Tanaka M, Tokuda N, Koga H, Yokomizo A, Sakamoto N, Naito S
Department of Urology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Urol. 2000 Aug;164(2):314-8.
We report our initial experience with a hand assisted laparoscopic radical nephrectomy for patients with renal carcinoma, and compare our results to those of conventional open radical nephrectomy.
The clinical data on 6 consecutive patients who underwent hand assisted laparoscopic radical nephrectomy for stage T1N0M0 renal cell carcinoma were reviewed. We performed hand assisted laparoscopic surgery using the new LAP DISC* abdominal wall sealing device. We compared the results of this procedure with those of conventional open radical nephrectomy in 12 patients with stage T1N0M0 renal cell carcinoma.
The hand assisted laparoscopic radical nephrectomy for renal carcinoma was successfully performed without any major or minor complications in all 6 patients. Mean operation time for the laparoscopic group was significantly longer than that for the open surgery group (303 minutes versus 224 minutes, p = 0.0042). However, no significant difference was observed in mean estimated blood loss for the 2 groups (264 ml. in the laparoscopic group versus 341 ml. in the open surgery group). The frequency of parenteral analgesia postoperatively in the laparoscopic group was significantly lower than that in the open surgery group (16.7% versus 75.0%, p = 0.043). In addition, the laparoscopic group seemed to recover more rapidly than the open surgery group. The abdominal wall sealing device was easy to attach to the abdominal wall, and allowed rapid hand removal and reinsertion.
Our preliminary results indicate that a hand assisted laparoscopic radical nephrectomy with the abdominal wall sealing device is an effective and safe surgical procedure, and is less invasive than open radical nephrectomy.
我们报告对肾癌患者行手辅助腹腔镜根治性肾切除术的初步经验，并将我们的结果与传统开放性根治性肾切除术的结果进行比较。
回顾了连续6例接受手辅助腹腔镜根治性肾切除术治疗T1N0M0期肾细胞癌患者的临床资料。我们使用新型LAP DISC*腹壁封闭装置进行手辅助腹腔镜手术。我们将该手术的结果与12例T1N0M0期肾细胞癌患者的传统开放性根治性肾切除术的结果进行了比较。
所有6例患者均成功进行了手辅助腹腔镜根治性肾切除术，无任何大小并发症。腹腔镜组的平均手术时间明显长于开放手术组（303分钟对224分钟，p = 0.0042）。然而，两组的平均估计失血量无显著差异（腹腔镜组为264 ml，开放手术组为341 ml）。腹腔镜组术后胃肠外镇痛的频率明显低于开放手术组（16.7%对75.0%，p = 0.043）。此外，腹腔镜组似乎比开放手术组恢复得更快。腹壁封闭装置易于附着在腹壁上，并允许快速手的移除和重新插入。
我们的初步结果表明，使用腹壁封闭装置的手辅助腹腔镜根治性肾切除术是一种有效且安全的手术方法，并且比开放性根治性肾切除术的侵入性更小。
