Wille Andreas H, Johannsen Manfred, Miller Kurt, Deger Serdar
Department of Urology, Charité-University Medicine Berlin, Berlin, Germany.
Surg Innov. 2009 Dec;16(4):306-12. doi: 10.1177/1553350609354605. Epub 2009 Dec 22.
The authors report their techniques, perioperative data, and oncological outcome for laparoscopic partial nephrectomy in a single-center experience with 3 different surgeons.
A total of 102 consecutive patients underwent laparoscopic transperitoneal partial nephrectomy for exophytic tumors using FloSeal for hemostasis. Mean age was 58 years (range = 26-79 years), and median tumor size was 2.6 cm (range = 0.5-8.5 cm). In 84 cases, the renal artery was clamped using endoscopic bulldog clamps, and tumor resection was performed using scissors or the harmonic scalpel. Hemostasis was achieved by application of FloSeal; lesions of the collecting system were closed with Lahodny sutures in 33 cases (31%). Frozen sections were obtained for margin status.
All 102 procedures were successful with no intraoperative complications. Mean surgical time was 201 minutes (range = 60-355 minutes); clamping time was 25.8 minutes (range = 6-75 minutes) in 64 cases. Margins were negative in 92 cases; in 8 cases secondary resection was necessary to achieve negative margin status, and in 2 cases radical nephrectomy was performed. Histological findings were clear-cell carcinoma in 51 (50.0%), papillary carcinoma in 26 (25.5%), and others in 25 (24.5%) cases. At a mean follow-up of 32 months (12-62 months), no recurrence was observed.
Laparoscopic partial nephrectomy with the use of FloSeal is a feasible and safe method for treatment of small renal masses. The technique is reproducible by surgeons who are used to complex laparoscopic procedures. Patient outcome during follow-up was comparable with data published for open standard procedures.
作者报告在单中心由3位不同外科医生进行腹腔镜肾部分切除术的技术、围手术期数据及肿瘤学结果。
共有102例连续患者接受了腹腔镜经腹肾部分切除术，用于治疗外生性肿瘤，术中使用FloSeal进行止血。平均年龄为58岁（范围26 - 79岁），肿瘤中位大小为2.6 cm（范围0.5 - 8.5 cm）。84例患者使用内镜牛头夹夹闭肾动脉，使用剪刀或超声刀进行肿瘤切除。通过应用FloSeal实现止血；33例（31%）患者的集合系统损伤用拉霍德尼缝线缝合。获取冰冻切片检查切缘情况。
102例手术均成功，无术中并发症。平均手术时间为201分钟（范围60 - 355分钟）；64例患者的夹闭时间为25.8分钟（范围6 - 75分钟）。92例患者切缘阴性；8例患者需要二次切除以达到切缘阴性状态，2例患者进行了根治性肾切除术。组织学结果显示，51例（50.0%）为透明细胞癌，26例（25.5%）为乳头状癌，25例（24.5%）为其他类型。平均随访32个月（12 - 62个月），未观察到复发。
使用FloSeal的腹腔镜肾部分切除术是治疗小肾肿块的一种可行且安全的方法。该技术对于习惯复杂腹腔镜手术的外科医生来说是可重复的。随访期间患者的结果与公开报道的开放标准手术的数据相当。
