国医师协会泌尿外科医师分会肿瘤专业委员会, 中国医师协会泌尿外科医师分会上尿路尿路上皮癌协作组. 上尿路尿路上皮癌诊断与治疗中国专家共识[J]. 中华泌尿外科杂志, 2018, 39(7): 485-488.
[3]
Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration[J]. Cancer, 2009, 115(6): 1224-1233.
[4]
Hemal AK, Stansel I, Babbar P, et al. Robotic-assisted nephroureterectomy and bladder cuff excision without intraoperative repositioning[J]. Urology, 2011, 78(2): 357-364.
[5]
Lee Z, Cadillo-Chavez R, Lee DI, et al. The technique of single stage pure robotic nephroureterectomy[J]. J Endourol, 2013, 27(2): 189-195.
[6]
Darwiche F, Swain S, Kallingal G, et al. Operative technique and early experience for robotic-assisted laparoscopic nephroureterectomy (RALNU) using Xi [J]. Springerplus. 2015, 4: 298.
[7]
Rose K, Khan S, Godbole H, et al. Robotic assisted retroperitoneoscopic nephroureterectomy-first experience and the hybrid port technique[J]. Int J Clin Pract, 2006, 60(1): 12-14.
[8]
Aboumohamed AA, Krane LS, Hemal AK. Oncologic outcomes following robot-assisted laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial carcinoma[J]. J Urol, 2015, 194(6): 1561-1566.
[9]
Trudeau V, Gandaglia G, Shiffmann J, et al. Robot-assisted versus laparoscopic nephroureterectomy for upper-tract urothelial cancer: a population-based assessment of costs and perioperative outcomes[J]. Can Urol Assoc J, 2014, 9(8): 9-10.
[10]
Eandi JA, Nelson RA, Wilson T, et al. Oncologic outcomes for complete robot-assisted laparoscopic management of upper-tract transitional cell carcinoma[J]. J Endourol2010, 24(6): 969-975.
[11]
Lim SK, Shin TY, Rha KH. Current status of robot assisted laparoscopic radical nephroureterectomy for management of upper tract urothelial carcinoma[J]. Curr Urol Rep, 2013, 14(2): 138-146.
[12]
Eun D, Bhandari A, Boris R, et al. Concurrent upper and lower urinary tract robotic surgery: strategies for success[J]. BJU Int, 2007, 100(5): 1121-1125.
[13]
Zargar H, Krishnan J, Autorino R, et al. Robotic nephroureterectomy: a simplified approach requiring no patient repositioning or robot redocking[J]. Eur Urol, 2014, 66 (4): 769-777.
[14]
Argun OB, Mourmouris P, Tufek I, et al. Radical nephroureterectomy without patient or port repositioning using the Xi robotic system:initial experience[J]. Urology, 2016, 92: 136-139.
[15]
Patel MN, Aboumohamed A, Hemal A. Does transition from the Si® to Xi robotic platform impact single-docking technique for robot-assisted laparoscopic nephroureterectomy[J]. BJU Int, 2015, 116(6): 990-994.
[16]
王卫平, 吴震杰, 徐红, 等. 机器人全腹膜外肾输尿管全长及膀胱袖状切除术的初步临床应用 [J]. 中华泌尿外科杂志, 2018, 39(3): 161-165.
[17]
管考鹏, 关有彦, 肖振东, 等. 单一体位经腹腔途径完全腹腔镜肾输尿管切除术+膀胱袖口状切除术的方法与技巧[J]. 中华泌尿外科杂志, 2020, 41(6): 454-458.
[18]
周利群, 张雷. 上尿路尿路上皮癌临床诊疗关键及争议问题[J]. 中华泌尿外科杂志, 2017, 38(12): 881-884.
[19]
王燕, 高旭. 机器人前列腺癌根治术中困难盆腔的评估和手术策略[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(3): 145-148.
[20]
张学宝, 王科, 张其强, 等. 一体位完全腹腔镜下治疗上尿路移行上皮癌[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(1): 45-48
[21]
宋灵敏, 蓝天, 董永超, 等. "一步法"机器人辅助腹腔镜下肾输尿管全长切除术[J]. 现代泌尿外科杂志, 2018, 23(8): 591-594.
[22]
王晨阳, 刘皓, 韩金利, 等. 单次锚定法经腹机器人辅助肾输尿管切除术的技术特点及疗效[J]. 中华泌尿外科杂志, 2020, 41(2): 85-89.
[1] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[2] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[3] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[4] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[5] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[6] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[7] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[8] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[9] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[10] 易明超, 汪鑫, 向涵, 苏怀东, 张伟. 一种T型记忆金属线在经脐单孔腹腔镜胆囊切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 599-599.
[11] 马涛, 叶春伟, 刘滔, 彭文希, 李志鹏. 腹腔镜与开放性离断式肾盂成形术治疗小儿肾盂输尿管连接部梗阻的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 605-610.
[12] 刘成, 赖聪, 黄健, 王建辰, 罗茜芸, 许可慰. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 642-646.
[13] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[14] 李博, 胡刚, 邱文龙, 汤坚强, 王锡山. 多功能吲哚菁绿近红外荧光血管成像技术在腹腔镜直肠癌经自然腔道取标本手术(NOSES Ⅳ式)中的应用(附视频)[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 524-528.
[15] 孙秀艳, 徐庆蕾, 马鹏涛, 胡志元, 郭传真, 祝成红. 腹腔镜胃癌根治术中患者体温变化与压力性损伤及受压部位微环境的相关性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 480-484.
阅读次数
全文


摘要