Hsu Thomas H, Su Li-Ming, Ong Albert
Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
J Urol. 2003 Jan;169(1):258-60. doi: 10.1016/S0022-5347(05)64081-5.
We describe a novel technique of laparoscopic retroperitoneal lymph node dissection via an anterior extraperitoneal approach.
With the patient in a modified flank position an 8 mm. incision is made along the lateral border of the ipsilateral rectus muscle at the umbilical level. Extraperitoneal space creation with finger dissection is initially made at this site and adequately enlarged with a balloon dilator, followed by gas insufflation and placement of 4 laparoscopic trocars. Laparoscopic retroperitoneal lymph node dissection based on a left modified template is then performed in a completely extraperitoneal manner.
Surgical time was 330 minutes, blood loss was 150 ml. and 58 lymph nodes were removed. Resumption of physical activity and oral intake was achieved on postoperative day 1. Hospital stay was 36 hours. Postoperative narcotic requirement was 28 mg. morphine sulfate equivalent. There were no intraoperative or postoperative complications. Normal antegrade ejaculation returned postoperatively.
This novel surgical technique is technically feasible and associated with satisfactory clinical outcomes in our preliminary study. Further studies are necessary to evaluate its potential as an alternative to the previously reported transperitoneal and retroperitoneoscopic approaches to laparoscopic retroperitoneal lymph node dissection.
我们描述一种通过前腹膜外途径进行腹腔镜腹膜后淋巴结清扫的新技术。
患者取改良侧卧位，在脐水平沿同侧腹直肌外侧缘做一个8毫米的切口。最初在此部位用手指分离创建腹膜外间隙，并用球囊扩张器充分扩大，随后进行气体注入并置入4个腹腔镜套管针。然后以完全腹膜外的方式基于左侧改良模板进行腹腔镜腹膜后淋巴结清扫。
手术时间为330分钟，失血150毫升，切除58个淋巴结。术后第1天恢复体力活动和经口进食。住院时间为36小时。术后所需麻醉药量为28毫克硫酸吗啡当量。无术中或术后并发症。术后顺行射精恢复正常。
在我们的初步研究中，这种新的手术技术在技术上是可行的，并且临床效果令人满意。需要进一步研究以评估其作为先前报道的经腹和后腹腔镜途径进行腹腔镜腹膜后淋巴结清扫替代方法 的潜力。
