Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector154410.17816/psaic1544Case reportsКлинические случаиResearch ArticleRobot-assisted transposition of aberrant lower polar renal vessels in a 14-year-old child with vasorenal hydrophnerosisРобот-ассистированное перемещение аберрантных нижнеполярных почечных сосудов у ребенка 14 лет при вазоренальном гидронефрозе在机器人辅助下重新定位一名14岁血管肾积水患儿的异常下肾血管https://orcid.org/0000-0003-2313-897X3682-0832KozlovYury A.КозловЮрий АндреевичKozlovYury A.
Russian Federation

MD, Dr. Sci. (Med.), Corresponding Member of Russian Academy of Sciences

д-р мед. наук, чл.-корр. РАН

MD, Dr. Sci. (Med.), Corresponding Member of Russian Academy of Sciences

yuriherz@hotmail.comhttps://orcid.org/0000-0001-7042-6646PoloyanSimon S.ПолоянСимон СтепановичPoloyanSimon S.
Russian Federation
simonpoloyan@ya.ruhttps://orcid.org/0000-0001-5470-7384SapukhinEduard V.СапухинЭдуард ВладимировичSapukhinEduard V.
Russian Federation

MD, Cand. Sci. (Med.)

канд. мед. наук

MD, Cand. Sci. (Med.)

sapukhin@yandex.ruhttps://orcid.org/0000-0002-1911-4468StrashinskyAlexey S.СтрашинскийАлексей СергеевичStrashinskyAleksei S.
Russian Federation
Leksus-642@yandex.ruhttps://orcid.org/0000-0001-8295-66874600-4071MakarochkinaMarina V.МакарочкинаМарина ВалериевнаMakarochkinaMarina V.
Russian Federation
m.makarochkina@gmail.comhttps://orcid.org/0000-0001-9767-0454MarchukAndrey A.МарчукАндрей АлексеевичMarchukAndrey A.
Russian Federation
simonpoloyan@ya.ruhttps://orcid.org/0000-0001-7922-7600RozhanskiiAlexander P.РожанскийАлександр ПавловичRozhanskiiAlexander P.
Russian Federation
alexanderozhanski@mail.ruhttps://orcid.org/0000-0002-9195-5480ByrgazovAnton A.БыргазовАнтон АлексеевичByrgazovAnton A.
Russian Federation
byrgazov.ant-doc38@yandex.ruhttps://orcid.org/0009-0005-1795-9386RomanovichElizaveta S.РомановичЕлизавета СергеевнаRomanovichElizaveta S.
Russian Federation
rom_94_00@mail.ruhttps://orcid.org/0000-0002-1489-50589030-1493NarkevichArtem N.НаркевичАртем НиколаевичNarkevichArtem N.
Russian Federation

MD, Dr. Sci. (Med.)

д-р мед. наук, доцент

MD, Dr. Sci. (Med.)

narkevichart@gmail.comChildren’s Regional Clinical HospitalДетская областная клиническая больницаChildren’s Regional Clinical HospitalIrkutsk State Medical Academy of Postgraduate EducationИркутская государственная медицинская академия последипломного образованияIrkutsk State Medical Academy of Postgraduate EducationIrkutsk State Medical UniversityИркутский государственный медицинский университетIrkutsk State Medical UniversitySouth Ural State Medical UniversityЮжно-Уральский государственный медицинский университетSouth Ural State Medical UniversityV.F. Voyno-Yasenetsky Krasnoyarsk State Medical UniversityКрасноярский государственный медицинский университет им. проф. В.Ф. Войно-ЯсенецкогоV.F. Voyno-Yasenetsky Krasnoyarsk State Medical University18122023201220231345655751710202319112023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-ВекторCopyright ©; 2023,2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1544

This study presents a patient with pyeloureteral segment obstruction caused by aberrant inferior polar vessels using the robotic Hellström – Chapman procedure and reports its short-term results. A 14-year-old girl was admitted to Irkutsk Regional Children’s Clinical Hospital because of obstruction of the pyeloureteral junction caused by external compression by aberrant lower polar vessels. The diagnosis was established by ultrasonography and Doppler sonography and confirmed by contrasted computed tomography. Surgery was performed using the Versius surgical robot manufactured by CMR (UK). Delicate actions were used to mobilize the abnormal vessels and move them to the anterior wall of the pelvis. Then, they were “wrapped” with the anterior wall of the pelvis. Postoperative follow-up included clinical evaluation and renal ultrasound examination 1, 3, and 6 months after surgery. The operative duration was 65 min. During the robot-assisted Hellström – Chapman operation, no intraoperative complications, such as damage to the vessels supplying the kidney and neighboring organs, were noted. The patient did not require internal or external drainage of the upper urinary tract or perinephric space. The anteroposterior diameter of the pelvis decreased from 30 to 8 mm. The resistive index of the blood flow in the renal vessels decreased from 0.74 to 0.58. The Hellström – Chapman robotic procedure is a safe and effective procedure for the correction of vasorenal hydronephrosis. However, this surgery requires patient selection to ensure future treatment success.

В настоящем исследовании мы представляем описание случая лечения пациента с обструкцией пиелоуртерального сегмента, вызванной аберрантными нижнеполярными сосудами, с использованием роботизированной операции Hellström – Chapman и сообщаем о ее краткосрочных результатах. Девочка 14 лет поступила в Иркутскую областную детскую клиническую больницу по поводу обструкции пиелоуретерального соединения, вызванной внешней компрессией аберрантными нижнеполярными сосудами. Диагноз был установлен на основании ультразвукового исследования и допплерографии и подтвержден на контрастной компьютерной томографии (КТ). Хирургическое вмешательство выполняли с помощью хирургического робота Versius производства компании CMR (Великобритания). Деликатными действиями производили мобилизацию аномальных сосудов и их перемещение на переднюю стенку лоханки. Затем выполняли их «обертывание» передней стенкой лоханки. Послеоперационное наблюдение включало клиническую оценку и ультразвуковое исследование почек через 1, 3 и 6 мес. после операции. Продолжительность операции составила 65 мин. В ходе выполнения робот-ассистированной операции Hellström – Chapman не отмечалось интраоперационных осложнений в виде повреждения питающих почку сосудов и соседних органов. Пациенту не потребовалось внутреннего или наружного дренирования верхних мочевых путей, а также дренирования паранефрального пространства. Переднезадний диаметр лоханки уменьшился с 30 до 8 мм. Резистивный индекс кровотока в почечных сосудах снизился с 0,74 до 0,58. Роботизированную процедуру HellstrÖm – Chapman можно считать безопасной и эффективной операцией для коррекции вазоренального гидронефроза. Однако, эта простая операция требует селекции пациентов, чтобы гарантировать в дальнейшем успех лечения.

在本研究中，我们使用 Hellström - Chapman 机器人手术治疗了一名因下极血管异常引起的肾盂尿道段阻塞患者，并报告了短期疗效。伊尔库茨克州儿童临床医院收治了一名14岁女孩，她的肾盂输尿管交界处因受到异常下极血管的外部压迫而阻塞。诊断是根据超声波和多普勒超声波检查确定的，并经对比增强计算机断层扫描确认。手术使用英国CMR公司生产的Versius手术机器人进行。通过精细的操作将异常血管移动到骨盆前壁。然后用骨盆前壁将其"包裹"起来。术后随访包括术后 1、3 和 6 个月的临床评估和肾脏超声波检查。手术时间为65分钟。在机器人辅助 Hellström-Chapman 手术中，没有观察到对肾脏和邻近器官供血血管造成损伤的术中并发症。患者无需进行上尿路内外引流或肾盂旁引流。肾盂的前胸直径从30毫米降至8毫米。肾血管血流阻力指数从0.74降至 0.58。Hellström-Chapman机器人手术可以说是矫正血管性肾积水的一种安全有效的手术。这种相对简单的操作需要对患者进行筛选，才能保证治疗的进一步成功。

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