Choi Kyung Hwa, Ham Won Sik, Rha Koon Ho, Lee Jae Won, Jeon Hwang Gyun, Arkoncel Francis Raymond P, Yang Seung Choul, Han Woong Kyu
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Korean J Urol. 2011 Jan;52(1):31-8. doi: 10.4111/kju.2011.52.1.31. Epub 2011 Jan 24.
We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution.
Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases.
Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma.
Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery.
我们报告了在单一机构中对171例因各种泌尿系统疾病接受腹腔镜单孔手术患者的经验。
2008年12月至2010年8月期间，我们连续进行了171例腹腔镜单孔手术。这些手术包括单纯肾切除术（n = 18；机器人手术，n = 1）、根治性肾切除术（n = 26；机器人手术，n = 2）、部分肾切除术（n = 59；机器人手术，n = 56）、肾输尿管切除术（n = 20；机器人手术，n = 12）、肾盂成形术（n = 4）、肾囊肿去顶减压术（n = 22）、肾上腺切除术（n = 4；机器人手术，n = 2）、输尿管切开取石术（n = 10）、部分膀胱切除术（n = 3）、输尿管切除术（n = 1）、脐尿管肿物切除术（n = 1）、睾丸切除术（n = 1）、精囊切除术（n = 1）和腹膜后肿物切除术（n = 1）。所有手术均使用自制的带伤口牵开器和手术手套的单孔装置进行。进行了一项前瞻性研究以评估171例患者的手术结果。
171例患者中，98例接受了传统腹腔镜单孔手术，73例接受了机器人辅助腹腔镜单孔手术。患者平均年龄为53岁，平均手术时间为190.8分钟，平均估计失血量为204毫升。术中并发症发生7例（4.1%），术后并发症发生9例（5.3%）。没有并发症被分类为IIIb级或更高（手术并发症的Clavien-Dindo分类）。7例（4.1%）患者转为小切口开放手术。关于肿瘤学结果，除1例尤因肉瘤侵袭性进展外，随访期间未发生与癌症相关的事件。
腹腔镜单孔手术对于各种泌尿系统疾病在技术上是可行且安全的；然而，需要手术经验和长期随访来检验腹腔镜单孔手术的优越性。
