Urology Unit, S Pio da Pietrelcina Hospital, Vasto, CH, Italy.
J Endourol. 2010 Dec;24(12):1997-2002. doi: 10.1089/end.2010.0313. Epub 2010 Oct 21.
Nephron-sparing surgery (NSS) ensures excellent oncologic and functional outcomes in small renal masses. Laparoendoscopic single-site surgery (LESS) is one of the major advances in the evolution of minimally invasive surgery. We describe our initial surgical experience and assess the feasibility of LESS unclamp-NSS.
From April to September 2009, all consecutive patients with solitary, exophytic, enhancing, small (≤4.0 cm) renal masses and normal contralateral kidney were selected to receive LESS unclamp-NSS. A multichannel port provided intra-abdominal transperitoneal access. Rigid and articulable instruments were used for dissection, tumor exposure, and excision under normal renal perfusion. Perioperative, pathologic, hematologic data together with a subjective evaluation of pain and scar were collected and evaluated.
Six patients underwent LESS unclamp-NSS (mean operative time, 148 min; mean blood loss, 201 mL; mean renal masses size, 2.1cm). One patient needed conversion to standard laparoscopy because of excessive bleeding. Postoperatively, a cerebrovascular accident developed in one patient. No transfusion was necessary. Pathologic examination revealed two clear-cell carcinoma, three benign cysts, and one angiomyolipoma (surgical margin positive). A 2.7 g/dL hemoglobin level decrease was recorded with minimal pain and great patient satisfaction. Mean length of stay was 6 days.
LESS unclamp-NSS in selected renal masses is feasible, provides postoperative outcomes overlapping the standard counterpart, and ensures subjective satisfaction. Additional trocars should be considered for the hemostatic stitches and for liver retraction. A wider experience and longer follow-up are necessary to establish the role of this technique.
保肾手术（NSS）可确保小肾肿瘤的出色肿瘤学和功能结果。经腹腔镜单部位手术（LESS）是微创外科发展的主要进步之一。我们描述了我们的初始手术经验，并评估了 LESS 无夹闭保肾手术的可行性。
从 2009 年 4 月至 9 月，所有连续患有单发、外生性、增强、小（≤4.0cm）肾肿瘤且对侧肾脏正常的患者均选择接受 LESS 无夹闭保肾手术。多通道端口提供腹腔内经腹膜入路。使用刚性和可弯曲的器械在正常肾灌注下进行解剖、肿瘤暴露和切除。收集并评估围手术期、病理、血液学数据以及疼痛和疤痕的主观评估。
六名患者接受了 LESS 无夹闭保肾手术（平均手术时间为 148 分钟；平均失血量为 201 毫升；平均肾肿瘤大小为 2.1cm）。一名患者因过度出血而需要转为标准腹腔镜。术后，一名患者发生脑血管意外。无需输血。病理检查显示两个透明细胞癌，三个良性囊肿和一个血管平滑肌脂肪瘤（手术切缘阳性）。血红蛋白水平下降 2.7g/dL，疼痛轻微，患者满意度高。平均住院时间为 6 天。
在选定的肾肿瘤中进行 LESS 无夹闭保肾手术是可行的，可提供与标准手术相重叠的术后结果，并确保主观满意度。应该考虑增加其他套管针以进行止血缝线和肝脏牵拉。需要更广泛的经验和更长的随访时间来确定该技术的作用。
