Mr. Xie, a Wenzhou native, works in Spain for many years, and in middle age, he has 4 children to raise, and not long ago, he learned a bad news in the physical examination - "left renal cystic tumor for 3 years, progressive enlargement for half a year", the tumor diameter is close to 6 cm, and it is cystic, completely endogenous growth, close to the left renal pelvis and renal arteries and veins. These characteristics gather three high risks, which are extremely rare and can be described as the "ceiling" of the difficulty of kidney protection surgery.
Mr. Xie traveled to seek medical treatment at home and abroad, and came to the same conclusion: one kidney needs to be removed.
Are the kidneys really not preserved? The kidney tumor surgery team led by Cui Xingang, director of the Department of Urology of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, challenged the "limit of kidney preservation": accurate pre-planning, three-dimensional modeling, robot "hands-on", original technology, racing against the clock... The 40-minute operation successfully saved Mr. Xie's kidney, just like a "raw egg" from the kidney. At present, Mr. Xie is recovering well after surgery and has been discharged from the hospital at about 2 p.m. today.
The difficulty of surgery can be described as a "ceiling"
Recently, Mr. Xie, who has been working abroad for a long time, had to return to China to seek medical treatment. During the physical examination, he found that a tumor had grown in his left kidney, and the situation was complicated, and it was extremely difficult to perform kidney preservation surgery. Mr. Xie traveled to many hospitals and searched for famous doctors at home and abroad, and was told that the chances of saving kidneys were slim.
Mr. Xie is 52 years old and has 4 children in his family to raise, and he does not want to give up the hope of "protecting his kidneys". Hearing that the kidney tumor surgery team led by Cui Xingang, director of the Department of Urology of Xinhua Hospital, had a lot of experience in kidney protection treatment, Mr. Xie came to Cui Xingang's outpatient clinic with the mentality of trying it out. After asking a detailed medical history, carefully reading the imaging film and carefully considering, Cui Xingang told Mr. Xie, "This kidney can be protected." ”
However, Mr. Xie's case is indeed very rare, gathering three high-risk difficulties in kidney protection surgery, and the difficulty of surgery can be described as a "ceiling". Cui Xingang introduced, the first major difficulty is the tumor is larger, in general, the diameter of more than 4 cm kidney tumors, the difficulty of surgery will be doubled, Mr. Xie's tumor diameter has been close to 6 cm, occupying more than half of the space in the entire kidney; the second major difficulty is the tumor position is deep, in the most complex kidney core area, equivalent to the position of the "apple core", from the outside can not be seen at all, and completely inward growth, surrounded by dense blood vessels, but also close to the renal pelvis, once the blood vessels are damaged during surgery, there is a risk of major bleeding, Life-threatening safety; the third difficulty is cystic tumors, which are much higher than solid tumors, cystic tumors are equivalent to large and small blisters gathered together, such as the implementation of surgery, need to be as careful as treating a "raw egg", can not break the shell, otherwise the fluid wrapped in the inner capsule of the tumor will flow into the abdominal cavity, which will lead to the wide spread of tumors in the abdominal cavity, and the consequences are unimaginable.
40 minutes of thrilling "Kidney Defense Battle"
This "kidney defense war" of "fighting a hand" was launched.
Without fighting the battle of no preparation, before the operation, Cui Xingang's team accurately assessed the relationship between the tumor and the left renal artery and vein and the renal pelvis through "intelligent three-dimensional full quantification IQQA three-dimensional reconstruction", calculated the degree to which renal function can be retained, and made adequate plans for surgery.
The surgical process is the most skilled, careful and precise moment. The location of the incision is extremely exquisite, the requirements are just right, both to cut in place, but also to reserve a place for the suture; the stripping of blood vessels is like walking a tightrope, and there is no room for error; the removal of tumors requires extreme precision, more than one point is not cut, one point is not left, and it cannot break the capsule membrane like ultra-thin paper; the time for kidney preservation surgery is the key, under the requirements of careful and precise operation, it is also necessary to race against the clock, and can not let the kidney ischemia time be too long...
"Da Vinci surgical robot" plus "original technology" is the basis for Cui Xingang's team to intervene and challenge the "limit of kidney protection". During the operation, Cui Xingang gave full play to the flexibility and precision of the da Vinci surgical robot, quickly found the tumor, and through the intraoperative ultrasound to show the boundary between the tumor and the left renal arteriovenous vein and the renal pelvis, using the original operation concept of "open skylight, blunt free, open bottom, fine suture, early opening", close to the tumor envelope, pull the cocoon, and carefully and skillfully remove the cystic tumor completely. The excised tumor envelope is intact, completely avoiding the risk of tumor spread. Then, Cui Xingang used the original "early sequential open blood flow technology" to quickly complete the wound suture, minimizing the time of renal ischemia.
In general, kidney preservation surgery needs to be controlled within 30 minutes to ensure kidney activity. Mr. Xie's surgery is extremely complex and thrilling, requiring double caution, time consumption is also large, experts do their best to shorten the operation time, the operation also gives the kidneys ice water local cooling, while operating, while repairing, as far as possible to protect kidney function.
The 40-minute kidney protection surgery was successfully completed, the tumor was removed cleanly, and according to experience, Mr. Xie's kidney function was preserved by nearly 50%. At present, he is recovering well, without bleeding, and there are no adverse reactions such as urinary leakage.
Robotic Surgery Raises "Kidney Protection Limit"
It is often believed that if you suffer from a malignant tumor, you should "cut the grass and remove the roots", even if the tumor is small, you should also remove the entire organ. However, according to the research data of the past 20 years, the effect of simple removal of renal tumors and patients who do radical renal resection is the same in the radical treatment of tumors. Patients who retain kidneys have better long-term survival rates, which may be related to the low probability of developing chronic renal insufficiency or kidney disease in the long term.
"The need to preserve the kidneys is very great. If a kidney is removed and then the contralateral kidney has a problem, a kidney transplant should be considered. However, if you have kidney protection surgery, you can avoid such risks to a large extent. Cui Xingang admitted that on the issue of tumor metastasis or recurrence, as long as the surgery is removed cleanly, the probability of kidney preservation surgery and kidney resection surgery in tumor recurrence and metastasis is the same. However, the kidney structure of each person is not exactly the same, the specific conditions of the tumor are also very different, and the technical requirements of kidney preservation surgery for doctors are very high. In recent years, robotic surgery has increased the "upper limit of kidney protection", which has greatly improved the success rate of surgery.
"Da Vinci surgical robots can enlarge the surgical area by a factor of 10 to 15, improving the certainty and safety of surgery. The robot can replace the human hand and rotate flexibly in 360 degrees in the abdominal cavity, which also greatly improves the stability and accuracy of the operation. Cui Xingang introduced that as of early January this year, the urology team of Xinhua Hospital has applied the da Vinci robotic surgical system to perform urological surgery for more than 200 patients. Among them, there are more than 90 kidney protection surgeries for kidney tumors, and more than a quarter of them are difficult kidney protection surgeries. It is reported that Shanghai Medical Insurance has officially included robot-assisted laparoscopic partial renal resection and radical prostate cancer resection into the scope of payment in April last year, and policy support is more conducive to patients enjoying the benefits brought by the latest medical technology.
"Hematuria, lumps, low back pain, this is a triple of kidney cancer, but when these symptoms appear, it is not too early." Cui Xingang reminded the public that they should pay attention to the early screening of kidney cancer, maintain a healthy lifestyle, do not stay up late, eat lightly, quit smoking and limit alcohol, which is the key to protecting kidney health.
Column Editor-in-Chief: Gu Yong Text Editor: Huang Yangzi
Source: Author: Huang Yangzi