Berends F J, den Hoed P T, Bonjer H J, Kazemier G, van Riemsdijk I, Weimar W, IJzermans J N M
Department of General Surgery, University Hospital Dijkzigt, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Surg Endosc. 2002 Jun;16(6):893-8. doi: 10.1007/s004640090078. Epub 2002 Feb 27.
Recent developments in laparoscopic solid organ surgery suggest a possible reduction in postoperative discomfort and disability for kidney donors. Technical aspects and the influence of surgical experience in laparoscopic donor nephrectomy were evaluated.
The clinical outcome of 57 laparoscopic donor nephrectomies (LapNx) was compared with that for a historic control group of 27 open donor nephrectomies (OpenNx).
Three conversions to open nephrectomy (5.2%) were necessary. Postoperative complications were minor and comparable in both groups. Patients who underwent laparoscopic surgery demonstrated significantly less postoperative pain and a shorter hospital stay, but operative time and warm ischemia time were significantly longer. Graft survival after LapNx was 100% during a median follow-up period of 13 months. Operative time for LapNx decreased considerably with experience gained and seemed to be less for right nephrectomy. Stenotic ureter-bladder anastomoses occurred after LapNx in four patients during the first half year (7.0%), but this problem seemed to be resolved after modification of the technique.
LapNx is associated with less postoperative discomfort and improved convalescence.
腹腔镜实体器官手术的最新进展表明，肾供体术后不适和功能障碍可能会减轻。对腹腔镜供肾切除术的技术方面及手术经验的影响进行了评估。
将57例腹腔镜供肾切除术（LapNx）的临床结果与27例开放性供肾切除术（OpenNx）的历史对照组进行比较。
有3例（5.2%）需要转为开放性肾切除术。术后并发症轻微，两组相当。接受腹腔镜手术的患者术后疼痛明显减轻，住院时间缩短，但手术时间和热缺血时间明显延长。腹腔镜供肾切除术后在中位随访期13个月期间移植物存活率为100%。随着经验的积累，腹腔镜供肾切除术的手术时间大幅缩短，且右肾切除术的手术时间似乎更短。腹腔镜供肾切除术后上半年有4例患者（7.0%）出现输尿管膀胱吻合口狭窄，但在技术改进后这个问题似乎得到了解决。
腹腔镜供肾切除术与术后不适减轻及康复改善相关。
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