Clinical practice of single-position robot-assisted left nephrectomy and venous tumor thrombectomy
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摘要: 目的 探讨经Kocher入路和左侧肠系膜上入路的单一体位机器人左肾癌伴静脉癌栓切除术的安全性和可行性。方法 回顾性分析2021年和2023年于中国人民解放军总医院第一医学中心经Kocher入路和左侧肠系膜上入路行单一体位机器人左肾癌伴静脉癌栓切除术的2例患者临床资料。2例患者均为男性，年龄分别为56、70岁；体重指数分别为20.6、26.0 kg/m2。根据301分级，0b级癌栓患者1例，Ⅱ级癌栓患者1例。结果 2例手术均在单一体位下顺利完成，无转开放或改变体位。手术时间分别为205、436 min，失血量分别为350、2 500 mL。患者术后总住院时间分别为6、10 d。根据Clavien-Dindo分级系统，无Ⅲ级以上并发症。随访时间分别29.4、13.5个月，2例患者均无肿瘤复发及转移。结论 对于原发灶位于左侧的301分级0b~Ⅱ级的肾癌伴静脉癌栓患者，经Kocher入路和左侧肠系膜上入路行单一体位肾癌伴静脉癌栓切除术是安全、可行的，有望缩短手术时间，提高取栓操作的效率及安全性，减少患者的医疗支出。Abstract: Objective To explore the safety and feasibility of single-position robot-assisted left nephrectomy and venous tumor thrombectomy via Kocher approach and left superior mesenteric approach.Methods The clinical data of the 2 patients who underwent single-position robot-assisted left nephrectomy and venous tumor thrombectomy via Kocher approach and left superior mesenteric approach at the First Medical Center of Chinese PLA General Hospital in 2021 and 2023 were retrospectively analyzed. Both patients were male, aged 56 and 70 years old. Body mass index was 20.6 and 26.0 kg/m2. According to the 301 classification, there was 1 patient with level 0b tumor thrombus and 1 patient with level Ⅱ tumor thrombus.Results Both operations were successfully completed in a single position without converting to open surgery or changing position. The operation time was 205 and 436 minutes, and the blood loss was 350 and 2 500 mL. The patient's total postoperative hospital stay was 6 and 10 days. According to the Clavien-Dindo classification system, there were no complications above Grade Ⅲ. Both patients showed no tumor recurrence or metastasis during the follow-up period of 29.4 and 13.5 months, respectively.Conclusion For patient's with level 0b-Ⅱ(301 classification) left renal tumor with venous tumor thrombus, single-position robot-assisted left nephrectomy and venous tumor thrombectomy via Kocher approach and left superior mesenteric approach is safe and feasible. It is expected to shorten the operation time, improve the efficiency and safety of thrombectomy, and reduce patient medical expenses.
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Key words:
- renal neoplasms /
- venous tumor thrombus /
- robot /
- laparoscopy /
- single position
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