Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065, USA.
Urology. 2011 Jun;77(6):1365-9. doi: 10.1016/j.urology.2010.09.064. Epub 2011 Mar 12.
To present our initial experience with right-sided laparoendoscopic single-site donor nephrectomy (LESS-RDN). Laparoendoscopic single-site (LESS) donor nephrectomy, although in its infancy, represents a potential exciting advancement over conventional laparoscopic donor nephrectomy (LDN). Almost all of the reported cases thus far have been left-sided kidneys.
Between August 2009 and June 2010, a total of 85 consecutive LESS DN were performed. Of these, 6 (7%) were LESS-RDN. Donor outcomes analyzed included operative time, estimated blood loss, complications, visual analog pain scores, and recovery time. Renal vein lengths were measured on preoperative computed tomography scans. Recipient outcomes analyzed included recipient creatinine at discharge and at 1 and 3 months. All data were prospectively accrued in an institutional review board-approved database.
Five LESS-RDN were successfully performed. One case was converted to hand-assisted laparoscopy to optimize hilar dissection. The mean (± SE) operative time until allograft extraction was 89 ± 5.1 minutes, total operative time was 146 ± 12.8 minutes, warm ischemia time was 3.9 ± 0.2 minutes, and estimated blood loss was 92 ± 27 mL. The mean renal vein length was 2.7 ± 0.3 cm. There were no perioperative complications. All allografts functioned after transplantation. When compared with a matched cohort of LESS-LDN, there was no difference in allograft function at discharge and at 1 and 3 months.
Although technically challenging, LESS-RDN in experienced hands can be performed safely and should be considered as an alternative if it is the preferred kidney for transplantation.
介绍我们在右侧经腹腔镜单部位供肾切取术（LESS-RDN）方面的初步经验。虽然经腹腔镜单部位（LESS）供肾切取术尚处于起步阶段，但它代表了一种相对于传统腹腔镜供肾切取术（LDN）的潜在令人兴奋的进步。迄今为止，几乎所有报道的病例都是左侧肾脏。
2009 年 8 月至 2010 年 6 月，共进行了 85 例连续的 LESS-DN，其中 6 例（7%）为 LESS-RDN。分析了供者的手术时间、估计失血量、并发症、视觉模拟疼痛评分和恢复时间等结果。术前 CT 扫描测量肾静脉长度。分析了受者的出院时和 1 个月、3 个月时的肌酐水平。所有数据均前瞻性地纳入机构审查委员会批准的数据库中。
5 例 LESS-RDN 手术成功完成。1 例转为手助腹腔镜以优化肾门解剖。供肾取出的平均（± SE）手术时间为 89±5.1 分钟，总手术时间为 146±12.8 分钟，热缺血时间为 3.9±0.2 分钟，估计失血量为 92±27ml。平均肾静脉长度为 2.7±0.3cm。无围手术期并发症。所有移植物在移植后均能正常工作。与 LESS-LDN 相匹配的队列相比，在出院时和 1 个月、3 个月时的移植物功能无差异。
虽然具有挑战性，但在有经验的医生手中，LESS-RDN 可以安全地进行，并且如果它是首选的移植肾，应考虑作为一种替代方法。
