Raman Jay D, Bensalah Karim, Bagrodia Aditya, Stern Joshua M, Cadeddu Jeffrey A
Department of Urology, University of Texas, Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Urology. 2007 Dec;70(6):1039-42. doi: 10.1016/j.urology.2007.10.001.
To describe our initial experience with single keyhole nephrectomy in a porcine model and in human subjects.
Eight nonsurvival laparoscopic nephrectomies were performed in 4 female farm pigs. In 3 renal units, the laparoscopic nephrectomy was performed via a novel single 25-mm trocar, while the remaining 5 nephrectomies were performed using one 10-mm and two 5-mm adjacent trocars. Articulating laparoscopic graspers, conventional endoshears, clips, and a stapler were used for dissection. Three human subjects underwent a single keyhole umbilical laparoscopic nephrectomy with similar instrumentation. Indications for nephrectomy included chronic infection in a nonfunctioning kidney in 2 patients, and a 4.5-cm enhancing renal mass in the other patient.
Single keyhole nephrectomy was successfully completed in all 8 porcine renal units and in all 3 human subjects. The mean operative time for the porcine nephrectomies was 49 minutes (range, 20 to 85), with a mean blood loss of 20 mL (range, 5 to 100). Incision size ranged from 3 to 5 cm. The mean operative time for the human nephrectomy cases was 133 minutes (range, 90 to 160). Estimated blood loss was 30 mL, and the kidneys were extracted through a solitary 2 to 4.5 cm periumbilical incision. There were no perioperative complications, and all 3 patients were discharged on hospital day 2.
Keyhole umbilical nephrectomy utilizing articulating laparoscopic instrumentation to facilitate triangulation is feasible. We demonstrate safe and successful completion both in a porcine model and in the 3 human patients. Future studies will need to assess the benefits of single-access surgery in comparison to conventional laparoscopy.
描述我们在猪模型和人体受试者中进行单孔腹腔镜肾切除术的初步经验。
对4只雌性农场猪进行了8例非存活腹腔镜肾切除术。在3个肾单位中，通过一种新型的单25毫米套管针进行腹腔镜肾切除术，而其余5例肾切除术则使用一个10毫米和两个5毫米相邻套管针进行。使用关节式腹腔镜抓钳、传统的内镜剪、夹子和吻合器进行解剖。3名受试者接受了使用类似器械的单孔脐部腹腔镜肾切除术。肾切除术的指征包括2例患者无功能肾的慢性感染，以及另一例患者4.5厘米的强化肾肿块。
所有8个猪肾单位和所有3名人体受试者均成功完成单孔腹腔镜肾切除术。猪肾切除术的平均手术时间为49分钟（范围为20至85分钟），平均失血量为20毫升（范围为5至100毫升）。切口大小为3至5厘米。人体肾切除术病例的平均手术时间为133分钟（范围为90至160分钟）。估计失血量为30毫升，肾脏通过单个2至4.5厘米的脐周切口取出。无围手术期并发症，所有3例患者均在术后第2天出院。
利用关节式腹腔镜器械促进三角定位的单孔脐部肾切除术是可行的。我们在猪模型和3例人类患者中均证明了安全且成功地完成了手术。未来的研究需要评估单通道手术与传统腹腔镜手术相比的益处。
