2022年 · 第60卷第11期

For robot-assisted laparoscopic partial nephrectomy, both transabdominal and extraperitoneal approaches are feasible approaches, and the extraperitoneal approach is considered to have less impact on the intestine and fewer postoperative complications^{［1, 2］}。 With the pursuit of incision aesthetics by surgeons and patients, single-port robot-assisted laparoscopic partial nephrectomy (sp-RAPN) has been applied clinically; Wu Zhenjie et al.^［3］Transabdominal sp-RAPN was reported in 2017. Our team carried out robot-assisted single-port laparoscopic surgery on the basis of^［4］An extraperitoneal approach was attempted to implement sp-RAPN, and the initial experience of its efficacy and safety is reported below.

Solitary kidney renal carcinoma is rare in clinical practice and difficult to manage. Treatment methods include radical nephrectomy and nephron-sparing surgery^［1］。 Nephron-sparing surgery has high technical requirements, many postoperative complications and high risks. From January 2015 to October 2021, 7 patients with solitary renal cancer were admitted to our hospital. The experience of performing nephron-sparing surgery is summarized and reported below.

A 50-year-old male patient was admitted to Zhejiang Provincial People's Hospital on May 9, 2018 due to "repeated left upper abdominal pain for more than 4 years and elevated tumor markers for 2 months (CA19-9 was 55.7 U/ml)". Past history: Old history of pulmonary tuberculosis, no history of trauma and surgery. Personal history: 25 years of smoking (40 cigarettes/d), 10 years of cessation; Drink alcohol for 25 years (beer, 1 500 ml/d) and has been sober for 10 years. There was no family history of tumors and genetic diseases. Physical examination: body mass index 19.4 kg/m²There was no yellowing stain on the skin sclera, flat and soft abdomen, tenderness in the middle and upper abdomen, no rebound pain, not reaching the liver and spleen, and not reaching obvious abdominal mass. Laboratory tests: blood routine, urine routine, stool routine, biochemical indexes were not abnormal. CA19-9 42.7 U/ml, CAE 3.3 μ g/L. Abdominal enhanced CT examination: pancreatic body lack of blood supply lesions (3.1 cm ×2.8 cm), heterogeneous enhancement, with distal pancreatic duct dilation, involving celiac trunk, portal vein, splenic arteriovenous origin, with pancreatic portal hypertension, retroperitoneal lymph node enlargement (Figure 1). Hepatobiliary enhanced MRI: No metastases were found in the liver, L₂Nodular enhancement of vertebral body, considering metastasis. PET-CT examination: pancreatic body occupies space (3.7 cm ×2.9 cm, maximum uptake value is about 10.5), involves splenic artery and vein, and the boundary with adjacent stomach wall is unclear, considering pancreatic cancer with central necrosis, retroperitoneal lymph node enlargement (1.6 cm ×1.1 cm, maximum uptake value is about 5.8), considering metastasis; L₂Increased focal metabolism in the vertebral body (maximum uptake value approximately 5.4), considering bone metastasis (Figure 2). Preliminary diagnosis: pancreatic cancer with bone metastasis (cT2N1M1).