Branco Anibal Wood, Kondo William, Branco Filho Alcides José, George Marco Aurélio de, Rangel Marlon, Stunitz Luciano Carneiro
Department of Urology, Red Cross Hospital, Curitiba, PA, Brazil.
Clinics (Sao Paulo). 2008 Dec;63(6):795-800. doi: 10.1590/s1807-59322008000600015.
To compare hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy techniques in live donor nephrectomy.
In this retrospective study, we included all patients submitted to hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy between May 2002 and December 2007. The operative data and post-operative courses were reviewed. Information was collected on the operative time, warm ischemia time, estimated blood loss, intra-operative complications, time to first oral intake, length of hospital stay, and post-operative complications. The data were analyzed using Student's t -tests and Fisher exact tests as appropriate, with statistical significance defined as p < 0.05.
The means of the operative duration, warm ischemia time and intra-operative bleeding were 83 min, 3.6 min and 130.9 cc, respectively, for hand-assisted laparoscopic donor nephrectomy, and 78.4 min, 2.5 min and 98.9 cc, respectively, for pure laparoscopic live donor nephrectomy (p=0.29, p<0.0001 and p=0.08, respectively). Intra-operative complications occurred in 6% of patients submitted to hand-assisted laparoscopic donor nephrectomy and in 4.5% of those submitted to pure laparoscopic live donor nephrectomy (p=0.68). Only one patient from each group required conversion to open surgery; one person receiving hand-assisted laparoscopic donor nephrectomy had bleeding and one person receiving pure laparoscopic live donor nephrectomy had low carbon dioxide levels during the warm ischemia period. Compared with patients receiving hand-assisted laparoscopic donor nephrectomy, patients submitted to pure laparoscopic live donor nephrectomy were able to take their first meal earlier (12.5 vs. 9.2 hours, p=0.046), were discharged home sooner (2.8 vs. 1.4 days, p<0.0001) and had fewer post-operative complications (7.5% vs. 0.6%, p=0.04).
Pure laparoscopic live donor nephrectomy had some advantages over hand-assisted laparoscopic donor nephrectomy in terms of the warm ischemia time, time to first oral intake, length of hospital stay, and post-operative donor complications.
比较活体供肾肾切除术中手辅助腹腔镜供肾切除术与单纯腹腔镜活体供肾切除术技术。
在这项回顾性研究中，我们纳入了2002年5月至2007年12月期间接受手辅助腹腔镜供肾切除术和单纯腹腔镜活体供肾切除术的所有患者。回顾手术数据和术后病程。收集手术时间、热缺血时间、估计失血量、术中并发症、首次经口进食时间、住院时间和术后并发症等信息。数据采用学生t检验和Fisher精确检验进行适当分析，统计学显著性定义为p<0.05。
手辅助腹腔镜供肾切除术的手术持续时间、热缺血时间和术中出血量的平均值分别为83分钟、3.6分钟和130.9毫升，单纯腹腔镜活体供肾切除术分别为78.4分钟、2.5分钟和98.9毫升（分别为p=0.29、p<0.0001和p=0.08）。接受手辅助腹腔镜供肾切除术的患者中有6%发生术中并发症，接受单纯腹腔镜活体供肾切除术的患者中有4.5%发生术中并发症（p=0.68）。每组仅1例患者需要转为开放手术；1例接受手辅助腹腔镜供肾切除术的患者出现出血，1例接受单纯腹腔镜活体供肾切除术的患者在热缺血期出现低二氧化碳水平。与接受手辅助腹腔镜供肾切除术的患者相比，接受单纯腹腔镜活体供肾切除术的患者能够更早进食（12.5小时对9.2小时，p=0.046），更早出院回家（2.8天对1.4天，p<0.0001），术后并发症更少（7.5%对0.6%，p=0.04）。
在热缺血时间、首次经口进食时间、住院时间和术后供体并发症方面，单纯腹腔镜活体供肾切除术比手辅助腹腔镜供肾切除术具有一些优势。
