Boni Luigi, Dionigi Gianlorenzo, Rovera Francesca, Di Giuseppe Matteo, Boggi Ugo, Pietrabissa Andrea, Dionigi Renzo
Minimally Invasive Surgery Research Center, Department of Surgical Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Viale Borri n.57, 21100 Varese, Italy.
Arch Surg. 2010 Jun;145(6):590-1. doi: 10.1001/archsurg.2010.94.
To present our personal technique for laparoscopic left nephrectomy for living donor transplant.
DESIGN, SETTING, AND PATIENT: The surgical technique is described in detail both in the text and in a commented video. The preoperative workup includes routine blood tests, chest radiography, electrocardiography, and high-definition abdominal computed tomographic angiography with 3-dimensional reconstruction to study the vascularization of the kidney. The patient is placed in right lateral decubitus, and 4 trocars are used.
The left colon is fully mobilized, the gonadic vessels and left ureter are identified, and the hilar vessels are dissected up to the origin on the renal artery from the aorta; the kidney is then mobilized. A 5- to 7-cm sovrapubic incision is made without entering the peritoneum, and a 15-mm laparoscopic bag is introduced through a small incision. The ureter and gonadic vessels are divided between clips and the main vessels are divided using an endoscopic stapler with a vascular cartridge. The kidney is quickly inserted in the endobag and removed through the sovrapubic incision.
The patients are allowed to drink the same day of the procedure, mobilized after 12 hours, and discharged on postoperative day 4 if no complications are recorded.
Laparoscopic left nephrectomy for living donor transplant can be safely performed with good results and an excellent postoperative course for the donor.
介绍我们用于活体供肾移植的腹腔镜左肾切除术的个人技术。
设计、地点和患者：手术技术在文本和带注释的视频中均有详细描述。术前检查包括常规血液检查、胸部X线摄影、心电图以及带有三维重建的高清腹部计算机断层血管造影，以研究肾脏的血管化情况。患者取右侧卧位，使用4个套管针。
充分游离左结肠，识别性腺血管和左输尿管，解剖肾门血管直至肾动脉在主动脉的起始处；然后游离肾脏。在不进入腹膜的情况下做一个5至7厘米的耻骨上切口，通过一个小切口置入一个15毫米的腹腔镜袋。输尿管和性腺血管在夹子间离断，主要血管使用带血管钉仓的内镜吻合器离断。肾脏迅速放入内袋，通过耻骨上切口取出。
患者在手术当天即可饮水，12小时后可活动，若未记录到并发症，则在术后第4天出院。
用于活体供肾移植的腹腔镜左肾切除术可以安全实施，效果良好，供体术后病程极佳。
