Objective: Nephroureterectomy (NU) is a challenging multi-quadrant surgical procedure that involves intra–infra- and retroperitoneal dissection. The introduction of the da Vinci Xi platform has further improved the minimally invasive approach. With the Xi robotic system, single docking for multi-quadrant dissection is now feasible and increasingly popular. Herein, we redefined the surgical technique by optimizing minimal port usage, maximizing template visualization, and utilizing the Xi platform’s retargeting system, based on our experience with 15 patients. Methods: This single-center cohort study was based on the experience of a single surgeon with 15 patients who underwent robotic radical nephroureterectomy (RRNU) between 2019 and 2024, performed via the one docking, three-port technique. Patient data were retrospectively collected and analyzed from the medical records. Results: The cohort’s median age was 79 years, with male predominance of 80%. The median operative time was 133 min, with 60% of procedures completed within 150 min; longer times (>150 min) were due to additional intraoperative non-robotic procedures. Median blood loss was 100 mL, with two patients requiring intraoperative blood transfusion. Lymph node dissection (LND) in six patients did not significantly affect the overall operative time. The intraoperative and major postoperative complication rates (Clavien-Dindo grade > III) were 13.3%. Conclusions: The use of three robotic ports combined with the Xi platform’s camera-hop feature is a safe and effective technique for multi-quadrant, minimally invasive procedures, particularly in RRNU. This approach facilitates procedural goals and reduces overall operative time.
目的：肾输尿管切除术（NU）是一种涉及腹腔内、腹腔下及腹膜后多象限解剖的复杂手术。达芬奇Xi平台的引入进一步优化了微创手术路径。借助Xi机器人系统，单次对接完成多象限解剖已成为可行且日益普及的技术。基于我们对15例患者的操作经验，本研究通过优化最小端口使用、最大化术野显露以及应用Xi平台的重定位系统，重新定义了该手术技术。方法：本单中心队列研究基于2019年至2024年间由同一位外科医师采用单次对接三孔技术完成的15例机器人辅助根治性肾输尿管切除术（RRNU）的临床经验。通过回顾性收集并分析病历资料获取患者数据。结果：队列中位年龄79岁，男性占80%。中位手术时间133分钟，60%手术在150分钟内完成；手术时间延长（>150分钟）主要因术中需联合非机器人辅助操作。中位失血量100毫升，2例患者需术中输血。6例患者行淋巴结清扫术（LND）未显著影响总手术时间。术中及主要术后并发症（Clavien-Dindo分级>III级）发生率为13.3%。结论：采用三个机器人端口结合Xi平台的镜头跳转功能，是实现多象限微创手术（特别是RRNU）安全有效的技术方案。该术式有助于实现手术目标并缩短总体手术时间。
肿瘤(癌症)患者之家