機器人手臂輔助腎盞憩室切除手術併部分卵巢切除手術: 病例報告
呂政昕1、余燦榮1,2、袁倫祥1、林鴻裕1,2
1.高雄義大醫院泌尿科
2.高雄義守大學醫學院
Robotic-assisted laparoscopic calyceal diverticulectomy and partial oophorectomy: a case report
Cheng Hsin Lu1,Tsan Jung Yu1,2, Lun-Hsiang Yuan1, Hung Yu Lin1,2
1. Department of Urology, E-Da Hospital, Kaohsiung, Taiwan;
2. College of Medicine, I-Shou University, Kaohsiung, Taiwan
Purpose:
We report a case of robotic-assisted laparoscopic calyceal diverticulectomy and partial oophorectomy by using Da Vinci Xi system and review the literature on laparoscopic treatment for this condition.
Case:
A 37-year-old woman without systemic disease referred to our outpatient clinic due to left renal stone and abnormal kidney shape noted in other hospital by CT scan. She had no history of urinary tract infection, left flank pain, palpable abdominal mass, gross hematuria or voiding symptoms. Her physical examination was unremarkable and laboratorial serum examinations were normal.
Abdominal CT scan showed 1) left renal cystic lesion with internal calcifications and contrast medium acumination, in favor of diverticulum; 2) Left adnexal cystic lesion, suspect left ovarian cystic tumor.
We attempt to remove the ovarian cyst at the same time. Therefore, robotic-assisted laparoscopic surgery was arranged with the help of Da Vinci Xi system.
The patient was placed in Johnnie Walker position. A 5mm RP catheter was placed initially under cystoscopy. Then a modified four-port robotic-assisted laparoscopic approach with 1 assistant port was used.
The appearance of renal parenchyma overlying the diverticulum was almost normal and needle method was used to identify its location. After demarcation of left renal lesion, the tumor was resected with cold scissor. The stone was then removed with a robotic grasper and entrapped within a bag. It was repaired by laparoscopic suture using 3-0 V-lock and Tisseel was sprayed on it. After calyceal diverticulectomy, we did not move the patient cart but rotate the boom to precede partial oophorectomy. Re-docking time only cost 10min. The whole operation was done smoothly.
The final pathology showed left renal diverticulum and endometriosis. The patient was discharge on post operation day 6 without complication.