Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Urol. 2011 Mar;185(3):1021-5. doi: 10.1016/j.juro.2010.10.084. Epub 2011 Jan 19.
We explored the safety and reproducibility of hand assisted laparoscopic bilateral native nephrectomy. We also present our improvements to the surgical technique.
We retrospectively reviewed the charts of 36 patients who underwent hand assisted laparoscopic bilateral nephrectomy at our institution between 2003 and 2010. In all cases the 2 kidneys were removed transperitoneally via a hand assisted laparoscopic technique.
Mean operative time was 222 minutes. Pathological kidney size was 20 to 34 cm. Mean hospital stay was 3 days (range 1 to 13). Average estimated blood loss was 175 cc (range 50 to 200). No patient required intraoperative blood transfusion. There were no intraoperative complications and no conversions to open surgery. Postoperatively complications developed in 8 patients (22%), including temporary adrenal insufficiency and pulmonary embolism in 1 each, and myocardial infarction, superficial wound infection and loss of arteriovenous fistula function in 2 each. According to the Clavien-Dindo classification complications were grades 1, 2, 3 and 4a in 2, 3, 1 and 2 patients, respectively. A total of 18 patients with kidney transplants continued to have normal graft function after surgery.
Simultaneous hand assisted bilateral nephrectomies are safe and reproducible. The complication rate is low and postoperative hospital stay is short compared to those in published open surgery series. Graft function was preserved in patients who underwent renal transplantation before native kidney removal.
我们探索了手助腹腔镜双侧原位肾切除术的安全性和可重复性。我们还介绍了我们对手术技术的改进。
我们回顾性分析了 2003 年至 2010 年在我院接受手助腹腔镜双侧肾切除术的 36 例患者的病历。所有病例均通过手助腹腔镜技术经腹腔切除双侧肾脏。
平均手术时间为 222 分钟。病理肾大小为 20 至 34cm。平均住院时间为 3 天（范围 1 至 13 天）。平均估计失血量为 175cc（范围 50 至 200cc）。无患者需要术中输血。无术中并发症，无中转开放手术。术后 8 例（22%）发生并发症，包括 1 例暂时性肾上腺功能不全和肺栓塞，2 例心肌梗死，2 例浅表伤口感染和动静脉瘘功能丧失。根据 Clavien-Dindo 分类，并发症分别为 2 例 1 级、3 例 2 级、1 例 3 级和 2 例 4a 级。18 例接受肾移植的患者在手术后继续保持正常移植物功能。
同期手助腹腔镜双侧肾切除术安全、可重复。与已发表的开放手术系列相比，并发症发生率低，术后住院时间短。在切除原肾之前接受肾移植的患者保留了移植物功能。
