国产模块化手术机器人系统辅助肾盂成形术的可行性和安全性评价

doi:10.19723/j.issn.1671-167X.2025.04.024

摘要/Abstract

摘要：

目的: 评估国产模块化海山一^Ⓡ腔镜手术机器人辅助肾盂成形术在治疗肾盂输尿管连接处狭窄(ureteropelvic junction obstruction，UPJO)中的技术可行性与围术期安全性。方法: 前瞻性纳入2024年11—12月在北京大学第一医院接受海山一^Ⓡ腔镜手术机器人辅助肾盂成形术的5例UPJO患者，收集其人口学特征、术中关键参数(包括设备对接时间、控制台时间和出血量等)、围术期相关指标、随访数据以及术者对系统性能的主观评价，采用描述性统计分析，连续变量以中位数(范围)表示，分类变量以频数和百分比表示。结果: 本研究包含4例女性和1例男性患者，均顺利完成机器人辅助肾盂成形术，无1例中转开放或腹腔镜手术。患者中位年龄32岁(24~37岁)，中位体重指数为21.6 kg/m²(15.8~27.3 kg/m²)。设备对接中位时间8 min(3~12 min)，中位控制台时间91 min(71~125 min)，术中出血量均为20 mL。中位术后引流管留置时间3 d(0~4 d)，中位术后住院时间4 d(4~9 d)，围术期所有患者未出现Clavien-Dindo分级≥Ⅲ的并发症，中位随访时间6个月(5~6个月)，所有患者在术后2个月拔出双J管，5例患者术前患侧肋腹部疼痛均得到缓解，手术主观成功率100%。术者反馈显示，设备运行稳定，手术过程中未出现机械臂干涉或视野漂移等影响操作流畅度的设备异常。结论: 模块化海山一^Ⓡ腔镜手术机器人辅助肾盂成形术具有良好的可行性与安全性。

关键词: 机器人手术, 肾盂输尿管连接处狭窄, 肾盂成形术

Abstract:

Objective: To evaluate the technical feasibility and perioperative safety of pyeloplasty assisted by the Carina^TM modular laparoscopic surgical robotic system in patients with ureteropelvic junction obstruction (UPJO). Methods: From November to December 2024, five consecutive patients diagnosed with UPJO underwent robot-assisted pyeloplasty using the Carina^TM modular laparoscopic surgical system at Peking University First Hospital. Data on patient demographics, intraoperative parameters (including docking time, console time, and estimated blood loss), perioperative outcomes, follow-up results, and surgeons' subjective evaluations of system performance were prospectively collected. Descriptive statistics were used; continuous variables were presented as median (range), and categorical variables as frequency and percentage. Results: The cohort included four females and one male. All the patients successfully completed the robotic procedure without conversion to open or conventional laparoscopic surgery. The median age was 32 years (24-37 years), and the median body mass index was 21.6 kg/m² (15.8-27.3 kg/m²). The median docking time was 8 min (3-12 min), and the median console time was 91 min (71-125 min). Intraoperative blood loss was uniformly 20 mL. The median postoperative drainage duration was 3 d (0-4 d), and the median length of hospital stay was 4 d (4-9 d). No Clavien-Dindo grade Ⅲ or higher complications occurred. All the patients had their double-J stents removed at 2 months postoperatively, and pain in the ipsilateral flank, reported preoperatively by all the five patients, was alleviated. The subjective surgical success rate was 100%. Surgeons reported stable system performance throughout all the procedures, with no instances of mechanical arm interference or visual drift affecting surgical fluency. Conclusion: Preliminary findings indicate that pyeloplasty using the domestically deve-loped Carina^TM modular laparoscopic robotic system is technically feasible and perioperatively safe for the treatment of UPJO.

Key words: Robotic surgical procedures, Ureteropelvic junction obstruction, Pyeloplasty

中图分类号:

R693.2

刘世豪, 徐丽清, 李新飞, 杨昆霖, 李兆莹, 张子博, 王祥, 傅炜骁, 李志华, 李学松. 国产模块化手术机器人系统辅助肾盂成形术的可行性和安全性评价[J]. 北京大学学报（医学版）, 2025, 57(4): 779-783.

Shihao LIU, Liqing XU, Xinfei LI, Kunlin YANG, Zhaoying LI, Zibo ZHANG, Xiang WANG, Wei-xiao FU, Zhihua LI, Xuesong LI. Evaluation of the feasibility and safety of a Chinese developed modular surgical robotic system for robot-assisted pyeloplasty[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 779-783.

图/表 3

图1

图2

表1

参考文献 20

1	Fan S , Dai X , Yang K , et al. Robot-assisted pyeloplasty using a new robotic system, the KangDuo-Surgical Robot-01: A prospective, single-centre, single-arm clinical study[J]. BJU Int, 2021, 128 (2): 162- 165.
2	Moreno-Sierra J , Castillon-Vela I , Ortiz-Oshiro E , et al. Robotic Anderson-Hynes dismembered pyeloplasty: Initial experience[J]. Int J Med Robot, 2013, 9 (2): 127- 133.
3	Fan S , Xiong S , Li Z , et al. Pyeloplasty with the Kangduo Surgical Robot vs. the da Vinci Si Robotic System: Preliminary results[J]. J Endourol, 2022, 36 (12): 1538- 1544.
4	Pokhrel G , Wang Z , Cui J , et al. Initial experience with the novel modular robotic system Carina in urology: A prospective study on safety feasibility and surgical settings[J]. Sci Rep, 2025, 15 (1): 12686.
5	郑浩轲, 于栓宝, 王泽远, 等. 国产模块化手术机器人系统辅助肾部分切除术的可行性和安全性分析[J]. 临床泌尿外科杂志, 2025, 40 (1): 39- 42.
6	Wang H , Ye D . New surgical robotic platforms in China and their applications in urologic surgeries[J]. Asian J Urol, 2025, 12 (2): 134- 138.
7	应沂岑, 杜毅聪, 李志华, 等. 机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管狭窄[J]. 北京大学学报(医学版), 2024, 56 (4): 640- 645. doi: 10.19723/j.issn.1671-167X.2024.04.016
8	Yang K , Yao L , Li X , et al. A modified suture technique for transperitoneal laparoscopic dismembered pyeloplasty of pelviureteric junction obstruction[J]. Urology, 2015, 85 (1): 263- 267.
9	Rasool S , Singh M , Jain S , et al. Comparison of open, laparoscopic and robot-assisted pyeloplasty for pelviureteric junction obstruction in adult patients[J]. J Robot Surg, 2020, 14 (2): 325- 329.
10	Abboudi H , Khan MS , Guru KA , et al. Learning curves for urological procedures: A systematic review[J]. BJU Int, 2014, 114 (4): 617- 629.
11	Bernie LH , Park K , Do J , et al. Systematic review and meta-analysis of robotic-assisted versus conventional laparoscopic pyeloplasty for patients with ureteropelvic junction obstruction: effect on operative time, length of hospital stay, postoperative complications, and success rate[J]. Eur Urol, 2009, 56 (5): 848- 857.
12	Diana M , Marescaux J . Robotic surgery[J]. Br J Surg, 2015, 102 (2): e15- e28.
13	Bagrodia A , Raman JD . Ergonomics considerations of radical prostatectomy: Physician perspective of open, laparoscopic, and robot-assisted techniques[J]. J Endourol, 2009, 23 (4): 627- 633.
14	Turchetti G , Palla I , Pierotti F , et al. Economic evaluation of da Vinci-assisted robotic surgery: A systematic review[J]. Surg Endosc, 2012, 26 (3): 598- 606.
15	Moscarelli M , Harling L , Ashrafian H , et al. Challenges facing totally endoscopic robotic coronary artery bypass grafting[J]. Int J Med Robot, 2015, 11 (1): 18- 29.
16	Koukourikis P , Rha KH . Robotic surgical systems in urology: What is currently available?[J]. Investig Clin Urol, 2021, 62 (1): 14- 22.
17	李学松, 樊书菠, 熊盛炜, 等. 国产内窥镜手术机器人系统在肾部分切除术中的初步临床应用[J]. 中华泌尿外科杂志, 2021, 42 (5): 375- 380.
18	张忠, 代海涛, 刘远华, 等. 图迈国产机器人辅助腹腔镜在泌尿外科手术中的安全性研究[J]. 微创泌尿外科杂志, 2023, 12 (4): 229- 232.
19	Zhang W , Li H , Cui L , et al. Research progress and development trend of surgical robot and surgical instrument arm[J]. Int J Med Robot, 2021, 17 (5): e2309.
20	Rebuffo S , Ticonosco M , Ruvolo CC , et al. Robot-assisted pyeloplasty with HUGO^TM Robotic System: Initial experience and optimal surgical set-up at a tertiary referral robotic center[J]. J Endourol, 2024, 38 (4): 323- 330.

相关文章 14

[1]	刘帅, 刘茁, 管允鹤, 王国良, 田晓军, 张洪宪, 刘磊, 马潞林, 张树栋. 机器人辅助腹腔镜下腔静脉节段性切除术治疗肾肿瘤瘤栓侵犯血管壁[J]. 北京大学学报（医学版）, 2025, 57(4): 796-802.
[2]	王焕瑞, 赖世聪, 胡浩浦, 丁泽华, 徐涛, 胡浩. 腹腔镜与输尿管软镜联合定位治疗复杂输尿管狭窄的疗效分析[J]. 北京大学学报（医学版）, 2025, 57(4): 784-788.
[3]	张启鸣, 陈泽波, 田雨, 潘大猛, 刘磊, 张洪宪, 赵磊, 张树栋, 马潞林, 侯小飞. 机器人辅助腹腔镜移植肾切除术经验总结[J]. 北京大学学报（医学版）, 2025, 57(4): 666-669.
[4]	李宗瀚, 黄洋阅, 李宁, 李明磊, 宋宏程, 张潍平, 刘超. 国产单孔蛇形臂机器人手术系统在儿童肾盂成形术中的应用[J]. 北京大学学报（医学版）, 2025, 57(4): 662-665.
[5]	应沂岑,杜毅聪,李志华,张一鸣,李新飞,王冰,张鹏,朱宏建,周利群,杨昆霖,李学松. 机器人辅助腹腔镜下颊黏膜补片输尿管成形术治疗复杂输尿管狭窄[J]. 北京大学学报（医学版）, 2024, 56(4): 640-645.
[6]	张树栋,谢睿扬. 机器人手术时代的肾癌合并腔静脉瘤栓治疗策略[J]. 北京大学学报（医学版）, 2024, 56(4): 562-564.
[7]	安立哲,熊六林,陈亮,王焕瑞,陈伟男,黄晓波. 腹腔镜肾盂成形术联合肾盂镜超声碎石取石术治疗肾盂输尿管连接部梗阻合并肾结石[J]. 北京大学学报（医学版）, 2022, 54(4): 746-750.
[8]	左炜,高菲,袁昌巍,熊盛炜,李志华,张雷,杨昆霖,李新飞,刘靓,魏来,张鹏,王冰,谷亚明,朱宏建,赵峥,李学松. 基于多中心数据库的10年上尿路修复手术术式及术型变化趋势[J]. 北京大学学报（医学版）, 2022, 54(4): 692-698.
[9]	周利群,徐纯如. 机器人时代中央型肾肿瘤的手术治疗策略[J]. 北京大学学报（医学版）, 2022, 54(4): 587-591.
[10]	郝瀚,刘越,陈宇珂,司龙妹,张萌,范宇,张中元,唐琦,张雷,吴士良,宋毅,林健,赵峥,谌诚,虞巍,韩文科. 机器人辅助前列腺癌根治术后患者的控尿恢复时间[J]. 北京大学学报（医学版）, 2021, 53(4): 697-703.
[11]	熊盛炜,王杰,朱伟杰,程嗣达,张雷,李学松,周利群. 二次肾盂成形术在复发性肾盂输尿管连接部梗阻中的研究进展[J]. 北京大学学报（医学版）, 2020, 52(4): 794-798.
[12]	程嗣达,李新飞,熊盛炜,樊书菠,王杰,朱伟杰,李子奡,丁光璞,俞婷,李万强,孙永明,杨昆霖,张雷,郝瀚,李学松,周利群. 机器人辅助腹腔镜上尿路修复手术:单一术者108例经验总结[J]. 北京大学学报（医学版）, 2020, 52(4): 771-779.
[13]	郑蒙蒙,丁光璞,朱伟杰,杨昆霖,樊书菠,关豹,李新飞,蔡宇坤,张进生,李学松,周利群. 术前三维影像重建在治疗肾盂输尿管连接部梗阻中的应用[J]. 北京大学学报（医学版）, 2020, 52(4): 705-710.
[14]	陈伟男，叶雄俊，刘士军，熊六林，黄晓波，徐涛，王晓峰. 三种手术方式治疗肾盂输尿管连接部梗阻的疗效及并发症比较[J]. 北京大学学报(医学版), 2016, 48(5): 817-821.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Items	Patient
Items	1	2	3	4	5
Gender	Female	Female	Female	Female	Male
Age/years	33	25	24	32	37
Body mass index/(kg/m²)	20.5	21.6	15.8	24.2	27.3
Previous surgical intervention	No	Yes	Yes	No	No
Surgical side	Left	Left	Left	Right	Left
Hydronephrosis	Yes	Yes	Yes	Yes	Yes
Flank pain	Yes	Yes	Yes	Yes	Yes
Presence of concomitant renal calculi	No	Yes	No	No	No
Previous ureteral stent placement	No	Yes	Yes	No	Yes
Underwent preoperative nephrostomy	No	No	Yes	No	Yes
Preoperative creatinine/(μmol/L)	75.3	55.7	64.6	72.9	101.7
Postoperative creatinine/(μmol/L)	53.4	42.2	43.7	68.7	89.4
Estimated intraoperative blood loss/mL	20	20	20	20	20
Docking time/min	12	6	8	9	3
Robot-assisted console time/min	125	71	91	88	115
Postoperative length of stay/d	4	4	4	7	9
Postoperative drainage placement duration/d	3	0	4	3	2
Follow-up/months	6	6	6	6	5
Intraoperative device stability	Yes	Yes	Yes	Yes	Yes
Device delays impacting surgery	No	No	No	No	No
Intraoperative operability	Yes	Yes	Yes	Yes	Yes
Device collision impacting surgery	No	No	No	No	No