8 years old, 0 kg, 0 cm tumor, 0 cm fat layer...... This is the real data of a patient, and it is also the one that the Department of Urology of the Second People's Hospital of Wuxi (Affiliated Central Hospital of Jiangnan University) has never seen such an obese surgical patient.

The young guy was diagnosed with a kidney tumor

Mr. Kong, who is 8 years old, weighs 0 pounds, has a body mass index (BMI) of nearly 0, and has underlying diseases such as hypertension, fatty liver disease, and metabolic diseases. At the end of last year, he went to the hospital for a check-up with hematuria and found a large mass in his left kidney. The local hospital has a high suspicion of malignancy and requires surgical removal to stop the tumor from growing further. However, his weight is high, the tumor is large, the location is deep, the thickness of the abdominal wall fat is more than 0 cm, the field of vision of traditional laparoscopic surgery is difficult to expose, and the space is limited.

Open surgery is more invasive and requires an incision of twenty or thirty centimeters in the patient's abdomen before removing the kidney tumor. Even because his left kidney is almost entirely occupied by the tumor, it is likely that the entire left kidney will have to be removed when the tumor is removed. Such a large trauma will also bring challenges to postoperative recovery, and after traveling to many hospitals, patients come to the Department of Urology of Wuxi Second Hospital.

Surgical Condition "Three Supers" Difficult

Professor Feng Ninghan's team at the hospital admitted the patient to the hospital, and after completing the examination, a multidisciplinary preoperative discussion was carried out. Everyone agrees that kidney cancer surgery for obese patients is the "hard bone" of urology, and the surgical risk of this patient is greater. First of all, there is the patient's overweight. A weight of 3 kg means that the patient's intra-abdominal fat accumulates, which severely squeezes the surgical space. Secondly, very large tumors. The patient's tumor was 0 cm long, occupying 0/0 of the volume of the left kidney, and the difficulty of laparoscopic resection was further increased. Finally, ultra-high risk. The tumor compresses the surrounding tissues and is more closely related to other organs and organs, making it more difficult to isolate the tumor during surgery, and the slightest carelessness may damage the surrounding blood vessels or organs, and even cause massive bleeding.

Robot-assisted precision "bomb disposal"

After repeated discussions, Professor Feng Ninghan's team formulated a detailed surgical plan and a strict emergency plan for the patient, and decided to implement robot-assisted laparoscopic radical renal cancer resection. Compared with the traditional laparoscope, the robotic system has a 3-degree rotating robotic arm and a 0D high-definition field of view with 0x magnification, which can achieve more accurate anatomical work in a small space, especially suitable for deep anatomical work of obese patients. During the operation, the Department of Anesthesiology and Pain Medicine assisted in robotic surgery using the anesthesia method of "lung-protective ventilation strategy". Professor Feng Ninghan uses the robot's flexible arm to avoid important organs such as the intestinal tube and pancreas, and accurately separates the renal arteriovenous and ureter, ureter and surrounding adhesion tissues from the adipose tissue, and gradually dissociates and completely resects the affected kidney and tumor.

The operation lasted 50 hours and was successfully completed, only four small holes of less than one centimeter were made in the patient's abdomen, the amount of bleeding was less than 0 ml, and the postoperative pathological diagnosis was kidney cancer with negative margins.

Correspondent: Yang Huiling, Yangtze Evening News/Purple Cow News Reporter Ji Nana