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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (4): 666-669. doi: 10.19723/j.issn.1671-167X.2025.04.006

• 论著 • 上一篇    下一篇

机器人辅助腹腔镜移植肾切除术经验总结

张启鸣1,*, 陈泽波2,*, 田雨1, 潘大猛1, 刘磊1, 张洪宪1, 赵磊1, 张树栋1, 马潞林1,*(), 侯小飞1,*()   

  1. 1. 北京大学第三医院泌尿外科, 北京 100191
    2. 宜昌市中心人民医院泌尿外科, 湖北宜昌 443000
  • 收稿日期:2025-03-03 出版日期:2025-08-18 发布日期:2025-08-02
  • 通讯作者: 马潞林, 侯小飞
  • 作者简介:

    *These authors contributed equally to this work

Experience summary of robot-assisted laparoscopic transplant nephrectomy

Qiming ZHANG1, Zebo CHEN2, Yu TIAN1, Dameng PAN1, Lei LIU1, Hongxian ZHANG1, Lei ZHAO1, Shudong ZHANG1, Lulin MA1,*(), Xiaofei HOU1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Yichang Central People's Hospital, Yichang 443000, Hubei, China
  • Received:2025-03-03 Online:2025-08-18 Published:2025-08-02
  • Contact: Lulin MA, Xiaofei HOU

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摘要：

目的: 总结机器人辅助腹腔镜移植肾切除术的经验, 为临床实践提供参考。方法: 回顾2023年8月至2024年12月于北京大学第三医院行机器人辅助腹腔镜移植肾切除术的患者, 收集患者围术期资料, 总结手术步骤和技术要点。连续变量采用中位数(范围)进行描述。结果: 共有5例患者纳入分析, 包括男性2例、女性3例, 中位年龄37(31~68)岁, 移植肾切除距离肾移植手术的中位时间为10(3~22)年。移植肾切除的指征包括反复血尿、腹痛、移植肾恶性肿瘤、移植肾积水伴反复感染。5例患者切除的移植肾均为单支肾动脉、单支肾静脉, 患者的中位手术时间为212(145~351) min, 中位出血量为300(20~500) mL, 中位术后住院日为7(4~25) d。只有1例患者发生术中并发症, 因髂外动脉损伤行缝合修补, 围术期无患者发生死亡。术后病理结果显示3例患者为终末期无功能肾, 1例患者为BK病毒感染相关性尿路上皮癌, 1例为慢性肾盂肾炎伴肾实质萎缩。结论: 机器人辅助腹腔镜移植肾切除术是一种安全且可行的手术方法, 与传统开放移植肾切除术相比, 其优势在于能直接观察并优先处理移植肾肾蒂, 同时在肾背膜外完整地游离并切除移植肾。随着经验的不断积累, 该术式有望成为传统开放移植肾切除术的一个有力替代方案。

关键词: 肾移植, 移植物, 肾切除术, 机器人手术

Abstract:

Objective: To review and summarize the experience of robot-assisted laparoscopic transplant nephrectomy, share the surgical steps and technical key points, and provide a reference for clinical practice. Methods: A retrospective analysis was conducted on the perioperative data of 5 patients who underwent robot-assisted laparoscopic donor nephrectomy at Peking University Third Hospital from August 2023 to December 2024. The surgical steps and key points were summarized. The continuous variables were described by medians(ranges). Results: A total of 5 patients were included in the analysis, of whom 2 were male and 3 were female. The median age of the patients was 37 (31-68) years. The median time from kidney transplantation to donor nephrectomy was 10 (3-22) years. The indications for donor nephrectomy included recurrent hematuria, abdominal pain, malignant tumor of the transplanted kidney, and recurrent infection with hydronephrosis of the transplanted kidney. The excised transplanted kidneys from all the 5 patients had a single renal artery and a single renal vein. The median operation time was 212 (145-351) min, the median blood loss was 300 (20-500) mL, and the median post-operative hospital stay was 7 (4-25) days. Only 1 patient experienced intraoperative complications, who experienced an external iliac artery injury during the operation and underwent suture repair. No patient died during the perioperative period. Postoperative pathological results showed that 3 patients had end-stage non-functional kidneys, 1 patient had BK virus-associated urothelial carcinoma, and 1 patient had chronic pyelonephritis with renal parenchymal atrophy. Conclusion: Robot-assisted laparoscopic transplant nephrectomy as a new surgical approach is feasible and safe. Compared with traditional open transplant nephrectomy, its advantage lies in the ability to directly observe and prioritize the management of the renal pedicle of the transplanted kidney, while completely freeing and removing the transplanted kidney outside the renal capsule. With the continuous accumulation of experience, this surgical technique is expected to become a powerful alternative to traditional open transplant nephrectomy.

Key words: Kidney transplantation, Transplants, Nephrectomy, Robotic surgical procedures

中图分类号: 

  • R692

图1

机器人辅助腹腔镜移植肾切除术(右侧为例)术前影像、穿刺孔布局及关键手术步骤图"

表1

机器人辅助腹腔镜移植肾切除患者的基本信息"

Characteristics Case 1 Case 2 Case 3 Case 4 Case 5
Gender Male Female Female Female Male
Age/years 33 68 60 31 37
Body mass index/(kg/m2) 17.83 24.24 20.73 14.57 21.05
Duration since kidney transplant/years 3 18 22 10 6
Number of transplanted kidneys 1 1 1 1 Double kidney transplant, removal of the left transplanted kidney
Indications for transplant nephrectomy Recurrent hematuria and fever Recurrent hematuria Recurrent hematuria and abdominal pain Mass of transplant kidney Hydronephrosis with recurrent pyelonephritis
Operative time/min 351 220 212 150 145
Blood loss/mL 300 500 150 300 20
Postoperative stay of hospital/d 7 6 8 25 4
Perioperative complications Injury of the external iliac artery None None Cardiac failure and infection None
Conversion to open surgery No No No Yes No
Perioperative motality No No No No No
Pathological results End-stage nonfunctioning kidney End-stage nonfunctioning kidney End-stage nonfunctioning kidney BK virus-associated urothelial carcinoma Chronic pyelonephritis with renal parenchymal atrophy
1
de Castro Rodrigues Ferreira F, Cristelli MP, Paula MI, et al. Infectious complications as the leading cause of death after kidney transplantation: Analysis of more than 10 000 transplants from a single center[J]. J Nephrol, 30(4): 301- 606.
2
Gómez-Dos-Santos V, Lorca-Álvaro J, Hevia-Palacios V, et al. The failing kidney transplant allograft. Transplant nephrectomy: Current state-of-the-art[J]. Curr Urol Rep, 2020, 21(1): 4.
3
张启鸣, 侯小飞. 微创技术在肾移植中的应用[J]. 器官移植, 2022, 13(1): 38- 43.
4
Abdul-Muhsin HM, McAdams SB, Syal A, et al. Robot assisted renal allograft nephrectomy: Initial case series and description of technique[J]. Urology, 2020, 146, 118- 124.
5
McCabe M, Osinski T, Kashyap R, et al. Robotic assisted transplant nephrectomy: Case series and training model for improving adoption[J]. JSLS, 2023, 27(1): e2022.00079.
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