Nouralizadeh Akbar, Ziaee Seyed Amirmohsen, Basiri Abbas, Simforoosh Nasser, Abdi Hamidreza, Mahmoudnejad Nastaran, Kashi Amir H
Urology and Nephrology Research Center and Shaheed Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Urol J. 2009 Summer;6(3):176-81.
We report our experience with a new technique for transperitoneal laparoscopic partial nephrectomy with the kidney turned upside down intraoperatively.
Laparoscopic partial nephrectomy was performed in 10 patients with upper pole lesions through a transperitoneal approach. Once complete mobilization of the kidney was achieved, it was rotated 180 degrees around the horizontal axis, so that the upper pole was positioned inferiorly. After performing partial nephrectomy, the resection bed was sutured by 2-0 polyglactin sutures and application of Hem-o-Lok clips. Then, the kidney was returned into its normal position and fixed to the abdominal wall.
We performed laparoscopic partial nephrectomy on 9 patients with a contrast-enhancing upper pole kidney mass and 1 patient with a nonfunctioning upper pole. The median tumor size was 58 mm (range, 41 mm to 92 mm). The median operative time was 206 minutes (range, 114 to 262 minutes) and the mean warm ischemia time was 30 minutes (range, 22 to 35 minutes). One patient underwent surgical exploration due to bleeding 6 hours after the operation. Prolonged urine leakage (more than 7 days) was observed in 1 patient, which responded to ureteral stent insertion. Surgical margins were negative in all of the patients. Renal cell carcinoma was histologically diagnosed in patients with a kidney tumor.
Laparoscopic upper pole partial nephrectomy had acceptable results while the kidney was turned upside down intraoperatively, in terms of operative time and complications. This approach facilitates the procedure by achieving a better field of vision.
我们报告了一种新的经腹膜腹腔镜部分肾切除术的经验，术中将肾脏倒置。
对10例上极病变患者采用经腹膜途径行腹腔镜部分肾切除术。肾脏完全游离后，绕横轴旋转180度，使上极位于下方。部分肾切除术后，用2-0聚乙醇酸缝线缝合切除床并应用Hem-o-Lok夹。然后，将肾脏恢复到正常位置并固定于腹壁。
我们对9例上极肾肿块有强化的患者和1例上极无功能的患者进行了腹腔镜部分肾切除术。肿瘤大小中位数为58mm（范围41mm至92mm）。手术时间中位数为206分钟（范围114至262分钟），平均热缺血时间为30分钟（范围22至35分钟）。1例患者术后6小时因出血接受手术探查。1例患者出现持续性尿漏（超过7天），输尿管支架置入后好转。所有患者手术切缘均为阴性。肾肿瘤患者经组织学诊断为肾细胞癌。
就手术时间和并发症而言，术中将肾脏倒置的腹腔镜上极部分肾切除术取得了可接受的结果。这种方法通过获得更好的视野便于手术操作。
