Objective: To examine a new technique of robot-assisted nephroureterectomy without robot reldocking or patient repositioning. Methods: Patients diagnosed as upper tract urothelial carcinoma treated with this modality between November 2015 and January 2019 at Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were included in this analysis. Data collection including patient demographics, operative procedure and postoperative morbidities were conducted by retrospective charts review, after receiving the institutional review board's approval. There were 35 males and 27 females with a median age of 70 years (range: 30 to 91 years) underwent single docking robot-assisted nephroureterectomy without repositioning. Among the 62 cases, 37 patients had pelvic carcinoma while 25 patients had ureteral carcinoma (with proximal portion 12 cases, middle portion 5 cases and distal portion 8 cases). The patient was placed in a 60 to 80-degree, modified flank position with a 15-degree Trendelenburg tilt. The contralateral arm was positioned perpendicular to the torso on an arm board while the ipsilateral arm was taped to the patient's side with ample padding. The robot cart was then docked at a 90-degree angle, perpendicular to the patient. A "W"-shape, three robotic-arm configurations was used for port placement. Results: The surgical procedures were performed successfully in all the 62 patients. The operation time was (171.6±54.7) minutes (range: 60 to 370 minutes). The estimated blood loss during the operation was 50(50) ml (range: 20 to 400 ml) with 4 patients had transfusion. No perioperative death was encountered. Eleven patients had post-operative complications (Clavien-Dindo grade 2) including 3 cases of hemorrhage and 8 cases of chylous leakage. All cases were regularly followed up with a median time of 37 months (range: 17 to 55 months). There were 8, 30, 19, 4 and 1 case followed up for 48, 36, 24, 18 and less than 18 months, respectively. Three patients had reginal recurrences and 11 cases of distant metastasis occurred, with 5 patients died for cancer. The survival rate within 24 months was estimated as 75.4%(43/57). Conclusion: Robot-assisted nephroureterectomy without robot redocking or patient repositioning could be safely reproduced, with surgical outcomes comparable to other established techniques.
目的： 探讨应用单一体位单次锚定的方法行机器人辅助腹腔镜肾输尿管全长切除术的可行性和有效性。 方法： 回顾性分析浙江大学医学院附属邵逸夫医院泌尿外科2015年11月至2019年1月连续收治并施行机器人辅助腹腔镜肾输尿管全长切除术的62例上尿路尿路上皮癌患者的临床和手术相关资料。男性35例，女性27例；中位年龄70岁（范围：30~91岁）。肾盂癌37例，输尿管癌25例（上段12例、中段5例、下段8例）。术中患者侧卧躯干后倾60°~80°，头低脚高约15°，患侧上肢紧贴同侧躯干，机器人手术车从患者背侧垂直推入；采用“W”形套管布局；采用全层袖套状切除、膀胱双层连续缝合处理壁内段输尿管。 结果： 所有病例顺利完成手术，无术中重新脱机锚定、更改体位，无中转开腹手术。手术时间（171.6±54.7）min（范围：60~370 min），术中出血量50（50）ml（范围：20~400 ml），术中输血4例。术后发生并发症（Clavien-Dindo分级2级）11例，其中出血3例，淋巴漏8例。术后中位随访时间37个月（范围：17~55个月），发生局部复发3例，远处器官转移11例，其中肿瘤相关死亡5例。术后24个月总体生存率为75.4%（43/57）。 结论： 单一体位单次锚定机器人辅助腹腔镜肾输尿管全长切除术可彻底切除肾输尿管全长，膀胱缝合可靠，淋巴结清扫方便，肿瘤控制效果满意，总体安全性、有效性良好。.