Ou Chien-Hui, Yang Wen-Horng, Tzai Tzong-Shin, Tong Yat-Ching, Chang Chien-Chen, Lin Yung-Ming
Department of Urology, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan, Republic of China.
J Urol. 2006 Nov;176(5):2063-7; discussion 2067. doi: 10.1016/j.juro.2006.07.043.
To minimize the operative time of hand assisted retroperitoneoscopic nephroureterectomy by avoiding position change we report an especially designed surgical position.
A total of 41 patients with upper tract transitional cell carcinoma who underwent hand assisted retroperitoneoscopic nephroureterectomy and bladder cuff resection were enrolled. Patients lay supine, and the flank and hip on the lesion side were elevated 30 degrees. The legs were extended and abducted in the Johnnie Walker position, allowing the operator to stand between them. Operation was completed via a 7 to 8 cm Gibson incision and 2 additional laparoscopic ports.
All procedures were successful except 1 open conversion due to bleeding, in which there was no need to reposition the patient. Average patient age was 65.2 years (range 34 to 85), mean operative time was 207.6 minutes (range 130 to 345) and mean estimated blood loss was 166 ml (range 50 to 900). Simultaneous transurethral endoscopic procedures were performed in 11 patients in the same position. Time to oral intake and ambulation was 2.1 and 2.0 days, respectively. Two patients had postoperative complications, including pneumonia and wound hematoma in 1 each. No complication was related to the position.
The Johnnie Walker position minimizes operative time by eliminating the delay caused by patient positioning and draping changes, allowing better coordination for the surgeon and assistant, and permitting more efficient use of the nondominant hand. The retroperitoneal approach prevents bowel interference in the visual field, making laparoscopic surgery in this modified supine position possible. Nephroureterectomy, bladder cuff resection and endoscopic procedures can be done with ease with the patient in this position.
为避免患者体位改变，从而缩短手辅助后腹腔镜肾输尿管切除术的手术时间，我们报告一种特别设计的手术体位。
纳入41例行手辅助后腹腔镜肾输尿管切除术及膀胱袖口切除术的上尿路移行细胞癌患者。患者仰卧位，病变侧的胁腹和臀部抬高30度。双腿伸直并外展呈约翰尼·沃克体位，使术者能站于两腿之间。通过一个7至8厘米的吉布森切口及另外两个腹腔镜端口完成手术。
除1例因出血中转开放手术外，所有手术均成功，且无需重新摆放患者体位。患者平均年龄65.2岁（范围34至85岁），平均手术时间207.6分钟（范围130至345分钟），平均估计失血量166毫升（范围50至900毫升）。11例患者在同一体位同时进行了经尿道内镜手术。术后恢复经口进食和下床活动的时间分别为2.1天和2.0天。2例患者出现术后并发症，分别为肺炎和伤口血肿各1例。无并发症与体位相关。
约翰尼·沃克体位消除了患者体位摆放和铺巾更换造成的延误，从而缩短了手术时间，使术者和助手能更好地配合，并能更有效地使用非优势手。后腹膜入路可防止肠道干扰视野，使在这种改良仰卧位进行腹腔镜手术成为可能。在此体位下，患者可轻松完成肾输尿管切除术、膀胱袖口切除术及内镜手术。
