单一体位机器人腹腔镜肝后下腔静脉癌栓取出术的初步体会

目的:探讨单一体位机器人辅助腹腔镜肝后下腔静脉癌栓取出术的可行性和安全性。方法:回顾性分析2015年12月至2020年8月郑州大学第一附属医院收治的6例行单一体位机器人辅助腹腔镜肝后下腔静脉癌栓取出术患者的临床资料。男5例，女1例；平均年龄58(46~74)岁。平均体质指数24.6 (20.6~28.2) kg/m ...

Robot-assisted retrohepatic inferior vena cava tumor thrombectomy in treating renal tumor with a single position:initial series

Objective To explore the feasibility and safety of robot-assisted retrohepatic inferior vena cava(IVC)tumor thrombectomy for renal tumor patients with a single position.Methods The clinical data of 6 renal tumor patients with retrohepatic IVC thrombus(5 males and 1 female,mean age of 58 years)who underwent robot-assisted retrohepatic IVC tumor thrombectomy with a single position in First Affiliated Hospital of Zhengzhou University from December 2015 to August 2020 were retrospectively reviewed.Four cases had the renal tumor on the right side and two on the left side.The mean tumor size was 9.6 cm(range 7-13 cm).There were 4 cases of Mayo levelⅡand 2 cases of levelⅢIVC thrombus with the mean IVC thrombus length of 6.5 cm(range 5-8cm).The"IVC-first,kidney-last"robotic technique was developed to minimize chances of IVC thrombus embolization for retrohepatic IVC thrombus,and a"artery-first,vein-second"robotic operative strategy were developed to minimize chances of intraoperative hemorrhage.The whole procedure(the suprahepatic infradiaphramatic IVC,first porta hepatis and left renal vein control,caval exclusion,tumor thrombectomy,IVC repair,radical nephrectomy)was performed exclusively robotically with a single position.Results All 6 robotic procedures were successful,without open conversion or mortality.The mean operative time was 210 min(130-320 min),estimated blood loss was 800 ml(300-2100 ml)and three patients(5%)received intraoperative blood transfusion.The mean time of occlusion of IVC was 21 min(15-43min).Incomplete blocking occurred in two cases(one IVC,one first porta hepatis),and tumor thrombectomy were completed with intraoperative loss.IVC invasion was confirmed intraoperatively in one patient and we staple-transected the IVC without reconstruction.Six patients were all transferred to the intensive care unit for median of 2.1 days(1-4 days)after surgery.The mean time of postoperative drainage was 5 days(4-9 days).Renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients,and all recovered after medical therapy.Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma and 1 case of renal sarcoma,and the 5 cases received targeted therapy.With a median follow-up of 27 months(3-54 months),3 patients were alive,1 alive with tumor recurrence,and 2 died of cancer.Conclusions Robot-assisted laparoscopic retrohepatic IVC thrombectomy with a single position have the advantage of simple procedure,shorter operative time,less trauma and quicker recovery,and it is a feasible and effective method for renal tumor patients with retrohepatic IVC thrombus.