Yashi M, Yagisawa T, Nukui A, Ishikawa N, Miyamoto N, Sakuma Y, Fujiwara T, Muraishi O
Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Tochigi, Japan.
Transplant Proc. 2009 Jan-Feb;41(1):88-90. doi: 10.1016/j.transproceed.2008.11.004.
Hand-assisted laparoscopic live donor nephrectomy has been widely applied, because it enables safe dissection of the renal vessels, reducing warm ischemia time (WIT) during rapid extraction of the kidney. In the method described in the current series, the hand-port device was placed after the kidney was mostly mobilized using a pure retroperitoneoscopic procedure. After placement of the hand port, the ureter was completely dissected by an open procedure. Finally, the renal vessels were dissected and transected under the hand-assisted retroperitoneoscopic procedure, and the kidney removed through the hand port. We performed 66 retroperitoneoscopic live donor nephrectomies, including 14 right-sided and 52 left-sided procedures, with this original method of hand assistance. The mean operative time, WIT, blood loss, and renal vein length were 246 +/- 43 minutes, 209 +/- 124 seconds, 202 +/- 180 mL, and 17.4 +/- 6.4 mm, respectively. Comparison of the operative data between the initial 30 cases and the recent 36 cases using the established method showed significant differences in blood loss and WIT that approached statistical significance. No delayed graft function was observed in the current series. The technical and functional outcomes were acceptable. The site and timing of hand assistance minimize the disadvantage of a small working space during the retroperitoneoscopic procedure, making surgery easier and safer.
手辅助腹腔镜活体供肾肾切除术已得到广泛应用，因为它能够安全地解剖肾血管，减少肾脏快速摘取过程中的热缺血时间（WIT）。在本系列所描述的方法中，在主要通过单纯后腹腔镜手术游离肾脏后放置手辅助端口装置。放置手辅助端口后，通过开放手术完全游离输尿管。最后，在手辅助后腹腔镜手术下解剖并横断肾血管，通过手辅助端口取出肾脏。我们采用这种原始的手辅助方法进行了66例后腹腔镜活体供肾肾切除术，包括14例右侧手术和52例左侧手术。平均手术时间、热缺血时间、失血量和肾静脉长度分别为246±43分钟、209±124秒、202±180毫升和17.4±6.4毫米。对最初30例和近期36例采用既定方法的手术数据进行比较，结果显示失血量和热缺血时间存在显著差异，接近统计学意义。本系列中未观察到移植肾功能延迟。技术和功能结果均可接受。手辅助的部位和时机将后腹腔镜手术中工作空间小的缺点降至最低，使手术更简便、更安全。
