Yang S C, Ko W J, Byun Y J, Rha K H
Department of Urology, College of Medicine, Yonsei University, Seoul, Korea.
J Urol. 2001 Apr;165(4):1099-102.
Retroperitoneoscopy assisted live donor nephrectomy has become standard based on our experience with 103 consecutive cases operated on between January 1993 and May 2000. We describe the advantages of retroperitoneoscopy assisted compared to laparoscopic live donor nephrectomy.
After performing more than 1,200 cases of open live donor nephrectomy (S. C. Y.), we combined our experience with open and laparoscopic surgery to develop a specific technique of minilaparotomy live donor nephrectomy. Operations were performed by 1 senior surgeon and 1 assistant, with the help of specially designed piercing abdominal and peritoneal retractors. A 5 to 7 cm. transverse pararectal skin incision is made at the level of 10th rib and the abdominal muscles are split without division. A 10 mm. port is placed at the lower abdomen to allow for the telescope. The procedure is performed extraperitoneally, combining open and laparoscopic instruments under direct vision. Renal pedicles and ureters are ligated using laparoscopic clips and sutures. The kidney is removed via laparotomy and the wound is closed.
Average operating time for the 103 live donor nephrectomies was 130 minutes (range 85 to 210), and there was no case of kidney loss, open surgical conversion or blood transfusion. Mean warm ischemia time was 2.3 +/- 1.2 minutes and average incision length was 6.5 cm. (range 5.1 to 7.0). Postoperative pain was minimal and analgesics were generally not required by postoperative day 2. Patients were fully ambulatory a mean 1.5 days (range 1 to 3.5) postoperatively.
Retroperitoneoscopy assisted live donor nephrectomy is not only feasible, but reproducible. Any surgeon with previous experience with conventional open live donor nephrectomy can perform this hybrid, minimally invasive procedure.
基于我们在1993年1月至2000年5月间连续开展的103例手术的经验，后腹腔镜辅助活体供肾切除术已成为标准术式。我们描述了后腹腔镜辅助与腹腔镜活体供肾切除术相比的优势。
在完成1200多例开放性活体供肾切除术（S.C.Y.）后，我们结合开放性手术和腹腔镜手术的经验，开发了一种小切口腹腔镜活体供肾切除术的特定技术。手术由1名资深外科医生和1名助手进行，借助专门设计的穿刺腹部和腹膜牵开器。在第10肋水平做一个5至7厘米的经直肠旁横切口，不切断腹直肌。在下腹部放置一个10毫米的端口以容纳腹腔镜。该手术在腹膜外进行，在直视下结合开放和腹腔镜器械。使用腹腔镜夹和缝线结扎肾蒂和输尿管。通过剖腹术取出肾脏并关闭伤口。
103例活体供肾切除术的平均手术时间为130分钟（范围85至210分钟），无肾脏丢失、转为开放手术或输血病例。平均热缺血时间为2.3±1.2分钟，平均切口长度为6.5厘米（范围5.1至7.0厘米）。术后疼痛轻微，术后第2天一般不需要镇痛药。患者术后平均1.5天（范围1至3.5天）即可完全活动。
后腹腔镜辅助活体供肾切除术不仅可行，而且可重复。任何有传统开放性活体供肾切除术经验的外科医生都可以进行这种混合的微创手术。
