Castillo Octavio A, Sánchez-Salas Rafael, Vidal-Mora Ivar, Campos Rodrigo, Ahualli Javier, Fonerón Alejandro, Feria-Flores Miguel
Clínica Indisa, Universidad Andrés Bello, Santiago de Chile, Chile.
Arch Esp Urol. 2009 May;62(4):296-300. doi: 10.4321/s0004-06142009000400005.
We present our initial experience with transumbilical surgery in a simple nephrectomy performed with a flexible cystoscope and standard laparoscopic instruments.
A 15 year-old child, with severe left renal parenchyma atrophy, secondary to recurrent urinary tract infection (UTI) complicated with left pyelonephritis. Decision for simple nephrectomy was taken and we planned to perform a single port laparoscopic nephrectomy. In the lumbotomy position, two 5mm ports were insertend through a 3 cm umbilical incision. One trocar permitted the progression of the flexible cystoscope (Olympus) and the other the entrance of the PKS Plasma Trissector. The latter was then changed for a 10mm port to allow the entrance of the Weck clips. A Maryland grasper for countertraction was placed without port in the lef-upper quadrant and progressed directly into de peritoneal cavity under direct vision.
The standard laparoscopic steps were duplicated uneventfully. Mean operative time was 90 minutes and mean blood loss was 200 mL. Hospital stay was 18 hours. No transfusion was needed.
Single port urologic surgery will expand in the future. There is lack of commercial availability of the ideal hardware needed for the procedures. Versatility of urologic instruments allow for its use in different settings.
我们展示了在使用柔性膀胱镜和标准腹腔镜器械进行的简单肾切除术中经脐手术的初步经验。
一名15岁儿童，因复发性尿路感染（UTI）并发左肾盂肾炎导致严重的左肾实质萎缩。决定进行简单肾切除术，并计划进行单孔腹腔镜肾切除术。在侧卧位，通过一个3厘米的脐部切口插入两个5毫米的端口。一个套管针用于推进柔性膀胱镜（奥林巴斯），另一个用于插入PKS等离子三分器。然后将后者换成一个10毫米的端口，以便插入韦克夹。一个用于反向牵引的马里兰抓钳在左上象限无端口放置，并在直视下直接进入腹膜腔。
标准的腹腔镜步骤顺利完成。平均手术时间为90分钟，平均失血量为200毫升。住院时间为18小时。无需输血。
单孔泌尿外科手术未来将会得到发展。该手术所需的理想硬件缺乏商业供应。泌尿外科器械的多功能性使其可用于不同的手术场景。
