在成人泌尿外科肿瘤中,机器人的使用已变得司空见惯;在儿科泌尿外科中很少见。在这里,我们描述了成人和儿科泌尿科医师为患有可疑或癌性泌尿生殖系统(GU)病变的儿童和年轻成人进行机器人手术的合作.
评估接受机器人手术的儿童和年轻人的临床和肿瘤学结果,以治疗GU道的可疑或癌性病变;描述我们在独立儿童医院的成人和儿科外科医生之间的合作模型。
我们回顾性回顾了2014年至2016年在我们机构为患有GU恶性肿瘤或可疑肿块的患者进行的所有机器人病例。手术由具有机器人经验的儿科泌尿科医生和经过研究金训练的MIS成人泌尿科医生进行,专门从事肿瘤学。记录围手术期和肿瘤学结果。
总共进行了8例机器人病例:4例部分肾切除术(PN)和腹膜后淋巴结清扫术(LND)(OT269-338分钟,EBL5-300mL,LOS3-6天),一次LND肾上腺切除术(6.4厘米肿块;OT172分钟,EBL5mL,LOS3天),1例肾切除术伴LND(9.8cm质量;234分钟,EBL25mL,LOS3天),和两个腹膜后LND(OT572和508分钟,EBL250和100,LOS3和4天)。患者体重范围为14至79kg(平均53.4kg)。无重大并发症(Clavien3-5)。PN的病理结果包括乳头状RCC(AJCCpT1aNx)和2例节段性囊性肾发育不良伴肾源性休息。双侧模板RPLND产生了睾丸旁横纹肌肉瘤(43个节点;COG低危II期I)和混合非精原细胞生殖细胞肿瘤(74个节点;COGIII期)。肾切除术产生了未分化肉瘤,低级别;肾上腺切除术有利型神经节神经瘤。
在儿科,泌尿系肿瘤病例通常采用开放手术治疗。我们的系列演示了在精心选择的情况下使用机器人方法的可行性。在这样做的时候,患者受益于微创手术,而外科医生受益于机器人手术的灵活性。我们通过常规执行机器人肿瘤学程序的成人泌尿科医师与在良性疾病中具有机器人经验的儿科泌尿科医师之间的逐步合作,无缝地推进了这些新技术。
在这个小系列中,我们安全有效地将成人机器人技术应用于儿童和年轻人的泌尿生殖系统肿瘤病例.
In adult urologic oncology the use of robotics has become commonplace; in pediatric urology it is rare. Herein, we describe a collaboration between an adult and a pediatric urologist performing robotic surgery for children and young adults with suspicious or cancerous genitourinary (GU) lesions.
To evaluate clinical and oncologic outcomes in children and young adults undergoing robotic surgery for suspicious or cancerous lesions of the GU tract; to describe our collaborative model between an adult and pediatric surgeon at a free-standing children\'s hospital.
We retrospectively reviewed all robotic cases performed at our institution from 2014 to 2016 for patients with a GU malignancy or a suspicious mass. The surgeries were performed by a pediatric urologist with robotic experience and a fellowship-trained MIS adult urologist specializing in oncology. Perioperative and oncologic outcomes were recorded.
A total of eight robotic cases were performed: four partial nephrectomies (PN) with retroperitoneal lymph node dissection (LND) (OT 269-338 min, EBL 5-300 mL, LOS 3-6 days), one adrenalectomy with LND (6.4 cm mass; OT 172 min, EBL 5 mL, LOS 3 days), one nephrectomy with pericaval LND (9.8 cm mass; 234 min, EBL 25 mL, LOS 3 days), and two retroperitoneal LNDs (OT 572 and 508 min, EBL 250 and 100, LOS 3 and 4 days). Patient weights ranged from 14 to 79 kg (mean 53.4 kg). There were no major complications (Clavien 3-5). Pathology results for PN included papillary RCC (AJCC pT1aNx) and two cases of segmental cystic renal dysplasia with nephrogenic rests. Bilateral template RPLNDs yielded paratesticular rhabdomyosarcoma (43 nodes; COG low risk group II stage I) and mixed non-seminomatous germ cell tumor (74 nodes; COG stage III). The nephrectomy yielded an undifferentiated sarcoma, low grade; the adrenalectomy favorable-type ganglioneuroma.
In pediatrics, urologic oncology cases are often managed with open surgery. Our series demonstrates the feasibility of using the robotic approach in carefully selected cases. In doing so, the patient benefits from a minimally invasive surgery, while the surgeon benefits from robotic surgical dexterity. We seamlessly advanced these new techniques through a step-wise collaboration between an adult urologist who routinely performs robotic oncology procedures and a pediatric urologist experienced in robotics for benign conditions.
In this small series, we safely and effectively adapted adult robotic techniques for genitourinary oncology cases in children and young adults.