Robot-assisted laparoscopic treatment of horseshoe kidney combined with renal tumor: a case report and literature review
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目的 探讨机器人辅助腹腔镜手术治疗马蹄肾合并肾肿瘤的技术重点。 方法 回顾性分析2021年9月大连医科大学附属第二医院1例机器人辅助腹腔镜肾部分切除术治疗马蹄肾合并肾肿瘤患者的临床资料。检索PubMed、中国知网、万方和维普数据库自建库至2022年12月所有采用机器人辅助腹腔镜肾切除术或肾部分切除术治疗马蹄肾合并肾肿瘤的文献。 结果 检索到10篇文献11例患者，加上本例共计12例患者。12例患者中，采用腹膜后入路4例，经腹腔入路8例。2例先行传统腹腔镜下操作，寻及动脉并控制后再置入机器人机械臂行肾部分切除及缝合；10例全程采用机器人辅助腹腔镜下操作。行一侧肾切除术5例，肾部分切除术7例。术后病理诊断为透明细胞癌8例，嫌色细胞癌1例，嗜酸细胞癌1例，肾细胞癌1例，肾脓肿1例。大连医科大学附属第二医院的1例患者，女，38岁，因发热入院，术前完善CT动脉造影和三维重建后，行机器人辅助腹腔镜右肾部分切除+峡部离断术治疗，术中肿瘤滋养血管以一次性使用组织闭合夹逐一结扎并离断，贴肿瘤左侧采用内镜下切割吻合器离断峡部，环肿瘤边缘锐性完整切除肿瘤。手术历时240 min，无热缺血时间，出血量约300 ml，患者术后恢复良好，术后病理诊断为肾脓肿。 结论 机器人辅助腹腔镜手术治疗马蹄肾合并肾肿瘤安全有效，较传统腹腔镜手术更具优势。术前应完善CT动脉造影或三维血管重建检查，充分评估变异血管，根据肿瘤大小和位置决定手术入路和手术方案，术中妥善处理变异血管，采用内镜下切割吻合器处理峡部会更利于手术操作。 Objective To explore the technical focus of robotic-assisted laparoscopic surgery for the treatment of horseshoe kidney combined with renal tumor. Methods The clinical data of a patient with horseshoe kidney combined with renal tumor treated by robot-assisted laparoscopic partial nephrectomy in the Second Hospital of Dalian Medical University in September 2021 were retrospectively analyzed. PubMed, CNKI, Wanfang and VIP databases were searched for all the literature on the use of robot-assisted laparoscopic nephrectomy or partial nephrectomy for the treatment of horseshoe kidney combined with renal tumor from the time of establishment to December 2022. Results A total of 11 patients from 10 articles were retrieved and 12 patients were enrolled. Among the 12 patients, 4 cases used the retroperitoneal approach and 8 cases used the transperitoneal approach. Two cases were operated by traditional laparoscope, and the arteries were searched for and controlled before the robotic arm was placed to perform the partial nephrectomy and suture and 10 cases were operated with the robotic-assisted laparoscopic approach throughout the whole procedure. Five cases of nephrectomy were performed on one side, and 7 cases were performed in the partial nephrectomy. Postoperative pathological diagnosis was clear cell carcinoma in 8 cases, chromophobe cell carcinoma in 1 case, eosinophilic cell carcinoma in 1 case, renal cell carcinoma in 1 case, and renal abscess in 1 case. The patient in the Second Hospital of Dalian Medical University was 38 years old female who was admitted to the hospital with a fever. After CT arteriography and three-dimensional reconstruction, robotic-assisted laparoscopic partial nephrectomy of right kidney and isthmus dissecting was performed. During the operation, tumor trophoblast vessels were ligated and dissected one by one by using single-use tissue closure clips, and the isthmus was dissected using endoscopic cutting anastomosis on the left side of the tumor, with the tumor edges sharply resected and completely dissected. The operation time was 240 min, without thermal ischemia time, and the bleeding volume was about 300 ml. The patient recovered well after the operation, and the postoperative pathological diagnosis was renal abscess. Conclusions Robot-assisted laparoscopic treatment of horseshoe kidney combined with renal tumor is safe and effective, and has more advantages than traditional laparoscopic surgery. Preoperative CT arteriography or three-dimensional reconstruction examination should be applied to fully evaluate the variant vessels. The surgical access and plan should be decided according to the size and location of the tumor. The variant vessels should be properly handled during operation. The use of endoscopic cutting anastomosis to deal with the isthmus can be more conducive to the surgical operation.
Objective To explore the technical focus of robotic-assisted laparoscopic surgery for the treatment of horseshoe kidney combined with renal tumor. Methods The clinical data of a patient with horseshoe kidney combined with renal tumor treated by robot-assisted laparoscopic partial nephrectomy in the Second Hospital of Dalian Medical University in September 2021 were retrospectively analyzed. PubMed, CNKI, Wanfang and VIP databases were searched for all the literature on the use of robot-assisted laparoscopic nephrectomy or partial nephrectomy for the treatment of horseshoe kidney combined with renal tumor from the time of establishment to December 2022. Results A total of 11 patients from 10 articles were retrieved and 12 patients were enrolled. Among the 12 patients, 4 cases used the retroperitoneal approach and 8 cases used the transperitoneal approach. Two cases were operated by traditional laparoscope, and the arteries were searched for and controlled before the robotic arm was placed to perform the partial nephrectomy and suture and 10 cases were operated with the robotic-assisted laparoscopic approach throughout the whole procedure. Five cases of nephrectomy were performed on one side, and 7 cases were performed in the partial nephrectomy. Postoperative pathological diagnosis was clear cell carcinoma in 8 cases, chromophobe cell carcinoma in 1 case, eosinophilic cell carcinoma in 1 case, renal cell carcinoma in 1 case, and renal abscess in 1 case. The patient in the Second Hospital of Dalian Medical University was 38 years old female who was admitted to the hospital with a fever. After CT arteriography and three-dimensional reconstruction, robotic-assisted laparoscopic partial nephrectomy of right kidney and isthmus dissecting was performed. During the operation, tumor trophoblast vessels were ligated and dissected one by one by using single-use tissue closure clips, and the isthmus was dissected using endoscopic cutting anastomosis on the left side of the tumor, with the tumor edges sharply resected and completely dissected. The operation time was 240 min, without thermal ischemia time, and the bleeding volume was about 300 ml. The patient recovered well after the operation, and the postoperative pathological diagnosis was renal abscess. Conclusions Robot-assisted laparoscopic treatment of horseshoe kidney combined with renal tumor is safe and effective, and has more advantages than traditional laparoscopic surgery. Preoperative CT arteriography or three-dimensional reconstruction examination should be applied to fully evaluate the variant vessels. The surgical access and plan should be decided according to the size and location of the tumor. The variant vessels should be properly handled during operation. The use of endoscopic cutting anastomosis to deal with the isthmus can be more conducive to the surgical operation.
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