Meraney A M, Gill I S, Kaouk J H, Skacel M, Sung G T
Section of Minimally Invasive Surgery, Urological Institute, and the Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Ohio 44195, USA.
J Endourol. 2001 Mar;15(2):143-9. doi: 10.1089/089277901750134403.
Renal autotransplantation is an extensive open surgical operation consisting of two distinct procedures, live-donor nephrectomy and autotransplantation, and requiring two large skin incisions. Herein, we analyze the feasibility of performing the entire procedure laparoscopically.
Renal autotransplantation was performed entirely laparoscopically in six female farm pigs. Following a left donor nephrectomy, intracorporeal renal hypothermia was achieved by intra-arterial perfusion of ice-cold solution through a 4F balloon catheter. During autotransplantation, the renal vessels were anastomosed intracorporeally to the previously prepared ipsilateral common iliac vessels in an end-to-side fashion. Laparoscopic freehand suturing (5-0 Prolene) and knot-tying techniques were employed exclusively. A staged contralateral native nephrectomy was performed in five animals. Postoperative follow-up included serial creatinine measurements, intravenous urography, aortography, and renal histologic examination.
The mean operating time was 6.2 hours (range 5.3-7.9 hours), the venous anastomosis time was 33 minutes (range 22-46 minutes), the arterial anastomosis time was 31 minutes (range 27-35 minutes), and the total iliac clamping time was 77 minutes (range 62-88 minutes). The total renal ischemia time was 68.7 minutes: warm ischemia 5.1 minutes, cold ischemia 33 minutes and rewarming 31 minutes. Serum creatinine concentrations remained stable: baseline 1.3 mg/dL, after autotransplantation 1.1 mg/dL, and after contralateral nephrectomy 1.6 mg/dL. Intravenous urography and aortography prior to euthanasia (N = 5) demonstrated prompt contrast uptake and excretion by the autotransplanted kidneys and patent arterial anastomoses, respectively. Histopathologic examination of the autograft demonstrated normal renal architecture.
Renal autotransplantation can be performed utilizing laparoscopic techniques exclusively. This study may form the basis for performance of complex urologic vascular procedures laparoscopically.
肾自体移植是一种广泛开展的开放性外科手术，由两个不同的步骤组成，即活体供肾切除术和自体移植术，需要两个较大的皮肤切口。在此，我们分析了腹腔镜下完成整个手术过程的可行性。
对6只雌性农场猪完全采用腹腔镜进行肾自体移植。在左侧供肾切除术后，通过4F球囊导管经动脉灌注冰冷溶液实现体内肾低温。在自体移植过程中，将肾血管在体内以端侧方式吻合至先前准备好的同侧髂总血管。仅采用腹腔镜徒手缝合（5-0普理灵缝线）和打结技术。对5只动物进行了分期对侧自体肾切除术。术后随访包括连续测定肌酐、静脉肾盂造影、主动脉造影和肾脏组织学检查。
平均手术时间为6.2小时（范围5.3 - 7.9小时），静脉吻合时间为33分钟（范围22 - 46分钟），动脉吻合时间为31分钟（范围27 - 35分钟），总髂血管阻断时间为77分钟（范围62 - 88分钟）。总的肾缺血时间为68.7分钟：热缺血5.1分钟，冷缺血33分钟，复温31分钟。血清肌酐浓度保持稳定：基线为1.3mg/dL，自体移植后为1.1mg/dL，对侧肾切除术后为1.6mg/dL。安乐死之前（n = 5）的静脉肾盂造影和主动脉造影分别显示自体移植肾造影剂摄取迅速且排泄正常，动脉吻合口通畅。自体移植肾的组织病理学检查显示肾脏结构正常。
肾自体移植可以完全利用腹腔镜技术进行。本研究可为腹腔镜下复杂泌尿外科血管手术的开展奠定基础。
