Beijing United Family Hospital successfully applies robotic surgery in new indication

BEIJING,Nov. 1,2018 -- On September 12,2018,Prof. Zhu Gang and his urology team in Beijing United Family Hospital performed a robot-assisted retroperitoneal lymph node dissection (RPLND) following testicular cancer chemotherapy + inferior vena cava tumor thrombectomy (IVCTT) + vena cava reconstruction for a young American patient.This was the world's first such case reported. This patient suffered from testicular cancer that had metastasized to the retroperitoneal lymph nodes and a tumor thrombus that had formed after the tumor had invaded the inferior vena cava.

In patients with testicular cancer,a tumor thrombus is normally removed by an incision of the inferior vena cava. Risks associated with such operations include massive hemorrhage,pulmonary embolism caused by tumor thrombusdislodgement,and the need to reconstruct the vena cava. Moreover,as in this case,wherethe thrombus was lying across the bilateral renal veins,it might be necessary to remove the right kidney,a risky procedure with a mortality rate between 5% and 10%. Such procedures have long been considered extremely risky in surgery and are known as "no-go zones."

Before the operation,the team made a full preparation,and MDT (multi-disciplinary team) discussions were organized five times,including anesthesiology,oncology,pathology,ultrasound,the intensive care unit,and the operating room nurses. The urological team decided on the da Vinci surgical robot as the platform to perform thesurgical operation,consisting of a regimen of testicular cancer followed by an RPLND + IVCTT + a vena cava reconstruction. There were as many as twenty major steps to be completed before the surgery could commence.

The operation took more than 9 hours and was successful. 3D image reconstruction technology,which presents the 3D image through computer graphic processing and analysis combined with virtual reality (VR) based on early CT or MRI images,was used to identify the location of tumor thrombus. The combination of preoperative 3D image reconstruction and the daVincirobot-assistedsurgicalsystem improved the level of precision needed for the surgery,while reducing the likelihood of operation-related complications and the time needed to complete the procedure,as well as enhancing safety.

Following the operation,the patient was quickly transferred from the intensive care unit to the general ward. He was discharged 7 days after surgery.