Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
Urology. 2011 Jun;77(6):1353-8. doi: 10.1016/j.urology.2010.11.055. Epub 2011 Feb 26.
To review our perioperative complications during the first decade of using hand-assisted laparoscopic nephrectomy using a sleeve (HALN). HALN is a minimally invasive procedure first reported by our group in 1997.
After institutional review board approval, the charts of the patients who had undergone HALN, hand-assisted laparoscopic partial nephrectomy, or hand-assisted laparoscopic nephroureterectomy from 1997 to 2007, at our institution, were retrospectively reviewed. Standard laparoscopic procedures were not included. The relevant patient characteristics, operative details, American Society of Anesthesiologists score, body mass index, comorbidities, medications, and complications were recorded.
A total of 227 consecutive patients had undergone Hand-assisted laparoscopic renal surgery, and all their charts were reviewed. Of these 227, 134 were radical HALN, 37 were nonradical HALN, 42 were hand-assisted laparoscopic partial nephrectomy, and 15 were hand-assisted laparoscopic nephroureterectomy. Complications developed in 59 patients (26%): 8% major and 18% minor. The procedure-specific complication rate was 29% for radical HALN, 27% for nonradical HALN, 33% for hand-assisted laparoscopic nephroureterectomy, and 17% for hand-assisted laparoscopic partial nephrectomy. Complications included blood transfusion in 6%, urinary retention in 4%, ileus in 4%, and wound infection in 4%. From 2003 through 2007 (n = 163), our overall complication rate was 22% (8% major and 13% minor). From 1997 to 2002 (n = 65), the overall complication rate was 38% (P = .02). The American Society of Anesthesiologists score and the use of systemic steroids were associated with the occurrence of perioperative complications.
Our results have shown that hand assistance provides a safe, minimally invasive laparoscopic procedure. Our complications rates were comparable to those with other standard and hand-assist series, although the spectrum of complications varied. Hand-assisted laparoscopic renal surgery could be a method by which to improve patient access to minimally invasive nephron-sparing surgery.
回顾使用袖套式手助腹腔镜肾切除术（HALN）的首个十年期间我们的围手术期并发症。HALN 是我们小组于 1997 年首次报道的一种微创程序。
在机构审查委员会批准后，我们回顾了 1997 年至 2007 年期间在我院接受 HALN、手助腹腔镜部分肾切除术或手助腹腔镜肾输尿管切除术的患者的病历。不包括标准腹腔镜手术。记录了相关患者特征、手术细节、美国麻醉师协会评分、体重指数、合并症、药物和并发症。
共有 227 例连续患者接受了手助腹腔镜肾脏手术，所有患者的病历均被审查。在这 227 例患者中，134 例为根治性 HALN，37 例为非根治性 HALN，42 例为手助腹腔镜部分肾切除术，15 例为手助腹腔镜肾输尿管切除术。59 例患者出现并发症（26%）：8%为主要并发症，18%为次要并发症。根治性 HALN 的特定手术并发症发生率为 29%，非根治性 HALN 为 27%，手助腹腔镜肾输尿管切除术为 33%，手助腹腔镜部分肾切除术为 17%。并发症包括输血 6%，尿潴留 4%，肠梗阻 4%，伤口感染 4%。从 2003 年至 2007 年（n = 163），我们的总并发症发生率为 22%（8%为主要并发症，13%为次要并发症）。从 1997 年至 2002 年（n = 65），总并发症发生率为 38%（P =.02）。美国麻醉师协会评分和全身皮质类固醇的使用与围手术期并发症的发生有关。
我们的结果表明，手辅助提供了一种安全的微创腹腔镜手术。我们的并发症发生率与其他标准和手助系列相似，尽管并发症的范围有所不同。手助腹腔镜肾脏手术可能是一种使更多患者能够接受微创保肾手术的方法。
