▲ Ren Shancheng, director of the Department of Urology at Shanghai Changzheng Hospital, performed robotic surgery.
“The tumor with a diameter of 20 cm filled the right kidney.” The doctor’s diagnosis was undoubtedly a bolt from the blue for the 65-year-old Mr. Feng. What’s more unfortunate is that Uncle Feng’s kidney cancer was complicated by tumor thrombus in the inferior vena cava, and the emboli could fall off at any time.
A few days ago, the team of Professor Ren Shancheng from the Department of Urology of Shanghai Changzheng Hospital, with the help of robotic technology, solved the big problem of Uncle Feng – comprehensively “mine-sweeping” multiple huge kidney cancer and tumor thrombus, and successfully “removed” hidden in the body “time bomb”.
Behind the “hematuria”, the right kidney is full of tumors
On weekdays, Mr. Feng pays great attention to maintenance, and his body is still in good condition. It’s tough. 5 years ago, I had hematuria several times, and there was no discomfort. I just thought that the inflammation had healed itself after a period of time, so I didn’t take it to heart. Unexpectedly, half a year ago, Uncle Feng had hematuria again, and the symptoms appeared repeatedly, accompanied by a progressive trend of aggravation.
Recently, Uncle Feng had difficulty urinating and unbearable abdominal distension. He was sent to the emergency department of Changzheng Hospital, where a large amount of blood was drawn out after indwelling catheterization. Enhanced CT showed that Uncle Feng had multiple tumors in his right kidney, involving perirenal fat, and tumor thrombus in the right renal vein and inferior vena cava. In an instant, the sky fell.
Wang Junkai, a professor of urology, introduced that renal cancer is one of the most common malignant tumors in urology. Uncle Feng’s right kidney is covered with tumors, about 20 cm in diameter, and the tumor cells run along the path. The renal blood vessels have spread and have eroded into the inferior vena cava to form tumor thrombus.
“Although it sounds scary, many patients have achieved clinical cure through active surgical strategies. As long as there is no contraindication to surgery, surgical treatment should be actively performed.” Hearing Wang Junkai’s words, the family calmed down a little Down, decided to face this sudden life challenge.
Multidisciplinary consultation to challenge “Mount Everest in kidney cancer surgery”
Kidney cancer with inferior vena cava tumor thrombus , is the most challenging operation in the field of renal tumor, with the characteristics of high surgical risk, high technical difficulty, and high perioperative mortality rate. It is called “the Mount Everest in renal cancer surgery”.
“The tumor involving the perirenal fat means that the cancer has broken through the most important line of defense of the perirenal fascia, and the tumor is accompanied by tumor thrombus in the renal vein and inferior vena cava, which means that the cancer has broken through the most important defense line of the perirenal fascia. The cells have diffused from the primary organs to the bloodstream piping system, especially the inferior vena cava, the ‘primary trunk’ where systemic venous blood returns to the right atrium,” explained Ren Shancheng, director of the Department of Urology.
In order to ensure that Uncle Feng’s surgery is foolproof, Professor Ren Shancheng organized the Department of Anesthesiology, Emergency and Critical Care Medicine, Interventional Department, Radiological Diagnosis Department, Cardiovascular Surgery, Hepatobiliary Surgery, Vascular Surgery, Respiratory and Critical Care Medicine Department , blood transfusion and other nine related departments for consultation.
The preoperative discussion should be more detailed, and the preoperative preparation should be more adequate… For the medical and nursing team, this operation is undoubtedly a “big test”.
Due to the high precision of surgery, the surgical team decided to use robotic surgery. Compared with ordinary laparoscopic surgery, Da Vinci robotic surgery has the advantages of more precision, less trauma, and less intraoperative bleeding. .
Robot surgery to remove the “time bomb”
On June 15, a difficult operation was carried out as scheduled. Ren Shancheng used the robot’s unique pair of 360-degree freely moving arms and a pair of high-definition magnifying glass-like eyes to accurately free the inferior vena cava and right renal vein. The main artery and an accessory renal artery, at this time, the “supply” of the entire huge right renal tumor was cut off.
Afterwards, the surgical team pre-blocked the distal end of the inferior vena cava, the beginning of the left renal vein, and the proximal end of the inferior vena cava, and the three sides were surrounded by a vicious “cancer thrombus”. Has become a trapped beast in a cage. After fully dissociating the kidney, tumor, and blood vessels, the vena cava and left renal vein were blocked, and the tumor thrombus that filled the right renal vein and the trunk of the vena cava was successfully removed. The right kidney and tumor were completely resected.
The operation lasted more than 3 hours. The process of “going straight to the cancer nest” was like a dangerous “mine clearing operation”. Difficulties or dangers appeared time and time again as expected or unexpected. The established goals were achieved, and no surgical complications such as emboli shedding, pulmonary embolism, massive hemorrhage, and shock predicted before surgery occurred.
After the operation, the patient was transferred to the ward smoothly. The next day, the patient’s bowels resumed ventilation, and he began to perform functional exercises on the bed. On the 5th day after the operation, the patient’s drainage tube, urinary catheter, and indwelling needle, etc. All the pipeline channels are pulled out, and you can walk in the ward. At present, Uncle Feng has recovered and been discharged from the hospital.
Although the operation was very successful, Ren Shancheng still felt a little pity. He reminded the public that regular physical examinations are of great significance for the early detection of kidney cancer. .
Author: Li Chenyan Wang Genhua
Editor: Li Chenyan< /p>
Responsible editor: Fan Liping
Photo source: Courtesy photo
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