El-Galley Rizk
Division of Urology, Department of Surgery, University of Alabama, Birmingham, Alabama 35294, USA.
J Urol. 2007 Nov;178(5):2062-6. doi: 10.1016/j.juro.2007.07.005. Epub 2007 Sep 17.
Most surgeons divide the renal vein with a laparoscopic stapler during laparoscopic donor nephrectomy. The right renal vein is usually shorter than the left one and using the stapler on the right side can result in a higher incidence of vascular complications for right kidney recipients. We present our experience with a new technique for hand assisted laparoscopic right donor nephrectomy.
We designed a new vascular clamp to be completely inserted into the peritoneal cavity through the hand port incision in hand assisted laparoscopy. The renal vein with a cuff of the inferior vena cava was then excised. The defect in the inferior vena cava was sutured intracorporeally.
A total of 80 kidney donors underwent hand assisted laparoscopic right donor nephrectomy using the new technique. Mean +/- SD operative time was 184 +/- 36 minutes. Operative time was decreased in the last 30 patients to 152 +/- 22 minutes. Intracorporeal suture time on the inferior vena cava was 16 +/- 3 minutes. No intraoperative complications were noted and there was no partial or total graft loss. Mean blood loss was 50 +/- 35 cc. Mean warm ischemia time was 4 +/- 2 minutes. Hospital discharge was on postoperative day 1 or 2 in 81% of patients. Graft function was normal in 78 recipients with a day 5 postoperative serum creatinine of 1.6 +/- 0.9 mg/dl. Two recipients showed delayed graft function and were treated medically.
This technique for hand assisted laparoscopic right donor nephrectomy has proved to be safe and reproducible. We recommend practicing laparoscopic inferior vena cava suturing in the animal laboratory before performing it in humans.
大多数外科医生在腹腔镜供肾切除术期间使用腹腔镜吻合器离断肾静脉。右肾静脉通常比左肾静脉短，在右侧使用吻合器会导致右肾受者血管并发症的发生率更高。我们介绍我们采用一种新的手辅助腹腔镜右供肾切除术技术的经验。
我们设计了一种新的血管夹，可通过手辅助腹腔镜检查中的手孔切口完全插入腹腔。然后切除带有下腔静脉袖套的肾静脉。下腔静脉的缺损在体内进行缝合。
共有80例供肾者采用新技术接受了手辅助腹腔镜右供肾切除术。平均手术时间±标准差为184±36分钟。最后30例患者的手术时间降至152±22分钟。下腔静脉体内缝合时间为16±3分钟。未观察到术中并发症，也没有部分或全部移植物丢失。平均失血量为50±35毫升。平均热缺血时间为4±2分钟。81%的患者在术后第1天或第2天出院。78例受者的移植物功能正常，术后第5天血清肌酐为1.6±0.9毫克/分升。两名受者出现移植肾功能延迟，接受了药物治疗。
这种手辅助腹腔镜右供肾切除术技术已被证明是安全且可重复的。我们建议在人体实施之前先在动物实验室练习腹腔镜下腔静脉缝合。
