Wolf J S, Marcovich R, Merion R M, Konnak J W
Sections of Urology and General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
J Urol. 2000 Jun;163(6):1650-3.
The technical difficulty of standard laparoscopic live donor nephrectomy has limited its application. Hand assistance, which takes advantage of the incision necessary for organ removal, facilitates laparoscopy without significant impact on patient recovery. We prospectively compared open surgical and hand assisted laparoscopic donor nephrectomy.
Our first 10 laparoscopic live donor nephrectomies were matched with 40 open donor nephrectomies by gender, age and body mass index. Data were obtained by pain scales, SF-12 survey instruments, questionnaires and chart abstraction.
Operative time was longer for the laparoscopic approach (mean 95 versus 215 minutes). However, laparoscopic group patients had a shorter hospital stay compared to those undergoing open surgery (mean 2.9 versus 1.8 days), returned sooner to nonstrenuous activity (mean 19.0 versus 9.9 days) and reported less pain 6 weeks postoperatively (mean 2.3 versus 0.6) (p </=0.03 for all). There were no differences between groups in terms of donor complications, allograft function and ureteral complications. Mean hospital cost was 23% greater in the laparoscopic group (p = 0.005) but global cost, which accounted for estimated loss of income from work during the recovery period, was only 15% greater (p = 0.10). Mean operative time was significantly improved for our second compared to our first 5 laparoscopic group patients (177 versus 254 minutes).
Laparoscopic live donor nephrectomy appears to be a safe and effective alternative to open donor nephrectomy. Indexes of patient recovery suggest patient morbidity similar to that reported following standard laparoscopic donor nephrectomy and significantly less than after open nephrectomy. Improvement in operative time in the first 10 cases suggests that hand assistance "shortens" the learning curve, which might encourage more surgeons to offer laparoscopic live donor nephrectomy.
标准腹腔镜活体供肾切除术的技术难度限制了其应用。手辅助技术利用器官切除所需的切口，在不显著影响患者恢复的情况下促进了腹腔镜检查。我们前瞻性地比较了开放手术和手辅助腹腔镜供肾切除术。
我们的前10例腹腔镜活体供肾切除术与40例开放供肾切除术在性别、年龄和体重指数方面进行了匹配。通过疼痛量表、SF - 12调查问卷、问卷和病历摘要获取数据。
腹腔镜手术入路的手术时间较长（平均95分钟对215分钟）。然而，与接受开放手术的患者相比，腹腔镜组患者的住院时间更短（平均2.9天对1.8天），恢复非剧烈活动的时间更早（平均19.0天对9.9天），且术后6周报告的疼痛更少（平均2.3对0.6）（所有p≤0.03）。两组在供体并发症、移植肾功能和输尿管并发症方面无差异。腹腔镜组的平均住院费用高23%（p = 0.005），但包括恢复期工作收入估计损失的总体费用仅高15%（p = 0.10）。与我们的前5例腹腔镜组患者相比，我们的后5例患者的平均手术时间有显著改善（177分钟对254分钟）。
腹腔镜活体供肾切除术似乎是开放供肾切除术的一种安全有效的替代方法。患者恢复指标表明患者发病率与标准腹腔镜供肾切除术后报告的相似，且显著低于开放肾切除术后。前10例手术时间的改善表明手辅助“缩短”了学习曲线，这可能会鼓励更多外科医生提供腹腔镜活体供肾切除术。
