Desgrandchamps F, Meria P, Almeida-Neto D, Mongiat-Artus P, Teillac P
Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Ann Urol (Paris). 2005 Apr;39(2):85-94. doi: 10.1016/j.anuro.2005.03.001.
Hand-assisted laparoscopic surgery bridges the gap between open and Laparoscopic surgery. It involves introduction of the surgeon's hand into the insufflated abdomen. Hand-assisted laparoscopy is clearly advantageous for those laparoscopic procedures that require removal of relatively large amount of tissue intact as living donor nephrectomy is. Technically, a short midline incision is performed to introduce the non dominant operators'hand. Trocars are placed. The colon is then reflected, the ureter dissected with its surrounding vascularization and divided. The renal vein is controlled, by transecting the surrenal vein on the left side, and the genital vein in both sides. Then the artery is dissected close to the aorta on the Left side, behind the vena cava on the right side. An endoscopic stapler is used to transect the renal artery and the renal vein. The kidney is quickly removed through the midline incision and immediately washed with a cooled preservation solution. The different incisions are closed.
手辅助腹腔镜手术弥合了开放手术和腹腔镜手术之间的差距。它涉及将外科医生的手放入充气的腹腔内。对于那些需要完整切除相对大量组织的腹腔镜手术，如活体供肾切除术，手辅助腹腔镜手术显然具有优势。从技术上讲，需做一个短的中线切口以放入非优势手。放置套管针。然后将结肠推开，解剖输尿管及其周围的血管并切断。通过切断左侧的肾上腺静脉和两侧的生殖静脉来控制肾静脉。然后在左侧靠近主动脉、右侧在腔静脉后方解剖动脉。使用内镜吻合器切断肾动脉和肾静脉。肾脏通过中线切口迅速取出，并用冷的保存液立即冲洗。关闭不同的切口。
