Sato Yoshikazu, Tanda Hitoshi, Kato Shuji, Onishi Shigeki, Nakajima Hisao, Nanbu Akihito, Nitta Toshikazu, Koroku Mikio, Akagashi Keigo, Hanzawa Tatsuo
Sanjukai Urological Hospital, Sanriki Basic and Clinical Research Center, Sapporo, Japan.
J Urol. 2005 Jul;174(1):53-6. doi: 10.1097/01.ju.0000162040.30026.2d.
A new approach for retroperitoneoscopic radical nephrectomy is introduced. The point of our surgical method is the application of a combination of hand assistance and pure laparoscopic procedures with appropriate surgical steps via the retroperitoneal approach. In our early series we had good surgical results and we completed radical nephrectomy in about 100 minutes using this procedure.
A total of 20 consecutive patients with renal cell carcinoma (cT1-2) who were operated on with this surgical method were analyzed. Surgical procedures occurred in 5 steps. In step 1 the retroperitoneal space was created manually from a pararectal incision at the umbilicus level. In step 2 the lateroconal fascia was incised and the renal hilar area was exposed with hand assistance. In step 3 hilar dissection was performed by pure laparoscopic procedure with another surgical instrument inserted from the hand device. Step 4 involved the application of hand assistance again for the quick mobilization of the kidney and adrenal gland. In step 5 the intact surgical specimen was retrieved from the hand device.
Mean operative time and estimated blood loss were 103 +/- 21 minutes (range 70 to 145) and 49 +/- 85 ml (range 5 to 360), respectively. Mean days to oral intake and ambulation were 1.0 and 1.1, respectively. Operative times of the steps of hilar dissection and mobilization of the kidney and adrenal were shorter than in other series performed by standard retroperitoneoscopic radical nephrectomy. Major complications were not experienced. At this point, no metastasis has been experienced.
Our surgical method may have the benefits of the retroperitoneal approach and hand assistance. The retroperitoneoscopic hand assisted method may be another important option in the 3 major approaches for laparoscopic radical nephrectomy, although longer-term followup is clearly required.
介绍一种后腹腔镜根治性肾切除术的新方法。我们手术方法的要点是通过后腹膜途径，将手辅助与单纯腹腔镜手术相结合，并采用适当的手术步骤。在我们的早期系列病例中，手术效果良好，采用该方法我们在约100分钟内完成了根治性肾切除术。
对连续20例采用该手术方法治疗的肾细胞癌（cT1-2）患者进行分析。手术步骤分为五步。第一步，在脐水平经直肠旁切口手动建立后腹膜间隙。第二步，切开侧锥筋膜，在手部辅助下暴露肾门区域。第三步，通过从手部装置插入另一手术器械，采用单纯腹腔镜手术进行肾门解剖。第四步，再次应用手部辅助以快速游离肾脏和肾上腺。第五步，从手部装置取出完整的手术标本。
平均手术时间和估计失血量分别为103±21分钟（范围70至145分钟）和49±85毫升（范围5至360毫升）。平均经口进食时间和下床活动时间分别为1.0天和1.1天。肾门解剖以及肾脏和肾上腺游离步骤的手术时间短于标准后腹腔镜根治性肾切除术的其他系列报道。未发生严重并发症。目前，未出现转移情况。
我们的手术方法可能兼具后腹膜途径和手辅助的优点。后腹腔镜手辅助方法可能是腹腔镜根治性肾切除术三大主要途径中的另一个重要选择，尽管显然需要进行长期随访。
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