Robot-assisted treatment of simple renal cysts

Abstract

BACKGROUND: The gold standard in the surgical treatment of simple renal cysts is laparoscopic cyst fenestration. However, laparoscopic procedures have disadvantages which include poor ergonomics of the instruments hindering surgeon's work in children's small abdomen. Robot-assisted surgery has the potential to make surgeon's work easier and to improve surgical outcomes in patients with kidney cysts for the instruments have seven degrees of freedom, hand tremor is filtered. It also promotes comfortable console positioning for the surgeon, and three-dimensional wide-angle imaging of the surgical field.

AIM: To present the first experience of applying robot-assisted surgery for fenestration (decortication) of the outer portion of the cyst and argon-plasma coagulation of its inner lining.

METHODS: The author's present retrospective data of all patients with simple renal cysts operated on with robot-assisted approach at the Irkutsk State Regional Children's Clinical Hospital. The diagnosis was put after ultrasound examination of kidneys and after computed tomography with intravenous contrast agent. Surgery was performed using a new model of the Versius robotic system manufactured by Cambridge Medical Robotics (UK).

RESULTS: Patients' mean age at the time of surgery was (13±5.3) years (median 15 [11; 16] years), mean weight — (46.7±17.2) kg (median 54 [40.5; 56.5] kg), smallest body weight — 27 kg, size of cysts — (1.8±2.4) cm (median 0.4 [0.4; 2.5] cm). Cystic formations in all patients were located on the left: in the upper pole in 2 patients, in the lower pole in 1 patient. During the surgical intervention, there were no complications in the form of bleeding from the kidney parenchyma or damage to neighbouring organs. Histological analysis revealed that the lining of the cyst wall contained transitional epithelium without signs of malignancy. Duration of surgery was (136.7±72.2) min (median 95 [95; 157] min), duration of patients' stay in the intensive care unit — (19.9±2.5) hours (median21.3 [19.1; 21.4] hours), duration of hospital stay — (9.3±2.3) days (median 8 [8; 10] days). Ultrasound examination made in 1, 3 and 6 months after the surgery revealed no signs of disease recurrence in the form of residual accumulation of fluid associated with kidney parenchyma.

CONCLUSION: The experience described in the article is encouraging and confirms the reasonability and safety of robot-assisted procedures in pediatric urology.

Keywords

simple renal cyst / robot-assisted surgery / children

References

[1] Akramov NR, Baibikov RS. Modern surgical approaches in treatment of simple solitary, multilocular, multiple cysts and polycystic kidney disease in children. Kazan Med J. 2016;(1):95–101. EDN: VGSRKH doi: 10.17750/KMJ2016-95

[2] Акрамов Н.Р., Байбиков Р.С. Современные хирургические подходы при лечении простых солитарных, мультилокулярных, множественных кист и поликистоза почек у детей // Казанский медицинский журнал. 2016. № 1. С. 95–101. EDN: VGSRKH doi: 10.17750/KMJ2016-95

[3] Bisceglia M, Galliani CA, Senger C, et al. Renal cystic diseases: A review. Adv Anat Pathol. 2006;13(1):26–56. doi: 10.1097/01.pap.0000201831.77472.d3

[4] Bisceglia M., Galliani C.A., Senger C., et al. Renal cystic diseases: A review // Adv Anat Pathol. 2006. Vol. 13, N 1. P. 26–56. doi: 10.1097/01.pap.0000201831.77472.d3

[5] Wang YC, Xia JD, Zhang QJ, et al. Robotic renal cyst decortication with calyceal diverticulectomy in a toddler-technical practicalities: A case report. J Med Case Rep. 2018;12(1):284. EDN: CUGZJN doi: 10.1186/s13256-018-1830-9

[6] Wang Y.C., Xia J.D., Zhang Q.J., et al. Robotic renal cyst decortication with calyceal diverticulectomy in a toddler-technical practicalities: A case report // J Med Case Rep. 2018. Vol. 12, N 1. P. 284. EDN: CUGZJN doi: 10.1186/s13256-018-1830-9

[7] Agarwal MM, Hemal AK. Surgical management of renal cystic disease. Curr Urol Rep. 2011;12(1):3–10. doi: 10.1007/s11934-010-0152-2

[8] Agarwal M.M., Hemal A.K. Surgical management of renal cystic disease // Curr Urol Rep. 2011. Vol. 12, N 1. P. 3–10. doi: 10.1007/s11934-010-0152-2

[9] Bosniak MA. The Bosniak renal cyst classification: 25 Years later. Radiology. 2012;262(3):781–785. doi: 10.1148/radiol.11111595

[10] Bosniak M.A. The Bosniak renal cyst classification: 25 Years later // Radiology. 2012. Vol. 262, N 3. P. 781–785. doi: 10.1148/radiol.11111595

[11] Eroglu FK, Kargın Çakıcı E, Can G, et al. Retrospective analysis of simple and stage II renal cysts: Pediatric nephrology point of view. Pediatr Int. 2018;60(12):1068–1072. doi: 10.1111/ped.13714

[12] Eroglu F.K., Kargın Çakıcı E., Can G., et al. Retrospective analysis of simple and stage II renal cysts: Pediatric nephrology point of view // Pediatr Int. 2018. Vol. 60, N 12. P. 1068–1072. doi: 10.1111/ped.13714

[13] Peng Y, Jia L, Sun N, et al. Assessment of cystic renal masses in children: Comparison of multislice computed tomography and ultrasound imaging using the Bosniak classification system. Eur J Radiol. 2010;75(3):287–292. doi: 10.1016/j.ejrad.2010.05.035

[14] Peng Y., Jia L., Sun N., et al. Assessment of cystic renal masses in children: Comparison of multislice computed tomography and ultrasound imaging using the Bosniak classification system // Eur J Radiol. 2010. Vol. 75, N 3. P. 287–292. doi: 10.1016/j.ejrad.2010.05.035

[15] Denning NL, Kallis MP, Prince JM. Pediatric robotic surgery. Surg Clin North Am. 2020;100(2):431–443. doi: 10.1016/j.suc.2019.12.004

[16] Denning N.L., Kallis M.P., Prince J.M. Pediatric robotic surgery // Surg Clin North Am. 2020. Vol. 100, N 2. P. 431–443. doi: 10.1016/j.suc.2019.12.004

[17] Shen LT, Tou J. Application and prospects of robotic surgery in children: A scoping review. World J Pediatr Surg. 2022;5(4):e000482. EDN: LSWTQW doi: 10.1136/wjps-2022-000482

[18] Shen L.T., Tou J. Application and prospects of robotic surgery in children: A scoping review // World J Pediatr Surg. 2022. Vol. 5, N 4. P. e000482. EDN: LSWTQW doi: 10.1136/wjps-2022-000482

[19] Wallis MC, Lorenzo AJ, Farhat WA, et al. Risk assessment of incidentally detected complex renal cysts in children: Potential role for a modification of the Bosniak classification. J Urol. 2008;180(1):317–321. doi: 10.1016/j.juro.2008.03.063

[20] Wallis M.C., Lorenzo A.J., Farhat W.A., et al. Risk assessment of incidentally detected complex renal cysts in children: Potential role for a modification of the Bosniak classification // J Urol. 2008. Vol. 180, N 1. P. 317–321. doi: 10.1016/j.juro.2008.03.063

[21] Skolarikos A, Laguna MP, de la Rosette JJ. Conservative and radiological management of simple renal cysts: A comprehensive review. BJU Int. 2012;110(2):170–178. doi: 10.1111/j.1464-410X.2011.10847.x

[22] Skolarikos A., Laguna M.P., de la Rosette J.J. Conservative and radiological management of simple renal cysts: A comprehensive review // BJU Int. 2012. Vol. 110, N 2. P. 170–178. doi: 10.1111/j.1464-410X.2011.10847.x

[23] Vrublevskaya EN, Kovarsky SL, Vrublevsky SG, et al. Diagnostics and tactics of surgical treatment of children with solitary cortical cyst lesions. Bulletin Russ State Med Univer. 2010;(4):25–29. EDN: NHKFWH

[24] Врублевская Е.Н., Коварский С.Л., Врублевский С.Г., и др. Диагностика и тактика хирургического лечения при солитарных кортикальных кистозных поражениях почек у детей // Вестник РГМУ. 2010. № 4. С. 25–29. EDN: NHKFWH

[25] Wang ZT, Chan EP, Vanin Moreno N, et al. What to do with renal cysts in children? Urology. 2020;(140):138–142. doi: 10.1016/j.urology.2020.03.001

[26] Wang Z.T., Chan E.P., Vanin Moreno N., et al. What to do with renal cysts in children? // Urology. 2020. N 140. P. 138–142. doi: 10.1016/j.urology.2020.03.001

[27] Stalmakhovich VN, Angarkhaeva LV, Yakovchenko SN. Comparative analysis of surgical treatment outcomes in children with solitary renal cysts. Russ J Pediatric Surg Anesthesia Intensive Care. 2019;9(4):57–68. EDN: HBHMCB doi: 10.30946/2219-4061-2019-9-4-57-68

[28] Стальмахович В.Н., Ангархаева Л.В., Яковченко С.Н. Сравнительный анализ результатов хирургического лечения детей с солитарными кистами почки // Российский вестник детской хирургии, анестезиологии и реаниматологии. 2019. Т. 9, № 4. С. 57–68. EDN: HBHMCB doi: 10.30946/2219-4061-2019-9-4-57-68

[29] Vrublevsky SG, Kovarsky SL, Menovshchikova LB, et al. Applicaion of the puncture method of treatment of simple renal cysts in children. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2008;(1):16–18. EDN: TKTZTH

[30] Врублевский С.Г., Коварский С.Л., Меновщикова Л.Б., и др. Использование пункционного метода лечения простых кист почек у детей // Детская хирургия. Журнал им. Ю.Ф. Исакова. 2008. № 1. С. 16–18. EDN: TKTZTH

[31] Esposito C, Settimi A, del Conte F, et al. Image-guided pediatric surgery using Indocyanine Green (ICG) fluorescence in laparoscopic and robotic surgery. Front Pediatr. 2020;(8):314. EDN: SPWRYD doi: 10.3389/fped.2020.00314

[32] Esposito C., Settimi A., del Conte F., et al. Image-guided pediatric surgery using Indocyanine Green (ICG) fluorescence in laparoscopic and robotic surgery // Front Pediatr. 2020. N 8. P. 314. EDN: SPWRYD doi: 10.3389/fped.2020.00314

RIGHTS & PERMISSIONS

Eco-Vector