機械手臂腎盂成形術: 應用於一歲幼兒腎盂輸尿管接合處阻塞之台灣經驗
陳妤甄1、陳浩瑋1、吳文正1、阮雍順2
高雄醫學大學附設醫學 泌尿部1
高雄市立大同醫院 泌尿科2
Experience of robotic-assisted laparoscopic pyeloplasty for 1-year-old girl with ureteropelvic junction obstruction in Taiwan
Yu-Chen Chen1, Hao-Wei Chen1, Wen-Jeng Wu1, Yung-Shun Juan2
1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
A one-year-old girl presented to our outpatient department with left hydronephrosis detected on the pediatric abdominal ultrasonography. The renal scan showed impairment of left renal function with obstruction of urine flow (Estimated glomerular filtration rate of left kidney was 8.3 ml/min and right kidney was 47.6 ml/min). The abdominal computed tomography showed left ureteropelvic junction obstruction. Robotic-assisted laparoscopic pyeloplasty (RALP) with transperitoenal approach was performed for her. The patient was placed in right decubitus position at an angle of 60 degrees. Pneumoperitoneal pressure was set in 10 mmHg. The 12 mm camera port was placed at the umbilicus, and two working 8-mm ports were placed in the ipsilateral lower quadrant and in between the xyphoid and umbilicus. After reflecting the descending colon, Anderson-Hynes dismembered pyeloplasty was performed smoothly. The 5 Fr. 12cm double-J ureteral stent was placed in antegrade fashion. The total operation time was 150 minutes and the bleeding was about 5 ml. The ureteral stent was removed 2 months after surgery. There were no hydronephrosis in the follow-up abdominal ultrasonography 6 months after surgery. Although robotic-assisted surgery has shown advantages in the older and larger children, its role in smaller and younger children remains controversial. Besides, most surgeons used smaller size instruments and scope in the robotic-assisted surgery for smaller children. In our experience, it’s feasible to use standard size instruments in the RALP for smaller children.