James Buchanan Brady Department of Urology, New York Presbyterian-Weill Cornell Medical College, New York, New York, USA.
J Urol. 2010 Nov;184(5):2049-53. doi: 10.1016/j.juro.2010.06.138. Epub 2010 Sep 18.
We present our initial experience in 40 patients undergoing laparoendoscopic single site donor nephrectomy.
We prospectively collected data on 40 consecutive patients. A single access GelPOINT™ device was inserted into the abdomen through a 4 to 5 cm periumbilical incision. We used a bariatric camera with a right angle attachment for the light cord to maximize triangulation. Parameters analyzed included warm ischemia time, operative time, estimated blood loss, visual analog pain score, time to recipient creatinine less than 3 mg/dl, and recipient creatinine at discharge home, and 3 and 6 months.
A total of 38 left and 2 right donor nephrectomies were performed. Complete laparoendoscopic single site donor nephrectomy was successful in 38 cases. One left and 1 right case were converted to a hand assisted approach. Average ± SD body mass index was 26.1 ± 5.2 kg/m(2). Mean operative time to allograft extraction was 93.5 ± 27.5 minutes and mean total operative time was 166.7 ± 33.8 minutes. Average estimated blood loss was 106.7 ± 93.5 cc. Mean warm ischemia time was 3.96 ± 0.72 minutes. Mean hospital stay was 1.77 ± 0.43 days and median time to recipient creatinine less than 3.0 mg/dl was 54.2 ± 110.3 hours. Mean recipient creatinine at discharge home, and at 3 and 6 months was 1.48 ± 0.67, 1.29 ± 0.38 and 1.19 ± 0.34 mg/dl, respectively. Complications included hyponatremia in 1 patient, wound infection in 1, and a grade III laceration in an allograft that was sustained during extraction.
Our initial experience with laparoendoscopic single site donor nephrectomy is encouraging. This approach to kidney donation without an extra-umbilical incision could become particularly relevant to minimize morbidity in young, healthy organ donors.
我们介绍了 40 例行腹腔镜单部位供肾切取术患者的初步经验。
我们前瞻性地收集了 40 例连续患者的数据。通过脐周 4-5cm 的切口插入单个 GelPOINT™装置。我们使用带有直角附件的减肥相机来插入光绳，以最大限度地实现三角测量。分析的参数包括热缺血时间、手术时间、估计失血量、视觉模拟疼痛评分、受体肌酐低于 3mg/dl 的时间、受体出院回家时、3 个月和 6 个月时的肌酐以及受体肌酐。
共行 38 例左供肾切除术和 2 例右供肾切除术。38 例成功完成完全腹腔镜单部位供肾切除术。1 例左供肾切除术和 1 例右供肾切除术转为手助方法。平均±SD 体重指数为 26.1±5.2kg/m²。供体肾提取的平均手术时间为 93.5±27.5 分钟，总手术时间为 166.7±33.8 分钟。平均估计失血量为 106.7±93.5cc。平均热缺血时间为 3.96±0.72 分钟。平均住院时间为 1.77±0.43 天，受体肌酐低于 3.0mg/dl 的中位时间为 54.2±110.3 小时。出院回家时、3 个月和 6 个月时的平均受体肌酐分别为 1.48±0.67、1.29±0.38 和 1.19±0.34mg/dl。并发症包括 1 例低钠血症、1 例伤口感染和 1 例供体肾提取时发生的 III 级撕裂伤。
我们对腹腔镜单部位供肾切取术的初步经验令人鼓舞。这种不额外切开脐部的肾脏捐献方法可能尤其适用于减少年轻健康器官捐献者的发病率。
