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,2024,(09):850-856.[doi:10.3760/cma.j.cn101785-202401001-009]
机器人辅助单孔腹腔镜手术在儿童重复肾治疗中的探索
- Title:
- Exploration of robot assisted laparoscopic single-port surgery in children with duplex kidney
- Keywords:
- Duplex Kidney; Robotic Surgical Procedures; Laparoscopy; Nephrectomy
- 摘要:
- 目的 探讨第四代达芬奇(Xi)机器人辅助单孔腹腔镜手术在儿童重复肾手术中的应用技巧及临床疗效。方法 本研究为回顾性研究,收集武汉大学中南医院小儿外科于2020年6月到2023年6月行单孔机器人手术治疗的10例重复肾患儿临床资料。其中男1例、女9例,年龄22天至83个月。完全性重复肾畸形8例,不完全性(Y型输尿管)重复肾畸形2例。临床表现为发热5例,反复泌尿系感染7例,尿道口溢尿2例,腹痛3例。患儿术前均行泌尿系B超、泌尿系磁共振水成像(magnetic resonance urography,MRU)或CT尿路造影(computed tomography urography,CTU),8例行二乙基三胺五乙酸核素肾动态显像(diethyltriamine pentaacetic acid,DTPA)。2例肾功能≤10%,1例为发育不良肾,1例为复发性上组肾积水;3例行排尿性膀胱尿路造影(voiding cystourethrography,VCUG)。手术方式包括输尿管输尿管吻合术5例,半肾切除术2例,输尿管膀胱再植术2例,肾盂成形术1例。术后1、3、6个月复查彩超、尿常规及尿培养,观察有无输尿管扩张或狭窄、输尿管反流及泌尿系感染。随访6~42个月。结果 手术均在机器人辅助单孔腹腔镜下完成,无一例中转开腹手术。输尿管输尿管吻合术手术时间(134.4±24.8)min,住院时间(7.0±2.7)d;半肾切除术手术时间(162.5±53.0)min,住院时间(7.5±0.7d);输尿管膀胱再植术手术时间(114.5±21.9)min,住院时间(5.5±0.7)d;肾盂成形术手术时间141 min,住院时间6 d。输尿管输尿管吻合术患儿中,1例出现吻合口漏,经抗感染、充分引流后症状好转出院,复查无输尿管狭窄;1例出现尿路感染伴发热,经足量应用抗生素后症状消失;1例输尿管膀胱再植术患儿术后2年行B超引导下输尿管造影,提示存在膀胱输尿管反流2级,无泌尿系感染,未予特殊处理。结论 单孔机器人手术安全、可行,但对医师、助手、麻醉师及器械护士的团队配合及操作技术要求相对较高。麻醉后患儿应采取合适体位,以方便术中操作,减少手术时间。术后手术瘢痕隐藏于肚脐,腹部外观满意。
- 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.
参考文献/References:
[1] Liu W,Zhang LJ,Ma R,et al.The morphology and treatment of coexisting ureteropelvic junction obstruction in lower moiety of duplex kidney[J].Int J Surg,2016,34:23-27.DOI:10.1016/j.ijsu.2016.08.015.
[2] 李骥,张谦,郭立华,等.不同腹腔镜微创术式处理儿童重复肾畸形的研究[J].中华小儿外科杂志,2020,41(5):431-436.DOI:10.3760/cma.j.cn421158-20191224-00702. Li J,Zhang Q,Guo LH,et al.Experiences of managing pediatric duplex renal malformation with different endoscopic mini-invasive surgical procedures[J].Chin J Pediatr Surg,2020,41(5):431-436.DOI:10.3760/cma.j.cn421158-20191224-00702.
[3] 桂萌,张磊,贺庆豹,等.腹腔镜下重复输尿管端侧吻合术治疗重复肾的疗效分析[J].临床小儿外科杂志,2024,23(5):469-473.DOI:10.3760/cma.j.cn101785-202302043-013. Gui M,Zhang L,He QB,et al.Efficacy of laparoscopic end-to-side ureterostomy for duplicate kidney[J].J Clin Ped Sur,2024,23(5):469-473.DOI:10.3760/cma.j.cn101785-202302043-013.
[4] Satyanarayan A,Preuss D,Davis TD,et al.Robotic excision and ureteroureterostomy of blind-ending ureteral ’Duplication’[J].J Pediatr Urol,2019,15(1):91-92.DOI:10.1016/j.jpurol.2018.11.018.
[5] Neheman A,Kord E,VanderBrink BA,et al.Outpatient robotic surgery in pediatric urology:assessment of feasibility and short-term safety[J].J Urol,2022,207(4):894-900.DOI:10.1097/JU.0000000000002362.
[6] Nelson RJ,Chavali JSS,Yerram N,et al.Current status of robotic single-port surgery[J].Urol Ann,2017,9(3):217-222.DOI:10.4103/UA.UA_51_17.
[7] 刘艳燕,易跃雄,张蔚,等.第四代达芬奇机器人Xi系统辅助单孔和多孔腹腔镜治疗妇科良性疾病围手术期效果分析[J].中国实用妇科与产科杂志,2021,37(6):679-682.DOI:10.19538/j.fk2021060118. Liu YY,Yi YX,Zhang W,et al.Analysis of perioperative effect of the fourth-generation Da Xi Vinci robotic single and multi-site laparoscopy for benign gynecological diseases[J].Chin J Pract Gynecol Obstet,2021,37(6):679-682.DOI:10.19538/j.fk2021060118.
[8] 高贺云,李庚,张文,等.机器人辅助单孔腹腔镜在小儿泌尿生殖系统手术中的应用[J].中华小儿外科杂志,2023,44(7):597-601.DOI:10.3760/cma.j.cn421158-20230321-00094. Gao HY,Li G,Zhang W,et al.Clinical applications of da Vinci robot-assisted single-port laparoscopy for pediatric genitourinary diseases[J].Chin J Pediatr Surg,2023,44(7):597-601.DOI:10.3760/cma.j.cn421158-20230321-00094.
[9] 中华医学会小儿外科学分会泌尿外科学组,中华医学会小儿外科分会小儿尿动力和盆底学组.儿童肾输尿管重复畸形诊治专家共识[J].中华小儿外科杂志,2021,42(6):485-493.DOI:10.3760/cma.j.cn421158-20201124-00714. Groups of Urology,Urodynamic & Pelvic floor,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Diagnosing & Treating Duplex Renal & Ureteral Malformations[J].Chin J Pediatr Surg,2021,42(6):485-493.DOI:10.3760/cma.j.cn421158-20201124-00714.
[10] Escobar PF,Fader AN,Paraiso MF,et al.Robotic-assisted laparoendoscopic single-site surgery in gynecology:initial report and technique[J].J Minim Invasive Gynecol,2009,16(5):589-591.DOI:10.1016/j.jmig.2009.05.004.
[11] 朱天琦,刘率斌,张文,等.达芬奇机器人手术系统在小儿肾上腺肿瘤切除手术中的应用[J].中华小儿外科杂志,2017,38(10):775-777.DOI:10.3760/cma.j.issn.0253-3006.2017.10.011. Zhu TQ,Liu LB,Zhang W,et al.Preliminary experience of robotic-assisted laparoscopic adrenalectomy in children[J].Chin J Pediatr Surg,2017,38(10):775-777.DOI:10.3760/cma.j.issn.0253-3006.2017.10.011.
[12] Bowen DK,Van Batavia JP,Srinivasan AK.Single-site laparoscopy and robotic surgery in pediatric urology[J].Curr Urol Rep,2018,19(6):42.DOI:10.1007/s11934-018-0794-z.
[13] 李宁,周学锋,袁继炎,等.达芬奇机器人在儿童肾盂成形术中的应用体会--附9例报告[J].临床小儿外科杂志,2019,18(4):294-298.DOI:10.3969/j.issn.1671-6353.2019.04.009. Li N,Zhou XF,Yuan JY,et al.Robot-assisted laparoscopic pyeloplasty in children:a report of 9 cases[J].J Clin Ped Sur,2019,18(4):294-298.DOI:10.3969/j.issn.1671-6353.2019.04.009.
[14] 张文,李庚,骆明双.单孔机器人技术在儿童中的应用[J].临床外科杂志,2023,31(5):404-406.DOI:10.3969/j.issn.1005-6483.2023.05.002. Zhang W,Li G,Luo MS.Application of single hole robot technology in children[J].J Clin Surg,2023,31(5):404-406.DOI:10.3969/j.issn.1005-6483.2023.05.002.
[15] Liu YF,Gao HY,Huang GB,et al.Single-port robot-assisted laparoscopic pyeloplasty in an infant:a video case report with 9 months follow up[J].J Pediatr Urol,2022,18(5):704-705.DOI:10.1016/j.jpurol.2022.07.019.
[16] Kaouk JH,Bertolo R.Single-site robotic platform in clinical practice:first cases in the USA[J].Minerva Urol Nefrol,2019,71(3):294-298.DOI:10.23736/S0393-2249.19.03384-8.
[17] Chandrasekharam VVS,Babu R.Robot-assisted laparoscopic extravesical versus conventional laparoscopic extravesical ureteric reimplantation for pediatric primary vesicoureteric reflux:a systematic review and meta-analysis[J].Pediatr Surg Int,2020,36(11):1371-1378.DOI:10.1007/s00383-020-04749-2.
[18] 周晓光,周辉霞,马立飞,等.经脐单孔腹腔镜实施小儿重复肾半肾切除术[J].临床小儿外科杂志,2012,11(5):357-359.DOI:10.3969/j.issn.1671-6353.2012.05.012.DOI:10.3969/j.issn.1671-6353.2012.05.012. Zhou XG,Zhou HX,Ma LF,et al.Transumbilical single port laparoscopic repeat nephrectomy in children[J].J Clin Ped Sur,2012,11(5):357-359.DOI:10.3969/j.issn.1671-6353.2012.05.012.DOI:10.3969/j.issn.1671-6353.2012.05.012.
[19] 黄立渠,董隽,朱浩波,等.腹腔镜下输尿管端侧吻合术治疗儿童完全性重复肾伴肾积水输尿管扩张畸形[J].中华实用儿科临床杂志,2018,33(23):1777-1780.DOI:10.3760/cma.j.issn.2095-428X.2018.23.005. Huang LQ,Dong J,Zhu HB,et al.Laparoscopic ureteroureterostomy for complete duplicated systems with hydronephrosis and ureteral dilation in children[J].J Appl Clin Pediatr,2018,33(23):1777-1780.DOI:10.3760/cma.j.issn.2095-428X.2018.23.005.
[20] Chertin L,Neeman BB,Stav K,et al.Robotic versus laparoscopic ipsilateral uretero-ureterostomy for upper urinary tract duplications in the pediatric population:a multi-institutional review of outcomes and complications[J].J Pediatr Surg,2021,56(12):2377-2380.DOI:10.1016/j.jpedsurg.2020.12.022.
[21] 殷晓鸣,许卓凡,杨屹.上位肾分肾功能<10%重复肾患者保留或不保留上肾手术的预后比较-单中心回顾性队列研究[J].临床小儿外科杂志,2021,20(4):325-329.DOI:10.12260/lcxewkzz.2021.04.005. Yin XM,Xu ZF,Yang Y.Evaluating the outcomes of differential surgical management of non-functioning upper pole renal moieties in duplex collecting systems:a single-center retrospective cohort study[J].J Clin Ped Sur,2021,20(4):325-329.DOI:10.12260/lcxewkzz.2021.04.005.
[22] Szklarz MT,Ruiz J,Moldes JM,et al.Laparoscopic upper-pole heminephrectomy for the management of duplex kidney:outcomes of a multicenter cohort[J].Urology,2021,156:245-250.DOI:10.1016/j.urology.2021.01.032.
[23] Villanueva CA.Open vs robotic infant ureteroureterostomy[J].J Pediatr Urol,2019,15(4):390.e1-390.e4.DOI:10.1016/j.jpurol.2019.05.003.
[24] Rague JT,Shannon R,Rosoklija I,et al.Robot-assisted laparoscopic urologic surgery in infants weighing ≤10 kg:a weight stratified analysis[J].J Pediatr Urol,2021,17(6):857.e1-857.e7.DOI:10.1016/j.jpurol.2021.09.023.
[25] 朱小江,邓永继,马耿,等.腹腔镜下与开放式Lich-Gregoir重复肾输尿管再植术的疗效比较[J].中华泌尿外科杂志,2016,37(9):707-708.DOI:10.3760/cma.j.issn.1000-6702.2016.09.018. Zhu XJ,Deng YJ,Ma G,et al.Comparison of the therapeutic effects of laparoscopic versus open Lich-Gregoir repeat renal ureteral reimplantation[J].Chin J Urol,2016,37(9):707-708.DOI:10.3760/cma.j.issn.1000-6702.2016.09.018.
[26] 魏春,何大维,刘星,等.腹腔镜治疗不完全性重复肾伴下肾积水的手术方式及效果[J].中华泌尿外科杂志,2017, 38(4):281-285.DOI:10.3760/cma.j.issn.1000-6702.2017.04.011. Wei C,He DW,Liu X,et al.Laparoscopic reconstructive surgery for hydronephrosis with incomplete duplex kidney[J].Chin J Urol,2017,38(4):281-285.DOI:10.3760/cma.j.issn.1000-6702.2017.04.011.
[27] Barbosa JABA,Barayan G,Gridley CM,et al.Parent and patient perceptions of robotic vs open urological surgery scars in children[J].J Urol,2013,190(1):244-250.DOI:10.1016/j.juro.2012.12.060.
[28] Gargollo PC.Hidden incision endoscopic surgery:description of technique,parental satisfaction and applications[J].J Urol,2011,185(4):1425-1431.DOI:10.1016/j.juro.2010.11.054.
相似文献/References:
[1]朱荣坤,张虹,荆晓英,等.计算机辅助手术系统在小儿重复肾精准手术中的应用[J].临床小儿外科杂志,2019,18(02):118.
Zhu RK,Zhang H,Jing XY,et al.Application of computeraided surgical system for repeated renal surgery in children.[J].Journal of Clinical Pediatric Surgery,2019,18(09):118.
[2]殷晓鸣,许卓凡,杨屹.上位肾分肾功能<10%重复肾患者保留或不保留上肾手术的预后比较-单中心回顾性队列研究[J].临床小儿外科杂志,2021,20(04):325.[doi:10.12260/lcxewkzz.2021.04.005]
Yin Xiaoming,Xu Zhuofan,Yang Yi.Evaluating the outcomes of differential surgical management of non-functioning upper pole renal moieties in duplex collecting systems:a single-center retrospective cohort study[J].Journal of Clinical Pediatric Surgery,2021,20(09):325.[doi:10.12260/lcxewkzz.2021.04.005]
[3]张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(08):701.[doi:10.12260/lcxewkzz.2021.08.001]
Zhang Shuhao,Gao Zhigang,Tou Jinfa,et al.Current applications of robotic procedures in pediatric surgery[J].Journal of Clinical Pediatric Surgery,2021,20(09):701.[doi:10.12260/lcxewkzz.2021.08.001]
[4]谭征,俞建根,梁靓,等.机器人辅助胸腔镜技术治疗小儿先天性肺部疾病的单中心研究[J].临床小儿外科杂志,2021,20(08):708.[doi:10.12260/lcxewkzz.2021.08.002]
Tan Zheng,Yu Jiangeng,Liang Liang,et al.Robot-assisted thoracoscopy in the treatment of congenital pulmonary diseases in children[J].Journal of Clinical Pediatric Surgery,2021,20(09):708.[doi:10.12260/lcxewkzz.2021.08.002]
[5]赵扬,周辉霞,马立飞,等.机器人辅助腹腔镜技术应用于儿童肾上腺肿物切除术的初步经验[J].临床小儿外科杂志,2021,20(08):712.[doi:10.12260/lcxewkzz.2021.08.003]
Zhao Yang,Zhou Huixia,Ma Lifei,et al.Preliminary experience of robot-assisted laparoscopic adrenal mass resection in children[J].Journal of Clinical Pediatric Surgery,2021,20(09):712.[doi:10.12260/lcxewkzz.2021.08.003]
[6]章跃滨,陈青江,蔡多特,等.机器人手术系统辅助儿童脾切除术三例并文献复习[J].临床小儿外科杂志,2021,20(08):718.[doi:10.12260/lcxewkzz.2021.08.004]
Zhang Yuebin,Chen Qingjiang,Cai Duote,et al.Robot-assisted laparoscopic splenectomy in children: a report of 3 cases with review of the literature[J].Journal of Clinical Pediatric Surgery,2021,20(09):718.[doi:10.12260/lcxewkzz.2021.08.004]
[7]马洪,汤显能,郭跃明.机器人手术系统辅助经皮原位固定术治疗儿童股骨头骨骺滑脱的比较研究[J].临床小儿外科杂志,2021,20(08):724.[doi:10.12260/lcxewkzz.2021.08.005]
Ma Hong,Tang Xianneng,Guo Yueming.Comparative study of percutaneous in stu fixation of slipped capital femoral epiphysis assisted by surgical robotic system[J].Journal of Clinical Pediatric Surgery,2021,20(09):724.[doi:10.12260/lcxewkzz.2021.08.005]
[8]陈艳,周立军,汪亚平,等.机器人辅助腹腔镜技术治疗儿童肾上腺嗜铬细胞瘤一例并文献复习[J].临床小儿外科杂志,2021,20(08):731.[doi:10.12260/lcxewkzz.2021.08.006]
Chen Yan,Zhou Lijun,Wang Yaping,et al.Robot-assisted laparoscopic adrenalectomy for children with adrenal pheochromocytoma: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2021,20(09):731.[doi:10.12260/lcxewkzz.2021.08.006]
[9]胡家祥,聂梅兰,杨嘉飞,等.儿童上尿路结石的外科治疗进展[J].临床小儿外科杂志,2021,20(10):985.[doi:10.12260/lcxewkzz.2021.10.017]
Hu Jiaxiang,Nie Meilan,Yang Jiafei,et al.Recent advances in surgical treatment of upper urinary calculi in children[J].Journal of Clinical Pediatric Surgery,2021,20(09):985.[doi:10.12260/lcxewkzz.2021.10.017]
[10]朱炜玮,周辉霞,李品,等.机器人辅助腹腔镜Lich-Gregoir输尿管再植术与气膀胱Cohen输尿管再植术治疗原发性膀胱输尿管反流的疗效对比[J].临床小儿外科杂志,2022,21(05):437.[doi:10.3760/cma.j.cn101785-202109034-008]
Zhu Weiwei,Zhou huixia,Li Pin,et al.Comparison of clinical efficacy of robot-assisted laparoscopic Lich-Gregoir procedure and gas-bladder laparoscopic Cohen ureteral reimplantation for primary vesicoureteral reflux[J].Journal of Clinical Pediatric Surgery,2022,21(09):437.[doi:10.3760/cma.j.cn101785-202109034-008]
备注/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