機器人手臂輔助非萎縮性腎切開取石手術在一位二歲的小孩:一案例報告
袁倫祥、余燦榮、林鴻裕
1.義大癌治療醫院泌尿科2.義大醫院泌尿科3.義守大學醫學院
Robot-assisted laparoscopic anatrophic nephrolithotomy in one 2 year-old child:
a case report
Lun Hsiang Yuan1、Tsan Jung Yu2,3、Hung Yu Lin1,3
1. Department of Urology, EDA Cancer Hospital, Kaohsiung, Taiwan;
2. Department of Urology, EDA Hospital, Kaohsiung, Taiwan;
3. College of Medicine, I-Shou University, Kaohsiung, Taiwan
Purpose:
We report a 2 year-old female child with complete left staghorn stone and repeated acute pyelonephritis, and she received robot-assisted laparoscopic anatrophic nephrolithotomy using da Vinci Xi surgical system
Case:
A 2 year-old female child presented with repeated left acute pyelonephritis and admitted three times. Left renal stone 2.5cm was impressed and metabolic survey showed no significant results. Urine culture showed ESBL E coli. PCNL was once suggested to eradicate infection, but her parents seeked second opinions. After thorough discussion and explanation to patient's family, robot-assisted laparoscopic anatrophic nephrolithotomy was chosed to treat her infection.
After discussion with anesthesiologist, paediatricians, and technical consultants of da Vinci Xi surgical system, we performed robot assisted laparoscopic anatrophic nephrolithotomy. Four robotic arms including scissors, Maryland bipolar forceps, and prograsp forceps were used. One 12mm assistant port was used to deliver needles and for suction. Port design was made as usual robotic kidney surgery. But trocar insertion is difficult due to patient's small body. The surgery was completed in 5 hours, warm ischemic time was 40 minutes. Patient wass discharged 5 days later. Post-op two months sonogram showed normal kidney size with mild hydronephrosis.
Pediatric renal staghorn stone is difficult to be managed because there's no optimal instrument specifically designed for such young child. We used da Vinci Xi surgical system to overcome this limitation. Long-term follow-up is still needed because of relative long warm ischemic time.