目的：探讨达芬奇手术机器人辅助腹腔镜下肾部分切除术中不同手术入路选择的临床疗效及安全性， 并为其临床应用提供经验。方法：回顾性分析 2020 年 11 月—2021 年 5 月于新疆维吾尔自治区人民医院泌尿中心采 用达芬奇 Xi 手术机器人行机器人辅助腹腔镜下 T1 期肾肿瘤肾部分切除术的 23 例患者临床资料。根据肿瘤部位与肾 蒂的关系、腹部手术史、肥胖等因素，将所有患者分为经腹入路组（10 例）和后腹膜入路组（13 例），比较两种 不同入路对围手术期的影响。结果：23 例患者手术均顺利完成，术中未出现周围脏器及大血管损伤，无中转开放。 比较不同手术入路发现，采用经后腹膜入路手术的装机速度及手术时间比经腹腔入路手术的时间显著缩短。结论： 采用达芬奇 Xi 手术机器人行机器人辅助腹腔镜下肾部分切除术治疗肾肿瘤的疗效及安全性良好，且经后腹膜入路 的手术方式效果更佳。

Objective: To investigate the clinical efficacy and safety of different surgical approaches in Da Vinci robotassisted laparoscopic partial nephrectomy, and to provide experience for its clinical application. Methods: The clinical data of 23 patients who underwent robot-assisted laparoscopic partial nephrectomy for T1 renal tumor using Da Vinci Xi surgical system in the Urology Center of Xinjiang Uygur Autonomous Region People’s Hospital from November 2020 to May 2021 were retrospectively analyzed. According to the relationship between tumor location and renal pedicle, history of abdominal surgery, obesity and other factors, all patients were divided into the transabdominal approach group (10 cases) and retroperitoneal approach group (13 cases), and the effect of two different approaches on the perioperative period was compared. Results: All the operations were successfully completed without conversion to open surgery. The operative time of retroperitoneal approach were significantly shorter than that of the transabdominal approach. Conclusion: The efficacy and safety of robot-assisted laparoscopic partial nephrectomy in the treatment of renal tumors with Da Vinci Xi surgical system are good, and the effect of retroperitoneal approach is better.

收稿日期：2022-01-13  录用日期：2024-01-28 

Received Date: 2022-01-13  Accepted Date: 2024-01-28 

基金项目：新疆维吾尔自治区自然科学基金面上项目（2021D01C189） 

Foundation Item: Natural Science Foundation of Xinjiang Uygur Autonomous Region (2021D01C189) 

通讯作者：倪泽称，Email：hmnzc@163.com 

Corresponding Author: NI Zecheng, Email: hmnzc@163.com 

引用格式：郭峰，艾合买提·卡德尔，倪泽称，等 . 达芬奇 Xi 手术机器人在肾部分切除术中手术入路选择的应用研究（附手术视频） [J]. 机器人外科学杂志（中英文），2024，5（4）：633-637. 

Citation: GUO F, AHMT K, NI Z C, et al. Application of Da Vinci Xi surgical system in partial nephrectomy with different surgical approaches (with surgical video) [J]. Chinese Journal of Robotic Surgery, 2024, 5(4): 633-637.

[1] 蔡彪 , 陈勇辉 , 黄吉炜 , 等 . 根治性肾脏切除术安全共识 [J]. 现 代泌尿外科杂志 , 2020, 25(2): 109-115. 

[2] Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer Clin,2021，71（3）, 209- 249. 

[3] Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European association of urology guidelines on renal cell carcinoma: the 2019 update[J]. European urology, 2019, 75(5): 799-810. 

[4] Porta C, Cosmai L, Leibovich B C, et al. The adjuvant treatment of kidney cancer: a multidisciplinary outlook[J]. Nature Reviews Nephrology, 2019, 15(7): 423-433. 

[5] Chowdhury N, Drake C G. Kidney cancer: an overview of current therapeutic approaches[J]. Urol Clin North Am, 2020, 47(4): 419-431. 

[6] Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries and 25 major cancers in 2018[J]. Eur J Cancer, 2018.DOI: 10.1016/ j.ejca.2018.07.005. Epub 2018 Aug 9. 

[7] Chen W Q, Zheng R S, Baade P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132. 

[8] Ljungberg B, Albiges L, Abu-Ghanem Y,et al. European association of urology guidelines on renal cell carcinoma: the 2022 update[J]. Eur Urol, 2022, 82 (4): 399-410. 

[9] Hennessey D B, Wei G, Moon D,et al. Strategies for success: a multiinstitutional study on robot-assisted partial nephrectomy for complex renal lesions[J].BJU Int, 2018, 121(Suppl 3):40 - 47. 

[10] Capitanio U, Terrone C, Antonelli A, et al. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function[J]. Eur Urol, 2015, 67(4): 683-689. 

[11] Alam R, Patel H D, Osumah T, et al. Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study[J]. BJU Int, 2019, 123(1): 42-50. 

[12] CHEN S H, WU Y P, LI X D, et al. R.E.N.A.L nephrometry score: a preoperative risk factor predicting the Fuhrman grade of clear-cell renal carcinoma[J]. Journal of Cancer, 2017, 8(18): 3725. 

[13] LI J, ZHANG Y, TENG Z, et al. Partial nephrectomy versus radical nephrectomy for cT2 or greater renal tumors: a systematic review and meta-analysis[J]. Minerva Urol Nefrol, 2019, 71(5): 435-444. 

[14] Alkazemi M H, Dionise Z R, Jiang R, et al. Partial and radical nephrectomy in children, adolescents, and young adults: equivalent readmissions and postoperative complications[J]. Journal of pediatric surgery, 2019, 54(11): 2343-2347. 

[15] Chung D Y, Lee J S, Ahmad A, et al. Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study[J]. World journal of urology, 2020, 38(5): 1235-1242. 

[16] Mottrie A, Larcher A, Patel V. The past, the present, and the future of robotic urology: robot-assisted surgery and human-assisted robots[J]. Eur Urol Focus, 2018, 4(5): 629-631. 

[17] Fábián N, Németh Z, Tenke P. Could robotic surgery really be a revolutionary change in the treatment of kidney cancer in Hungary?[J]. Magy Onkol, 2023, 67(1): 27-31. 

[18] Peyronnet B, Seisen T, Oger E, et al. Comparison of 1800 robotic and open partial nephrectomies for renal tumors[J]. Ann Surg Oncol, 2016, 23(13): 4277-4283. 

[19] Leow J J, Heah N H, Chang S L, et al. Outcomes of robotic versus laparoscopic partial nephrectomy: an updated Meta-analysis of 4919 patients[J]. J Urol, 2016, 196(5): 1371-1377. 

[20] Teraoka S, Morizane S, Takenaka A. Robotic-assisted surgery for renal cancer and cancer of the renal pelvis and ureter[J]. Gan To Kagaku Ryoho, 2023, 50(4): 442-446.