Department of Urology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2010 May;65(5):507-10. doi: 10.1590/S1807-59322010000500008.
We describe the results of over one hundred nephrectomies performed using a subcostal mini incision.
A major effort has been undertaken to encourage living donor renal transplantation. New techniques that use minimally invasive approaches to perform donor nephrectomy have been progressively accepted. Among these new procedures is the mini-incision approach.
We prospectively analyzed one hundred and seventeen consecutive donors that were subjected to subcostal mini-incision nephrectomy at a single center. Surgical time, warm and cold ischemia time, intraoperative complications, time until hospital discharge, presence of infection, bleeding, the need for a second operation, and death were analyzed. Eventual loss of donor renal function was indicated by increases in serum creatinine and proteinuria.
The mean time of surgery was 180.5 +/- 26.2 minutes. The mean warm ischemia time was 93 +/-8.3 seconds, while the mean cold ischemia time was 85.9 (+/-23.5) minutes. We had one case with an intraoperative complication, and only two patients required another operation. An intra-abdominal abscess occurred in one patient (0.85%), proteinuria occurred in one patient (0.85%), and a transitory increase of creatinine levels occurred in two patients (1.7%).
Reducing the length of the abdominal incision did not influence surgical time or result in an increase in intraoperative complications relative to our historical data or literature reports. Organ preparation was accomplished successfully with a brief warm ischemia time. Additionally, the mean hospital stay was short, and few surgical complications occurred.
The use of a subcostal mini incision is both safe and similar to conventional techniques previously described in the literature.
我们描述了使用肋缘下小切口进行的一百多次肾切除术的结果。
为鼓励活体供肾移植，我们做出了巨大的努力。使用微创方法进行供肾切除术的新技术已经逐渐被接受。这些新程序中包括小切口方法。
我们在一个中心前瞻性地分析了 117 例连续接受肋缘下小切口肾切除术的供者。分析了手术时间、热缺血和冷缺血时间、术中并发症、住院时间、感染、出血、需要再次手术以及死亡的情况。供体肾功能丧失最终表现为血清肌酐和蛋白尿升高。
手术时间平均为 180.5+/-26.2 分钟。平均热缺血时间为 93+/-8.3 秒，平均冷缺血时间为 85.9+/-23.5 分钟。我们有 1 例术中并发症，仅 2 例需要再次手术。1 例患者发生腹腔脓肿（0.85%），1 例患者出现蛋白尿（0.85%），2 例患者肌酐水平短暂升高（1.7%）。
与我们的历史数据或文献报告相比，减少腹部切口长度并未影响手术时间或导致术中并发症增加。通过短暂的热缺血时间成功完成了器官准备。此外，平均住院时间较短，手术并发症较少。
使用肋缘下小切口既安全又与文献中先前描述的常规技术相似。
