Ponsky Lee E, Steinway Matthew L, Lengu Irma J, Hartke David M, Vourganti Srinivas, Cherullo Edward E
Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio 44106-5046, USA.
Urology. 2009 Sep;74(3):482-5. doi: 10.1016/j.urology.2009.06.002. Epub 2009 Jul 30.
To present the initial clinical experience with laparoendoscopic single-site (LESS) radical nephrectomy and nephroureterectomy performed completely through a Pfannenstiel incision.
Two patients underwent a single-site nephrectomy and nephroureterectomy for the diagnosis of an enhancing renal parenchymal mass and a renal pelvic mass, respectively. In both cases, a 7.5-cm Pfannenstiel incision was made and GelPort was inserted. Trocars were placed through the access port, and nephrectomy was performed using standard and bariatric length laparoscopic instruments. Distal ureter was resected through the Pfannenstiel incision for nephroureterectomy. No additional ports were used as both procedures were completed via the Pfannenstiel approach.
The procedures were completed in 187 and 409 minutes, respectively, without complication. Blood loss was estimated at 50 and 200 mL, respectively. Postoperatively, the patients required minimal analgesia. Patients were discharged on postoperative days 2 and 4, respectively.
LESS nephrectomy and nephroureterectomy using only a Pfannenstiel incision are technically feasible and reproducible in human beings if performed by surgeons with standard laparoscopic skills. Using standard and bariatric length laparoscopic instruments, the procedures were performed without complication, with minimal blood loss and minimal variance from standard laparoscopic techniques. We anticipate that this approach can be incorporated by the urologist adept at laparoscopic surgery and provides a practical application of LESS surgery for extirpative procedures.
介绍经Pfannenstiel切口完全实施的腹腔镜单孔（LESS）根治性肾切除术和肾输尿管切除术的初步临床经验。
两名患者分别因诊断为强化肾实质肿块和肾盂肿块而接受了单孔肾切除术和肾输尿管切除术。在这两例手术中，均做了一个7.5厘米的Pfannenstiel切口并插入GelPort。通过该接入端口置入套管针，使用标准长度和肥胖专用长度的腹腔镜器械进行肾切除术。对于肾输尿管切除术，经Pfannenstiel切口切除输尿管远端。由于这两种手术均通过Pfannenstiel入路完成，因此未使用额外的端口。
手术分别在187分钟和409分钟内完成，无并发症发生。估计失血量分别为50毫升和200毫升。术后，患者所需镇痛药物极少。患者分别在术后第2天和第4天出院。
对于具备标准腹腔镜技术的外科医生而言，仅经Pfannenstiel切口实施的LESS肾切除术和肾输尿管切除术在技术上是可行且可重复的。使用标准长度和肥胖专用长度的腹腔镜器械，手术无并发症发生，失血量极少，与标准腹腔镜技术的差异极小。我们预计，这种方法能够被擅长腹腔镜手术的泌尿外科医生所采用，并为切除性手术提供LESS手术的实际应用。
