Department of Surgery, Chiba-east National Hospital, 673 Nitona, Chuo-ku, Chiba 2608712, Japan.
J Hepatobiliary Pancreat Sci. 2010 Mar;17(2):193-6. doi: 10.1007/s00534-009-0247-7. Epub 2010 Jan 19.
The simultaneous transplantation of pancreas and kidney from live donors is performed in select countries. One of the reasons for this reduced applicability is the invasiveness of the donor operation. We propose the method of laparoscopic-assisted operation to be performed on live donors with minimal invasion.
The donor was placed in the right lateral decubitus position. A 7-cm upper midline incision was made, and a handport was installed in addition to two or three 12-mm ports. After the removal of the left kidney graft, the spleen and the distal part of the pancreas were completely mobilized. The splenic vein and artery were identified and mobilized. The donor was then rotated to a supine position. Dissection of the pancreatic parenchyma using ultrasound shears and ligation of the splenic vessels were performed through midline incision under direct vision. The distal part of the pancreas and the spleen were extracted.
Since December 2007, 3 donors have undergone this operation. In all 3 cases, the postoperative course was uneventful, and both the renal and pancreatic grafts functioned well.
This technique is minimally invasive and safe, and may become the standard method of live donor operation for simultaneous pancreas-kidney transplantation.
在一些国家，会从活体供者同时移植胰腺和肾脏。这种方法适用范围有限的原因之一是供者手术具有侵入性。我们提出了一种微创的腹腔镜辅助手术方法。
供者取右侧卧位，取上腹部正中 7cm 切口，安装一个手操作孔和两个或三个 12mm 操作孔。在切除左肾移植物后，充分游离脾脏和胰体尾部。识别和游离脾静脉和动脉。然后将供者旋转至仰卧位，通过正中切口直视下使用超声刀解剖胰腺实质并结扎脾血管。切除胰体尾部和脾脏。
自 2007 年 12 月以来，已有 3 例供者接受了这种手术。在所有 3 例中，术后过程均顺利，且肾和胰腺移植物功能良好。
这种技术微创、安全，可能成为同时胰腺-肾脏移植活体供者手术的标准方法。
