Guo Yunkai,Gao Heyun,Zhang Wen,et al.Exploration of robot assisted laparoscopic single-port surgery in children with duplex kidney[J].Journal of Clinical Pediatric Surgery,,():850-856.[doi:10.3760/cma.j.cn101785-202401001-009]
Exploration of robot assisted laparoscopic single-port surgery in children with duplex kidney
- Keywords:
- Duplex Kidney; Robotic Surgical Procedures; Laparoscopy; Nephrectomy
- Abstract:
- Objective To explore the applications and efficacy of IV generation Da Vinci (XI) robot assisted single-port laparoscopy in children of duplex kidney (DK). Methods From June 2020 to June 2023,the relevant clinical data were retrospectively reviewed for 10 DK girls undergoing robot assisted single port laparoscopy.Age range was (0.75-83) month.The clinical manifestations included fever (n=5),urinary tract infections (n=7),urethral discharge (n=2) and abdominal pain (n=3).Preoperative examinations of ultrasonography,magnetic resonance urography (MRU) and computed tomography urography (CTU) were performed.Diethyltriamine pentaacetic acid (DTPA) imaging (n=8) and voiding cystourethrography (VCUG,n=3) were conducted.There were renal function ≤ 10%(n=2),underdeveloped kidney (n=2) and recurrent upper group hydronephrosis (n=1).The procedures included ureteroureterostomy (n=5),heminephrectomy (n=2),ureterovesical reimplantation (n=2) and pyeloplasty (n=1). Results All procedures were performed under robot assisted single port laparoscopy without any conversion into open surgery.For ureteroureterostomy,mean operative duration was (134.4±24.8) min and mean hospitalization stay (7±2.7) day;for heminephrectomy,mean operative duration was (162.5±53) min and mean hospitalization stay (7.5±0.7) day;for ureterovesical reimplantation,mean operative duration was (114.5±21.9) min and mean hospitalization stay (5.5±0.7) day;for pyeloplasty,mean operative duration was 141 min and mean hospitalization stay 6 days.Doppler ultrasonography and urinary routine/culture were regularly rechecked postoperatively to observe whether or not there was an onset of ureteral dilation/stenosis,ureteral reflux or urinary tract infections.The follow-up period was (6-42) month.One case of postoperative anastomotic fistula improved after proper anti-infection and sufficient drainage.Another case of urinary tract infection with fever disappeared after antibiotic dosing.One child of ureteral bladder replantation was diagnosed with grade Ⅱ VUR by ureterography under B-ultrasonic guidance at Year 2 post-operation.Without urinary tract infection,no special treatment was given. Conclusions Single-port robotic surgery is both safe and feasible.However,there are strict requirements for cooperations and operational skills of teams such as surgeons,assistants,anesthesiologists and nurses.After anesthesia,a proper body position shall facilitate intraoperative handling and reduce operative duration.Surgical scar is hidden in navel and parents are satisfied with the postoperative appearance of scar.
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Memo
收稿日期:2024-1-1。
基金项目:武汉大学中南医院学科能力建设项目(YYXKNLJS2024020)
通讯作者:张文,Email:wzhang115@163.com