Ma L, Ye J, Tian X, Wang G, Hou X, Zhao L
Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Transplant Proc. 2010 Nov;42(9):3440-3. doi: 10.1016/j.transproceed.2010.08.068.
The objective of this article is to report a single-center experience and technical modifications of retroperitoneoscopic live donor nephrectomy (RPLDN).
One hundred twenty-one 3-port RPLDNs were performed at our institution. No prisoners or organs from prisoners were used to collect the data for this study. The tributaries of renal artery and vein were transected using a harmonic scalpel after both ends of the tributary were coagulated intermittently until the color turned light yellow. Transection was made using shifting coagulation. A longitudinal 6-8-cm skin incision was extended inferiorly from the primary trocar with muscles intact. The renal artery was clipped using two Hem-o-Lok clips at the proximal end, and then sheared by scissors without any clips on the kidney side. The renal vein was controlled similarly. The graft was retrieved by insertion of a hand through the longitudinal lumbar incision.
The mean operative time and warm ischemia time were 126.1 and 3.6 minutes, respectively. No blood transfusion or open conversion was required. None of the donors encountered a major complication, but 7 suffered minor complications. Preoperative and postoperative mean serum creatinine levels of the donors were 1.00 and 1.29 mg/dL, respectively. The mean serum creatinine levels of the recipients postoperatively at day 1 and month 1 were 5.48 and 1.60 mg/dL, respectively.
The modified approach of RPLDN may be a useful alternative with flexible control of the renal vessels and tributaries and easy retrieval of the graft.
本文旨在报告单中心后腹腔镜活体供肾切除术（RPLDN）的经验及技术改进。
我们机构共进行了121例三孔RPLDN手术。本研究未使用囚犯或来自囚犯的器官收集数据。肾动静脉分支两端间歇性凝固直至颜色变为浅黄色后，使用超声刀切断。采用交替凝固进行切断。从主套管向下延伸6 - 8厘米的纵向皮肤切口，肌肉保持完整。肾动脉近端用两个Hem - o - Lok夹夹闭，然后在肾侧无夹的情况下用剪刀剪断。肾静脉采用同样方法处理。通过经纵向腰部切口插入手来取出移植物。
平均手术时间和热缺血时间分别为126.1分钟和3.6分钟。无需输血或转为开放手术。所有供者均未发生严重并发症，但7例出现轻微并发症。供者术前和术后平均血清肌酐水平分别为1.00和1.29mg/dL。受者术后第1天和第1个月的平均血清肌酐水平分别为5.48和1.60mg/dL。
改良的RPLDN方法可能是一种有用的替代方法，对肾血管和分支的控制灵活，移植物取出容易。
