Casale Paolo, Pomara Giorgio, Simone Maurizio, Casarosa Claudio, Fontana Luca, Francesca Francesco
J Endourol. 2007 Aug;21(8):915-8. doi: 10.1089/end.2006.0101.
Control and division of the renal vessels is a critical step in laparoscopic nephrectomy. Although the linear cutting stapler is easy to use, a 1.7% malfunction rate has been reported, and the consequences of this failure can be serious, including often-emergency conversion to an open procedure and even death. We reviewed the purely laparoscopic nephrectomies performed in our center, in which both the renal artery and the vein were secured using only nonabsorbable polymer ligating (NPL) clips. Our purpose was to evaluate the reliability, safety, and cost-effectiveness of this surgical approach.
We retrospectively reviewed our 31 laparoscopic nephrectomies performed from November 2002 to November 2005. In all the procedures, both the renal artery and the renal vein were secured using only NPL clips. For each patient, the operative time, estimated blood loss, early and late complications, and length of hospital stay were analyzed. Further, we performed a MEDLINE search for laparoscopic nephrectomies in which both the renal artery and the vein were secured using only Hem-o-lok clips.
No renal vessel injuries, cases of clip dislodgement or slippage, or bleeding were recorded. Worthy of note, we achieved a meaningful reduction in the cost per procedure. To the best of our knowledge, renal-pedicle control exclusively with Hem-o-lok clips during purely laparoscopic nephrectomy has not been yet published.
Any device or technique for vascular control is prone to malfunction in either open or laparoscopic surgery. The described approach is safe, reliable, rapid, and inexpensive.
肾血管的控制与离断是腹腔镜肾切除术的关键步骤。尽管直线切割吻合器使用简便，但据报道其故障率为1.7%，这种故障的后果可能很严重，包括常需紧急中转开腹手术甚至死亡。我们回顾了在本中心进行的单纯腹腔镜肾切除术，术中仅使用不可吸收聚合物结扎（NPL）夹来处理肾动脉和肾静脉。我们的目的是评估这种手术方法的可靠性、安全性和成本效益。
我们回顾性分析了2002年11月至2005年11月期间在本中心进行的31例腹腔镜肾切除术。在所有手术中，仅使用NPL夹来处理肾动脉和肾静脉。分析了每位患者的手术时间、估计失血量、早期和晚期并发症以及住院时间。此外，我们在MEDLINE数据库中检索了仅使用Hem-o-lok夹来处理肾动脉和肾静脉的腹腔镜肾切除术。
未记录到肾血管损伤、夹子移位或滑脱以及出血的情况。值得注意的是，我们成功地显著降低了每例手术的成本。据我们所知，单纯腹腔镜肾切除术中仅使用Hem-o-lok夹来控制肾蒂的情况尚未见报道。
在开放手术或腹腔镜手术中，任何用于血管控制的器械或技术都可能出现故障。所描述的方法安全、可靠、快速且成本低廉。
