Challacombe B, Kandaswamy R, Dasgupta P, Mamode N
Transplantation and Urology Guy's Hospital, London, UK.
Transplant Proc. 2005 Mar;37(2):613-6. doi: 10.1016/j.transproceed.2005.01.065.
Laparoscopic living donor nephrectomy is a major advance but a challenging procedure to learn even after laparoscopic training. It requires significant previous training in both laparoscopic and transplant surgery. Telementoring has been shown to reduce the laparoscopic learning curve in other fields. Of six cases of hand-assisted laparoscopic (HAL) living donor nephrectomy at our institution, an on-site mentor supervised the initial two. We present the subsequent four cases as the first documented examples of telementored HAL live donor nephrectomy. Telelink was established with a Comstation (Zydacron, UK) incorporating a Z360 telementoring codec and four ISDN lines (512 kb/s) with time delay of 500 ms for both audio and video. The remote surgeon in Minnesota (USA) could change independently between the laparoscopic and external views. The operating surgeons were able to look at the mentor and converse with him throughout. There were no adverse events in recipients and graft function was excellent. With regards to the telementored group the mean operative time was 240 minutes, the mean warm ischemic time 189 seconds, the mean estimated blood loss 171 mL, and the mean length of hospital stay 3 days. Telementoring for laparoscopic donor nephrectomy is feasible, effective, and likely to aid independent practice by providing continued supervision and reducing the learning period.
腹腔镜活体供肾切除术是一项重大进展，但即便经过腹腔镜培训，也是一项颇具挑战性的术式。它要求术者此前在腹腔镜手术和移植手术方面均接受过大量培训。远程指导已被证明可缩短其他领域的腹腔镜学习曲线。在我们机构开展的6例手辅助腹腔镜（HAL）活体供肾切除术中，前两例由现场指导者监督。我们呈现后续4例，作为远程指导的HAL活体供肾切除术的首例文献记载案例。通过一台配备Z360远程指导编解码器和四条ISDN线路（512 kb/s）的Comstation（英国Zydacron公司）建立远程连接，音频和视频的时延均为500毫秒。美国明尼苏达州的远程外科医生能够在腹腔镜视野和外部视野之间独立切换。术者在整个手术过程中都能看到指导者并与之交流。受者未发生不良事件，移植肾功能良好。在接受远程指导的组中，平均手术时间为240分钟，平均热缺血时间为189秒，平均估计失血量为171毫升，平均住院时间为3天。腹腔镜供肾切除术的远程指导是可行、有效的，并且可能通过持续监督和缩短学习期来助力独立开展手术。
