Kaouk Jihad H, Gill Inderbir S
Section of Laparoscopic and Minimally Invasive Surgery, Glickman Urological Institute, The Cleveland Clinic Foundation, Ohio, USA.
Curr Opin Urol. 2003 May;13(3):215-9. doi: 10.1097/00042307-200305000-00008.
The widespread use of available imaging techniques has resulted in an increased detection of incidental small renal tumors. For these small tumors, there has been a definite trend towards nephron-sparing surgery over the past decade.
With increasing experience, advanced ablative and complex reconstructive procedures are now being performed laparoscopically. Laparoscopic partial nephrectomy has lagged behind while laparoscopic radical nephrectomy is widely practiced and has become an established procedure. This lag is largely due to the technical difficulty in achieving renal hypothermia and securing renal parenchymal hemostasis.
Advanced laparoscopic suturing skills and the availability of laparoscopic vascular instruments have allowed laparoscopic partial nephrectomy to become a viable option for select patients, wherein laparoscopic partial nephrectomy attempts to duplicate traditional, established open surgical techniques.
现有成像技术的广泛应用导致偶然发现的小肾肿瘤检出率增加。在过去十年中,对于这些小肿瘤,保留肾单位手术呈明确趋势。
随着经验的增加,现在先进的消融和复杂的重建手术可通过腹腔镜进行。腹腔镜部分肾切除术进展滞后,而腹腔镜根治性肾切除术广泛开展且已成为既定术式。这种滞后主要是由于实现肾脏低温和确保肾实质止血存在技术困难。
先进的腹腔镜缝合技术和腹腔镜血管器械的可用性使腹腔镜部分肾切除术成为特定患者的可行选择,腹腔镜部分肾切除术试图复制传统的、成熟的开放手术技术。