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Objective:To investigate the effect and safety of using the fourth arm in robot assisted partial nephrectomy via retroperitoneal approach.Methods:The clinical data of 480 patients with newly diagnosed renal tumors treated in the First Affiliated Hospital of Medical College of Zhejiang University from January 2016 to December 2018 were analyzed retrospectively. All patients underwent robot assisted partial nephrectomy with the fourth arm and were divided into two groups according to the surgical approaches. There were 312 cases in the retroperitoneal group, 198 males and 114 females, aged 18-82 years, with an average of 54.0 years. The tumors were located in the right kidney in 152 cases (48.7%), left kidney in 155 cases(49.7%), double kidney in 5 cases (1.6%), with tumor size of (3.5±2.7) cm, R.E.N.A.L. score of 4-5 in 105 cases (33.7%), 6-8 in 143 cases(45.8%), and 9-12 in 64 cases (20.5%). There were 168 cases in the transperitoneal group, 105 males and 63 females, the age ranged from 21 to 79 years, with an average of 53.2 years. The tumors were located in the right kidney in 85 cases (50.6%), left kidney in 78 cases (46.4%), double kidney in 3 cases (1.8%), with tumor size of (3.8±2.9) cm, R.E.N.A.L. score of 4-5 in 52 cases (31.0%), 6-8 in 81 cases (48.2%), and 9-12 in 35 cases (20.8%). In the retroperitoneal group, the patients were placed in the 90 ° lateral position on the healthy side, the lens hole cannula was placed 2-3 cm above the iliac crest, and one operation hole cannula was placed 8 cm away from the lens hole cannula on the ventral and dorsal sides respectively. The included angle between the two operation holes and the lens hole was 150°-180°. The fourth arm operation hole was established 8 cm away from the ventral operation hole, and the included angle between the connecting line and the horizontal line is ≤15°. The fourth arm operating hole was placed with ProGrasp forceps, which can be used to push away fat, peritoneum, traction and lift kidney, etc., so as to obtain satisfactory operating space and position. The perioperative conditions and surgical complications of the two groups were compared.Results:The operations were successfully completed in both groups, and there was no conversion to open surgery. The installation time of retroperitoneal group and transperitoneal group were (12.3±5.3)min and (7.8±3.8)min respectively, the console time was (70.5±17.1)min and (89.4±23.9)min respectively, the warm ischemia time was (17.3±8.2)min and (19.2±9.1)min respectively, the intraoperative bleeding volume was (115.2±47.3)ml and (125.8±52.1)ml respectively, and the intestinal recovery time was (1.5±1.8)d and (2.7±2.4)d respectively.The postoperative hospital stay was(6.3±1.8)d and (7.4±2.8)d, respectively ( P<0.05). The positive rates of incision margin in retroperitoneal group and transperitoneal group were 0(0 cases) and 0.6% (1 case). The time of indwelling drainage tube was (4.6±2.5)d and (4.9±2.8)d, respectively, and there was no significant difference ( P>0.05). The incidence of postoperative complications in the retroperitoneal group was lower than that in the transperitoneal group (67 cases, 21.5% vs. 51 cases, 30.3%, P=0.031). There was significant difference in the incidence of Clavien grade Ⅰ-Ⅱ complications (62 cases, 19.8% vs. 48 cases, 28.6%, P=0.030). There was no significant difference in the incidence of Clavien grade Ⅲ-Ⅳ complications (5 cases, 1.6% vs. 3 cases, 1.9%, P>0.05). Conclusions:Compared with the transperitoneal approach, the retroperitoneal approach with the fourth arm robot assisted partial nephrectomy is safe and effective, with shorter operation time, warm ischemia time, postoperative recovery time and fewer complications.
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BACKGROUND@#Minimally invasive and rapid recovery are trends in surgical treatment of lung cancer, and Da Vinci Surgical Robotic System plays an important role in them. This study was planned to explore the effect of chest wall external nursing interventions on reducing postoperative thoracic drainage and promoting rapid recovery of patients.@*METHODS@#The patients who underwent robotic radical lung cancer resection in our hospital from November 2017 to April 2018were randomly divided into two groups. The control group received robotic radical lung cancer resection with abdominal bands wrapped around the chest. The experimental group underwent Da Vinci robotic radical lung cancer surgery and assisted chest wall external nursing interventions after surgery.@*RESULTS@#The total and average daily drainage of the experimental group were less than those of the control group. Both the extubation time and the hospitalization time were shorter than those of the control group, but there was no significant difference. The pain score in the second days after operation of the experimental group was slightly higher than that of the control group, with no significant statistical difference. For patients whose chest wall thickness is less than 4 cm, mirabilite external application can significantly reduce the average daily and total drainage volume, but there is no significant difference in extubation time and hospitalization time.@*CONCLUSIONS@#Chest wall external nursing interventions are beneficial to the recovery of patients undergoing Vinci robotic lung cancer surgery. Especially for patients with thinner chest wall. It can reduce postoperative drainage, shorten tube retention time and accelerate discharge. Further improvement is expected to achieve better clinical results.
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Objective:To evaluate the effect of position change and pneumoperitoneum pressure on the respiratory system of patients undergoing DaVinci assisted laparoscopic prostate cancer surgery.Methods:Peak airway pressure, lung compliance and airway resistance were recorded by ventilator as the basic values to evaluate the change of respiratory function. When the artificial pneumoperitoneum pressure was 10 mmHg or 15 mmHg, the changes of respiratory function were recorded in five different positions: trendelenburg position (head low foot height) 30°, 15°, supine position, anti-trendelenburg position (head high foot height) 15° and 30°, peak airway pressure, lung compliance, airway resistance and so on.Results:At 10 mmHg and 30° trendelenburg, peak airway pressure, lung compliance and airway resistance were 28.13 cmH 2O, 23.33 ml/cmH 2O,16.06 cmH 2O·L -1·Sec -1, respectively. When the pneumoperitoneum pressure was adjusted to 15 mmHg, peak airway pressure increased to 32.03 cmH 2O, lung compliance decreased to 20.14 ml / cmH 2O, and airway resistance increased to 117.24 cmH 2O·L -1·Sec -1( P<0.01). At 10 mmHg and trendelenburg returned to 15°, peak airway pressure, lung compliance and airway resistance were 26.66 cmH 2O, 24.95 ml/cmH 2O,15.50 cmH 2O·L -1·Sec -1, peak airway pressure increased to 30.61 cmH 2O, the lung compliance decreased to 20.89 ml/cmH 2O and airway resistance increased to 16.66 cmH 2O·L -1·Sec -1 ( t value was -43.81, 24.638, -12.812, P<0.01). Conclusion:With the increase of trendelenburg position angle and artificial pneumoperitoneum pressure, the peak airway pressure and airway resistance are increased, while the lung compliance decreases gradually. Compared with trendelenburg position, the change of artificial pneumoperitoneum pressure has more influence on respiratory function.
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OBJECTIVE@#To summarize the experience of perioperative prevention during double-lung transplantation for elderly patients with coronavirus disease 2019 (COVID-19).@*METHODS@#Clinical data of 2 elderly patients with COVID-19 who underwent double-lung transplantation in the First Affiliated Hospital of Zhejiang University School of Medicine in March 2020 were retrospectively reviewed. Perioperative protective measures were introduced in terms of medical staffing, respiratory tract, pressure injuries, air in operating room, instruments and equipment, pathological specimens, and information management.@*RESULTS@#Two cases of double-lung transplantation were successfully completed, and the patients had no operation-related complications. Extracorporeal membrane oxygenator was successfully removed 2 to 4 days after surgery and the patients recovered well. There was no infection among medical staff.@*CONCLUSIONS@#Adequate preoperative preparation, complete patient transfer procedures, proper placement of instruments and equipment, strengthening of intraoperative care management, and attention to prevention of pressure injury complications can maximize the safety of COVID-19 patients and medical staff.