Chan D, Bishoff J T, Ratner L, Kavoussi L R, Jarrett T W
Department of Urology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
J Urol. 2000 Aug;164(2):319-21.
Controlled ligation and division of the renal hilum are critical steps during any nephrectomy procedure. The use of the endovascular gastrointestinal anastomosis (GIA) stapling device for control of the renal vessels during laparoscopic nephrectomy has become standard practice. However, malfunction can lead to serious consequences which require emergency conversion to an open procedure. We report our experience with GIA malfunction during laparoscopic nephrectomy.
From July 1993 to September 1999, 565 patients underwent laparoscopic nephrectomy at 2 institutions for benign and malignant diseases, and for live renal donation. Retrospective chart reviews and primary surgeon interviews were conducted to determine etiology of failure, intraoperative management and possible future prevention.
Malfunction occurred in 10 cases (1.7%). In 8 cases the renal vein was involved and malfunctions affected the renal artery in 2. The estimated blood loss ranged from 200 to 1,200 cc. Open conversions were necessary in 2 cases (20%). The etiology of the failure included primary instrument failure in 3 cases and preventable causes in 7. Open surgery was required in 2 patients and laparoscopic management was possible in 8.
The endovascular GIA stapler is useful in performing laparoscopic nephrectomy. However, malfunctions may occur, and can be associated with significant blood loss and subsequent need for conversion to an open procedure. The majority of errors could be avoided with careful application and recognition. Many failures, especially when recognized before release of the device, can be managed without conversion to an open procedure.
在任何肾切除术过程中，对肾门进行控制性结扎和离断都是关键步骤。在腹腔镜肾切除术中使用血管腔内胃肠吻合（GIA）吻合器控制肾血管已成为标准操作。然而，器械故障可能导致严重后果，需要紧急转为开放手术。我们报告了我们在腹腔镜肾切除术中处理GIA故障的经验。
1993年7月至1999年9月，两所机构的565例患者因良性和恶性疾病以及活体肾捐赠接受了腹腔镜肾切除术。通过回顾病历和对主刀医生进行访谈，以确定故障原因、术中处理方法以及未来可能的预防措施。
10例（1.7%）出现故障。其中8例累及肾静脉，2例影响肾动脉。估计失血量在200至1200毫升之间。2例（20%）需要转为开放手术。故障原因包括原发性器械故障3例，可预防原因7例。2例患者需要进行开放手术，8例可以通过腹腔镜处理。
血管腔内GIA吻合器在腹腔镜肾切除术中很有用。然而，可能会出现故障，并可能导致大量失血以及随后需要转为开放手术。通过仔细操作和识别，大多数错误是可以避免的。许多故障，尤其是在器械释放前被识别出来的，无需转为开放手术即可处理。
