Single Port Robotic Nephrectomy via lower anterior retroperitoneal approach: feasible, safe and effective option in surgically complex patients.

IF 3.1 3区 医学 Q1 UROLOGY & NEPHROLOGY International Braz J Urol Pub Date : 2024-11-01 DOI:10.1590/S1677-5538.IBJU.2024.0420
Angelo Orsini, Francesco Lasorsa, Gabriele Bignante, Jamie Yoon, Kyle Anna Dymanus, Edward E Cherullo, Riccardo Autorino
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Abstract

Purpose: Minimally invasive radical nephrectomy is often preferred for larger renal tumours not suitable for partial nephrectomy (1). When performed with a multiport robot, the procedure is routinely performed with a transperitoneal approach, with recent studies highlighting important factors for surgical outcomes, including predictive factors (2), segmental artery unclamping techniques (3), and comparisons of robotic techniques (4). This video shows that SP Robot-Assisted Radical Nephrectomy (RARN) via a lower anterior approach is valuable in challenging cases.

Materials and methods: We performed SP-RARN on two complex patients using a retroperitoneal lower anterior approach. The first patient, a 54-year-old female with a BMI of 36.8 kg/m², had a ventral hernia and bowel obstruction history, with a 9 cm right middle kidney mass. The second patient, a 58-year-old male with a BMI of 31.19 kg/m², had ESRD and was on peritoneal dialysis for 8 years, with a 3.4x3.7 cm mass in the right superior pole, suspected to be RCC. The surgical technique is detailed in the video.

Results: Both procedures were successful, with operative times of 173 and 203 minutes and blood loss of 150 mL. No complications occurred. Patients were discharged after 31 and 38 hours, respectively. Histopathology confirmed RCC. At the 3-month follow-up, no complications or readmissions were reported. Second patient continued peritoneal dialysis without issues.

Conclusion: Retroperitoneal SP-RARN via the lower anterior approach avoids the peritoneal cavity, making it suitable for certain patients. In these patients, more so than in others, this procedure is feasible, safe, and less morbid than the standard multiport approach.

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经腹膜后下前方入路的单孔机器人肾切除术:手术复杂患者的可行、安全和有效选择。
目的:对于不适合进行肾部分切除术(1)的较大肾肿瘤,通常首选微创根治性肾切除术。最近的研究强调了影响手术效果的重要因素,包括预测因素(2)、节段动脉松解技术(3)和机器人技术比较(4)。这段视频显示,通过前下途径进行的SP机器人辅助根治性肾切除术(RARN)对具有挑战性的病例很有价值:我们采用腹膜后下前路为两名复杂患者实施了 SP-RARN 手术。第一例患者是一名 54 岁的女性,体重指数(BMI)为 36.8 kg/m²,有腹股沟疝和肠梗阻病史,右肾中段有一个 9 厘米的肿块。第二名患者是一名 58 岁的男性,体重指数为 31.19 kg/m²,患有 ESRD,腹膜透析 8 年,右上极有一个 3.4x3.7 厘米的肿块,怀疑是 RCC。手术技巧详见视频:两次手术都很成功,手术时间分别为173分钟和203分钟,失血量为150毫升。无并发症发生。患者分别在 31 小时和 38 小时后出院。组织病理学证实为 RCC。在三个月的随访中,没有报告并发症或再入院情况。第二名患者继续进行腹膜透析,未出现任何问题:结论:经腹膜后SP-RARN前下入路可避开腹腔,因此适合某些患者。对这些患者而言,这种手术比其他手术更可行、更安全,而且比标准多孔腹腔镜手术的发病率更低。
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来源期刊
International Braz J Urol
International Braz J Urol UROLOGY & NEPHROLOGY-
CiteScore
4.60
自引率
21.60%
发文量
246
审稿时长
6-12 weeks
期刊介绍: Information not localized
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