Maurya Kamlesh, Sivanandam S E, Sukumar Sudhir, Bhat Sanjay, Kumar Ginil, Nair Balagopal
Department of Urology, Amrita Institute of Medical Sciences, Kochi - 682 041, India.
J Minim Access Surg. 2009 Jul-Sep;5(3):67-71. doi: 10.4103/0972-9941.58500.
With advancement in minimal access surgery two laparoscopic procedures can be combined together shortening the total hospital stay, decreasing morbidity and overall reduced cost. Combining two laparoscopic procedures in a single session has been reported in general surgery. Very few articles are available in literature with regard to combined urological laparoscopic surgeries. This article retrospectively analyses the outcomes of multiple laparoscopic procedures performed in a single stage at our centre.
Patients undergoing simultaneous procedures from May 2003 to Jan 2009 were included in the study. Patients were categorised into three groups according to the primary urological organ involved, for better comparison with the control group. Diseases involving the adrenals gland were grouped in (group 1), kidney (group 2) and renal collecting system/ureter (group 3). All patients had one urological procedure for either of the above-mentioned organs combined with another surgical procedure. Similarly three control groups were chosen according to the primary urological organ involved (group 1c- unilateral laparoscopic adrenalectomy, group 2c- unilateral laparoscopic radical nephrectomy and group 3c- unilateral laparoscopic ureterolithotomy) for comparative study. The operative details, hospital stay and complications were analysed.
Thirty-two patients underwent 64 laparoscopic procedures under single anaesthesia. The most common procedure in this series was laparoscopic adrenalectomy (n=34) followed by laparoscopic nephrectomy (n=13). Group 1 patients had a prolonged operative time ( P=0.012) and hospital stay ( P=0.025) when compared with group 1c. However, blood loss was comparable in both the groups. Patients in groups 2 and 3 had comparable operative times, blood loss and recovery period with respect to their controls. Intraoperatively, the end tidal carbon dioxide levels were within permissible limits. All procedures were completed using the laparoscopic approach, without any conversion.
Simultaneous laparoscopic procedures can be done for urological diseases in selected patients with the advantages of single anaesthesia and hospital admission without increasing the morbidity.
随着微创外科手术的发展，两种腹腔镜手术可联合进行，从而缩短总住院时间、降低发病率并总体降低成本。普通外科领域已有报道在同一手术期内联合两种腹腔镜手术。关于联合泌尿外科腹腔镜手术的文献报道很少。本文回顾性分析了在我们中心一期进行的多种腹腔镜手术的结果。
纳入2003年5月至2009年1月期间接受同期手术的患者。根据所涉及的主要泌尿外科器官将患者分为三组，以便与对照组进行更好的比较。涉及肾上腺的疾病归为（第1组），肾脏（第2组）和肾集合系统/输尿管（第3组）。所有患者均针对上述任一器官进行了一项泌尿外科手术，并与另一项外科手术联合进行。同样，根据所涉及的主要泌尿外科器官选择了三个对照组（第1c组 - 单侧腹腔镜肾上腺切除术，第2c组 - 单侧腹腔镜根治性肾切除术，第3c组 - 单侧腹腔镜输尿管切开取石术）进行对比研究。分析了手术细节、住院时间和并发症。
32例患者在单次麻醉下接受了64例腹腔镜手术。本系列中最常见的手术是腹腔镜肾上腺切除术（n = 34），其次是腹腔镜肾切除术（n = 13）。与第1c组相比，第1组患者的手术时间延长（P = 0.012）且住院时间延长（P = 0.025）。然而，两组的失血量相当。第2组和第3组患者与各自对照组相比，手术时间、失血量和恢复期相当。术中，呼气末二氧化碳水平在允许范围内。所有手术均通过腹腔镜方法完成，无需中转。
对于选定的泌尿外科疾病患者，可同时进行腹腔镜手术，具有单次麻醉和住院的优势，且不增加发病率。
