Gill I S, Uzzo R G, Hobart M G, Streem S B, Goldfarb D A, Noble M J
Sections of Laparoscopic and Minimally Invasive Surgery, and Transplantation, Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2000 Nov;164(5):1500-4.
We report the technique of and initial experience with retroperitoneal laparoscopic live donor right nephrectomy for purposes of renal allotransplantation and autotransplantation.
A total of 5 patients underwent retroperitoneoscopic live donor nephrectomy of the right kidney for autotransplantation in 4 and living related renal donation in 1. Indications for autotransplantation included a large proximal ureteral tumor, a long distal ureteral stricture and 2 cases of the loin pain hematuria syndrome. In all cases a 3-port retroperitoneal laparoscopic approach and a pelvic muscle splitting Gibson incision for kidney extraction were used. In patients undergoing autotransplantation the same incision was used for subsequent transplantation.
All procedures were successfully accomplished without technical or surgical complications. Total mean operating time was 5.8 hours and average laparoscopic donor nephrectomy time was 3.1 hours. Mean renal warm ischemia time, including endoscopic cross clamping of the renal artery to ex vivo cold perfusion, was 4 minutes. Average blood loss for the entire procedure was 400 cc. Radionuclide scan on postoperative day 1 confirmed good blood flow and function in all transplanted kidneys. Mean analgesic requirement was 58 mg. fentanyl. Mean hospital stay was 4 days (range 2 to 8), and convalescence was completed in 3 to 4 weeks.
In the occasional patient requiring renal autotransplantation live donor nephrectomy can be performed laparoscopically with renal extraction and subsequent transplantation through a single standard extraperitoneal Gibson incision, thus, minimizing the overall operative morbidity. Furthermore, these data demonstrate that live donor nephrectomy of the right kidney can be performed safely using a retroperitoneal approach with an adequate length of the right renal vein obtained for allotransplantation or autotransplantation.
我们报告用于肾同种异体移植和自体移植的腹膜后腹腔镜活体供体右肾切除术的技术及初步经验。
共有5例患者接受了腹膜后腹腔镜右肾切除术，其中4例用于自体移植，1例用于活体亲属肾移植。自体移植的适应证包括近端输尿管大肿瘤、远端输尿管长段狭窄以及2例腰痛血尿综合征。所有病例均采用三孔腹膜后腹腔镜入路及经盆腔肌肉劈开的吉布森切口取出肾脏。接受自体移植的患者，后续移植也采用相同切口。
所有手术均成功完成，无技术或手术并发症。总平均手术时间为5.8小时，平均腹腔镜供肾切除时间为3.1小时。平均肾热缺血时间（包括肾动脉内镜下夹闭至体外冷灌注）为4分钟。整个手术过程平均失血量为400cc。术后第1天的放射性核素扫描证实所有移植肾血流和功能良好。平均镇痛药物需求量为58mg芬太尼。平均住院时间为4天（范围2至8天），3至4周康复。
对于偶尔需要进行肾自体移植的患者，可通过腹腔镜进行活体供肾切除术，并通过单一标准的腹膜外吉布森切口取出肾脏并进行后续移植，从而将总体手术发病率降至最低。此外，这些数据表明，采用腹膜后入路可安全地进行右肾活体供肾切除术，为同种异体移植或自体移植获取足够长度的右肾静脉。
