Abstract：Objective: To explore the application value of Robot-assisted laparoscopic ultrasound in Da Vinci robotic operations. Methods: A retrospective analysis on the clinical data of 18 cases subject to Da Vinci robotic assisted laparoscopic surgery in our hospital using laparoscopic ultrasound (Robot-assisted laparoscopic ultrasound, RLUS) in operations were collected, between September 2014 and September 2017. There were 13 cases of endogenous renal tumor receiving partial nephrectomy; 1 case of renal carcinoma combined with inferior vena cava tumor thrombus receiving radical nephrectomy and thrombectomy and 4 cases of ureteropelvic junction obstruction combined renal calculi receiving pyeloplasty and ureteroscopic lithotripsy with RLUS positioning. Results: All 18 cases were performed successfully with robotic assisted laparoscopic surgery. The operative time of 13 cases of partial nephrectomy was 55-70 min (average 60 min), and estimated blood loss was 20-100 mL (average 35 mL). There were 12 cases of clear cell carcinoma, and 1 case of papillary carcinoma. All samples had negative margin, postoperative follow-up period was 3-35 months, and no recurrence or metastasis was found. The surgical time of radical nephrectomy and thrombectomy was 135 min, and estimated blood loss was 110 mL. The renal clear cell carcinoma with inferior vena cava tumor thrombus was confirmed pathologically, and during a follow-up period of 3 months, no recurrence or metastasis was found. The operative time of pyeloplasty and ureteroscopic lithotripsy was 95-135 min (mean 110 min), and the double J tube was removed at 2nd month after surgery. Hydronephrosis was significantly alleviated at 3rd month after operations, and IVU reexamination showed the clear unobstructed ureter in 2 cases. Conclusions: The application of Robot-assisted laparoscopic ultrasound in Da Vinci robotic operations can accurately locate the focus and achieve a series of complicated operations.
[1] 梁朝朝,周骏,邰胜,等.达芬奇机器人辅助腹腔镜下肾部分切除术手术入路的新选择.中华泌尿外科杂志,2016,37(5):323-327. [2] 马潞林,肖博,张树栋,等.术中超声定位在经腹腹腔镜肾部分切除中的应用.临床泌尿外科杂志,2011,26(3):203-205. [3] Shaaban H, Welch A, Rao S.Laparoscopic ultrasound for the diagnosis of choledocholithiasis: Quick, safe and effective. Surg Laparosc Endosc Percutan Tech, 2014,24(3):274-276. [4] Ellebæk SB, Fristrup CW, Mortensen MB.Laparoscopic ultrasound imaging in colorectal cancer resection may increase the detection rate of small liver metastases. Ugeskr Laeger, 2016,178(24): V01160007. [5] 吴近峰,朱庆国,胡明雄,等.腹腔镜超声在完全内生型和肾门旁肾肿瘤行肾部分切除术中的临床应用.微创泌尿外科杂志,2016,5(6):331-335. [6] Våpenstad C, Rethy A, Langø T, et al.Laparoscopic ultrasound:a survey of its current and future use, requirements, and integration with navigation technology. Surg Endosc, 2010,24(12):2944-2953. [7] Assimos DG, Boyce H, Woodruff RD, et al.Intraoperative renal ultrasonography: a useful adjunct to partial nephrectomy. J Urol, 1991,146(5):1218-1220. [8] 邱敏,向军吉,马潞林,等.实时超声监测后腹腔镜下肾部分切除术治疗完全内生型肾肿瘤的疗效分析.中华泌尿外科杂志,2016,37(10):730-734. [9] Kaczmarek BF, Sukumar S, Kumar RK, et al.Comparison of robotic and laparoscopic ultrasound probes for robotic partial nephrectomy. J Endourol, 2013,27(9):1137-1140. [10] Hu JC, Treat E, Filson CP, et al.Technique and outcomes of robot-assisted retroperitoneoscopic partial nephrectomy: a multicenter study. Eur Urol, 2014,66(3):542-549. [11] Kaczmarek BF, Sukumar S, Petros F, et al.Robotic ultrasound probe for tumor identification in robotic partial nephrectomy: Initial series and outcomes. Int J Urol, 2013,20(2):172-176. [12] Wang BJ, Li HZ, Ma X, et al.Robot-assisted Laparoscopic Inferior Vena Cava Thrombectomy: Different Sides Require Different Techniques. Eur Urol, 2016,69(6):1112-1119. [13] Hopf HL, Bahler CD, Sundaram CP.Long-term Outcomes of Robot-assisted Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction. J Urol, 2015,193(4, S):E475-E476. [14] 周骏,梁朝朝,方卫华,等.机器人辅助腹腔镜肾盂输尿管离断成形术的初步经验(附21例报告).微创泌尿外科杂志,2017,6(2):43-47. [15] 刘小彭,陆敏华,王喻,等.超声辅助的腹腔镜下肾实质切开取石术.中华腔镜泌尿外科杂志(电子版),2016,10(5):42-44.
