目的:探讨运用国产“术锐”单孔蛇形臂机器人手术系统完成腹膜后入路单孔肾上腺切除术的初步经 验。方法:南京医科大学第二附属医院泌尿外科于 2021 年 11 月—2021 年 12 月收治的 4 例肾上腺肿瘤患者,运用国 产“术锐”单孔蛇形臂机器人手术系统完成单孔肾上腺切除术,手术均采用经腹膜后入路,记录肿瘤大小、手术时间、 术中出血量等信息,并对围手术期资料、手术并发症及术后恢复情况进行分析。结果:4 例患者中男女各 2 例,年龄 40~68 岁,平均年龄 54 岁,平均 BMI 值为 26.2(24.8~29.8)kg/m2 ;肿瘤最大直径 1.2~3.3 cm,其中左侧 1 例,右侧 3 例;4 例手术均采用纯单孔方式,术中均未增加辅助通道,手术总时间 104~200 min,机器人操作时间 50~96 min, 术中出血量 10~50 ml。术后病理诊断为肾上腺皮质腺瘤 3 例,右血管内乳头状内皮细胞增生(Masson 瘤)1 例。术 后均未出现出血、发热、切口感染等并发症。结论:运用“术锐”单孔蛇形臂机器人手术系统可安全、有效地完成 腹膜后入路单孔肾上腺切除术,蛇形臂具有动作灵活、指向性准确等优势,可保障手术的顺利实施。
Objective: To explore the surgical experience of domestic single-port robotic surgical system (Single-port surgical robot with sneak-like arms, Beijing Surgerii Robotics Co., Ltd) in retroperitoneal adrenalectomy. Methods: 4 patients who were scheduled for adrenalectomy due to adrenal neoplasm in the Department of Urology of the Second Affiliated Hospital of Nanjing Medical University from Nov. 2021 to Dec. 2021 were selected as the research objects. Domestic singleport robotic surgical system was used to perform single-port adrenalectomy on the 4 patients with retroperitoneal approach. Clinical data on tumor size, operative time, intraoperative blood loss was recorded, and perioperative data, surgical complications and postoperative recovery were analyzed. Results: 4 patients (2 male and 2 female) with a mean age of 54 years (40 to 68 years) and a mean BMI of 26.2 (24.8 to 29.8) kg/m2 . The tumors ranged from 1.2 to 3.3 cm in maximum diameter, including 1 case of left side and 3 cases of right side. The 4 cases of surgeries were all performed under single-port without extra auxiliary channels, and the total operative time ranged from 104 to 200 min, while the robotic operative time ranged from 50 to 96 min, with the intraoperative blood loss of 10 to 50 ml. Adrenocortical adenoma was confirmed in 3 patients and papillary endothelial cell hyperplasia (Masson’s tumor) within the right vessel in 1 patient by postoperative pathological diagnosis. There were no complications such as bleeding, fever, and incision infection found in the postoperative period. Conclusion: With the advantages of flexible movement and accurate operation of serpentine arms, retroperitoneal adrenalectomy could be safely and effectively performed with the domestic single-port robotic surgical system.
收稿日期:2022-07-12 录用日期:2023-08-22
Received Date: 2022-07-12 Accepted Date: 2023-08-22
基金项目:江苏省卫生健康委科研项目(ZD2021028)
Foundation Item: Scientific Research Project of Jiangsu Provincial Health Commission (ZD2021028)
通讯作者:朱清毅,Email:drzhuqingy@126.com
Corresponding Author: ZHU Qingyi, Email: drzhuqingy@126.com
引用格式:魏勇,沈露明,沈百欣,等 . 运用国产单孔机器人手术系统完成腹膜后入路单孔肾上腺切除术的初步经验(附视频)[J]. 机器人外科学杂志(中英文),2024,5(1):13-19.
Citation: WEI Y, SHEN L M, SHEN B X, et al. Primary experience of a domestic single-port robotic surgical system in retroperitoneal adrenalectomy (with video) [J]. Chinese Journal of Robotic Surgery, 2024, 5(1): 13-19.
[1] Gavriilidis P, Camenzuli C, Paspala A, et al. Posterior retroperitoneoscopic versus laparoscopic transperitoneal adrenalectomy: a systematic review by an updated metaanalysis[J]. World J Surg, 2021, 45(1): 168-179.
[2] Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma[J]. N Engl J Med, 1992, 327(14): 1033. [3] Raffaelli M, De Crea C, Bellantone R. Laparoscopic adrenalectomy[J]. Gland Surg, 2019, 8(Suppl 1): S41-S52.
[4] Kook Y, Choi H R, Kang S W, et al. Laparoscopic adrenalectomy: comparison of outcomes between posterior retroperitoneoscopic and transperitoneal adrenalectomy with 10 years’ experience[J]. Gland Surg, 2021, 10(7): 2104-2112.
[5] 吴震杰 , 王坚超 , 王杰 , 等 . 机器人单孔腹腔镜肾 上腺肿瘤切除术初步临床应用报告 [J]. 临床泌尿外 科杂志 , 2017, 32(6): 437-439, 443.
[6] Garbens A, Morgan T, Cadeddu J A. Single port robotic surgery in urology[J]. Curr Urol Rep, 2021, 22(4): 22.
[7] Horgan S, Vanuno D. Robots in laparoscopic surgery[J]. J Laparoendosc Adv Surg Tech A, 2001, 11(6): 415-419.
[8] 王林辉 , 吴震杰 , 朱清毅 . 中国泌尿外科单孔腹腔 镜技术的发展与展望 [J]. 中华泌尿外科杂志 , 2020, 41(11): 807-810.
[9] Barret E, Sanchez-Salas R, Ercolani M, et al. Roboticassisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis[J]. Minerva Urol Nefrol, 2011, 63(2): 115-122.
[10] Janetschek G. Robotics: will they give a new kick to single-site surgery? [J].Eur Urol, 2014, 66(6): 1044-1045.
[11] Kaouk J, Garisto J, Bertolo R. Robotic urologic surgical interventions performed with the single port dedicated platform: first clinical investigation[J].Eur Urol, 2019, 75 (4): 684-691.
[12] 我国成功研发单孔手术机器人 [J]. 微创医学 , 2021, 16(2): 235.
[13] 张超 , 王正 , 张宗勤 , 等 . 国产单孔蛇形臂机器人 手术系统在零缺血肾部分切除术中的初步应用 [J]. 中华泌尿外科杂志 , 2022, 43(2): 132-137.
[14] Economopoulos K P, Mylonas K S, Stamou A A, et al. Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis[J]. Int J Surg, 2017. DOI: 10.1016/j.ijsu.2016.12.118.
[15] Dobbs R W, Halgrimson W R, Talamini S, et al. Singleport robotic surgery: the next generation of minimally invasive urology[J]. World J Urol, 2020, 38(4): 897-905.
[16] Lee I A, Kim J K, Kim K, et al. Robotic adrenalectomy using the da Vinci SP robotic system: technical feasibility comparison with single-port access using the da Vinci multi-arm robotic system[J]. Ann Surg Oncol, 2022, 29(5): 3085-3092.
[17] Marek-Safiejko M, Safiejko K, Łukaszewicz J, et al. A comparison of two approaches to laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach[J]. Adv Clin Exp Med, 2016, 25(5): 829-835.
[18] Tutar O, Samanci C, Bakan S, et al. Typical MDCT angiography findings of an unusual cutaneous neoplasia; Masson tumor[J]. Pol J Radiol, 2015. DOI: 10.12659/ PJR.892043.
[19] Holmes C, Akhras A, Schneider A, et al. Adrenal intravascular papillary endothelial hyperplasia[J]. World Journal of Endocrine Surgery, 2017, 9(1): 16-19.