近腎門之腎臟腫瘤：機械手臂輔助下部分腎切除之強化精準度
方琬云、 郭謹瑋、蔡秉浩、王百孚
彰化基督教醫院 外科部 泌尿科
When Renal Tumor Close to Hilum: The Enhanced Accuracy of Partial Nephrectomy by Robotic Assistance
Wan-Yun Fang, Chin-Wei Kuo, Ping-Hao Tsai, Pai-Fu Wang
Division of Urology, Department of Surgery, Changhua Christian Hospital, Taiwan
Introduction
When renal hilar tumor was encountered, the surgery would become challenging. With refined instrument and devices, the morbidity could be reduced by enhanced accuracy of dissection, resection, and reconstruction. We demonstrated a delicate and prompt procedure of partial nephrectomy by robotic assistance or renal hilar tumor.
Case presentation
A 55-year-old male, who had left renal tumor found near to hilum, had received robotic-assisted partial nephrectomy. The nephrometry score was 7p. The whole procedure was smooth and delicate especially during tumor dissection and suturing the rough surface while renal arteries were under controlled. Minimized blood loss and well protection of hilum were achieved. Unusual pathological characteristic was also noted; it turned out to be a thyroid-like follicular type renal cell carcinoma.
Discussion
The steady and 3-dimension (3-D) vision of robotic system enhanced the accuracy of dissection and resection. Thus, the tissue could be clearly identified to protect hilum and to avoid unnecessary destruction. 7-degree freedom of instrument makes renal reconstruction more delicate and secure by proper handling the renal defect.
Conclusion
Enhanced accuracy and safety can be achieved by robotic assistance in challenging partial nephrectomy.