A study on perioperative nursing care of a case of Da Vinci robot-assisted laparoscopic autologous kidney transplantation for renovascular hypertension
1例达芬奇机器人辅助腹腔镜自体肾移植术治疗肾血管性高血压的围术期护理研究

摘要

目的 总结分析应用达芬奇机器人辅助技术完成自体肾移植以治疗肾血管性高血压过程中的专项手术配合经验与护理管理路径，为优化此类复杂术式的临床护理方案提供依据。方法 对1例患顽固性高血压、经检查确诊为双侧肾动脉中重度狭窄的青年男性病例进行回顾性梳理。患者于全麻状态下取左侧45°斜卧位，先经由达芬奇系统实施腹腔镜肾脏切取，继而进行离体肾脏的低温灌注液（0-4℃）保护及修整，最终完成同侧髂窝的异位自体移植。护理干预核心包括：术前心理干预与访视；达芬奇专用器械及显微血管耗材的高规格预备；术中变更体位时压伤防范；离体脏器低温维护；血管吻合阶段的精细配合；以及全程体温维持管理。结果 该例手术总耗时约9小时，实际失血量控制在200mL以内。术后监测显示患者肾功能指标处于正常范围，血压逐步趋于稳定，尿量及尿色均正常。围术期未出现压疮、低体温、感染或其余不良并发症。患者术后1周左右状态良好，总计住院19天后康复离院。结论 达芬奇机器人参与的自体肾移植结合了微创与显微外科特性，耗时长且协作要求高。护理团队除需夯实解剖基础与跨科室协作能力外，通过周密的术前规划、熟练的机器人系统协助、严苛的离体肾低温管理以及细致的生命体征监护，能显著降低操作风险，确保护理质量，助力患者术后快速康复。

Abstract

Objective To summarize and analyze the experience and nursing management pathways of specialized surgical cooperation in the process of autologous kidney transplantation for the treatment of renovascular hypertension using Da Vinci robot-assisted technology, providing a basis for optimizing the clinical nursing plan for such complex procedures.
Methods A retrospective review was conducted on a young male patient with refractory hypertension who was diagnosed with moderate to severe bilateral renal artery stenosis. Under general anesthesia, the patient was placed in a left 45° oblique position. Laparoscopic kidney harvesting was performed using the Da Vinci system, followed by protection and trimming of the excised kidney with a low-temperature perfusion solution (0-4℃). Finally, ectopic autologous transplantation to the ipsilateral iliac fossa was completed. The core nursing interventions included: preoperative psychological intervention and visit; high-standard preparation of da Vinci-specific instruments and microvascular consumables; prevention of pressure injuries during intraoperative repositioning; hypothermia maintenance of excised organs; meticulous coordination during vascular anastomosis; and continuous temperature management.
Results The total surgery time was approximately 9 hours, with actual blood loss controlled within 200ml. Postoperative monitoring showed that the patient’s renal function indicators were within the normal range, blood pressure gradually stabilized, and urine output and color were normal. No pressure sores, hypothermia, infection, or other adverse complications occurred during the perioperative period. The patient was in good condition for about one week postoperatively and was discharged after a total hospital stay of 19 days.
Conclusion   Da Vinci robotic autologous kidney transplantation combines minimally invasive and microsurgical characteristics, is time-consuming, and requires a high degree of collaboration. In addition to a solid foundation in anatomy and interdisciplinary collaboration, the nursing team can significantly reduce operational risks, ensure nursing quality, and facilitate rapid postoperative recovery through meticulous preoperative planning, skilled robotic system assistance, rigorous hypothermia management of the excised kidney, and meticulous vital sign monitoring.