2023年 · 第61卷第01期

The results of open renal transplantation are definite, but the trauma is large, and the incidence of incision bleeding and infection is high after operation. Ordinary laparoscope has only two-dimensional visual field, and long straight laparoscopic instruments cannot be bent, so it is difficult to use vascular anastomosis in renal transplantation. The robotic surgical system can provide high-definition three-dimensional visual field, flexible and freely rotatable robotic arm and shock absorption and fibrillation filtering function; 2010 Giulianotti et al.^［1］robotic-assisted kidney transplant (RAKT) was reported, 2011 Boggi et al.^［2］Peritoneal externalization RAKT was achieved. In order to verify the feasibility of robotic surgery system in laparoscopic donor kidney resection-transplantation and to open up new ideas for optimizing kidney transplantation technology, we performed two robot-assisted laparoscopic kinship donor kidney resection-transplantation cases in August 2020, which are reported as follows.

A 60-year-old male patient was admitted to our hospital on August 25, 1975 because "physical examination found an upper abdominal mass and positive alpha-fetoprotein for more than one month". One month before the patient went to the doctor, it was convenient for the local hospital to go to the doctor because of black. During the physical examination, the doctor touched an upper abdominal mass and blood alpha-fetoprotein was positive, thus considering the possibility of liver cancer. The patient had a history of duodenal ulcer bleeding. There was no history of hepatitis and family history of liver cancer. Admission physical examination: There was no yellowing stain in the skin sclera, no liver palm and spider nevus, and no swollen lymph nodes on the left clavicle were palpable. The abdomen is flat and no tenderness. Hard masses can be accessed in the middle and upper abdomen, with clear boundaries, smooth surface and no tenderness. The upper edge of the liver is behind the xiphoid process, and the lower edge reaches 5 transverse fingers below the xiphoid process, and moves up and down with breathing. The spleen was not palpable under the left costal margin. Negative ascites sign. Laboratory tests: Alkaline phosphatase 15 U/L, γ-glutamyltransferase 34.4 U/L, alpha-fetoprotein agar diffusion (+), convection (+), radioimmunoassay>1 500 μ g/L (normal<20 μ g/L). Radionuclide scan of the liver: space-occupying lesion of the left lobe of the liver. The physical signs, laboratory findings and imaging findings were consistent with the manifestations of liver cancer. Admission diagnosis: Upper abdominal mass, primary liver cancer possible.

Whether performing surgery at night increases postoperative complications and deaths has been of constant clinical interest. At present, there is no unified definition of night surgery, which can generally be understood as the surgery performed after the end of normal working hours on the same day to before the start of normal working hours on the second day (16: 00 to 8: 00 on the second day). The results of research on the safety of night surgery are different at home and abroad, and there is no agreement on whether all night emergency surgery should be included in night surgery for safety assessment. A study from the United States that included 140,000 patients showed that after excluding emergency surgery, the complication rate of night surgery increased 1.6 times compared with routine surgery, but the mortality rate was comparable^［1］； Another study from the United States, which included 2.94 million cases, showed a 1.64-fold increase in mortality from night surgery^［2］。 However, the above differences do not exist in trauma and transplantation specialty surgery^{［3, 4］}。 In-depth analysis of the related factors of adverse events after night surgery can provide reference for effectively ensuring the safety of night surgery.