James Buchanan Brady Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
J Urol. 2011 Dec;186(6):2333-7. doi: 10.1016/j.juro.2011.07.071. Epub 2011 Oct 20.
Laparoendoscopic single site surgery is a recent advance in minimally invasive urology. We report outcomes from our initial 100 consecutive laparoendoscopic single site live donor nephrectomies done by a single surgeon and provide a matched comparison of conventional laparoscopic live donor nephrectomies done by the same surgeon.
From 2009 to 2010 at a tertiary referral center 100 consecutive laparoendoscopic single site live donor nephrectomies were performed by a single surgeon through a periumbilical incision using the GelPoint® system. No extraumbilical incisions or punctures were made. A retrospective review was performed using a prospectively managed database of standard perioperative and convalescent parameters. Comparison was made using a matched cohort of conventional live donor nephrectomies done by the same surgeon.
Mean operative time was longer in the laparoendoscopic single site group (156 vs 130 minutes) but there was no difference in estimated blood loss or warm ischemia time. There was no difference in the complication rate between the 2 groups. Mean hospital stay and visual analog pain scores were similar in the groups but the laparoendoscopic group showed improved convalescence with faster return to work, normal activity and 100% recovery. Recipient graft function was equivalent in the 2 groups.
In this retrospective, matched comparison laparoendoscopic single site live donor nephrectomy was associated with longer operative time but equivalent recipient graft function and improved convalescence. The benefits of laparoendoscopic single site surgery over conventional laparoscopy may be limited. However, with respect to live donor nephrectomy the benefits of laparoendoscopic single site surgery may nevertheless prove beneficial to decrease barriers to live organ donation.
腹腔镜单部位手术是微创泌尿外科的一项新进展。我们报告了由一位外科医生完成的最初 100 例腹腔镜单部位活体供肾切除术的结果，并对同一外科医生进行的传统腹腔镜活体供肾切除术进行了匹配比较。
在 2009 年至 2010 年期间，在一家三级转诊中心，一位外科医生通过脐部切口使用 GelPoint®系统完成了 100 例连续的腹腔镜单部位活体供肾切除术。未进行额外的脐部切口或穿刺。使用标准围手术期和恢复期参数的前瞻性管理数据库进行回顾性审查。使用同一外科医生进行的传统活体供肾切除术的匹配队列进行比较。
腹腔镜单部位组的平均手术时间较长（156 分钟对 130 分钟），但估计出血量或热缺血时间无差异。两组的并发症发生率无差异。两组的平均住院时间和视觉模拟疼痛评分相似，但腹腔镜组的恢复期更快，更快恢复工作、正常活动和 100%恢复。两组受者移植物功能相当。
在这项回顾性匹配比较中，腹腔镜单部位活体供肾切除术与较长的手术时间相关，但受者移植物功能相当，恢复期改善。腹腔镜单部位手术相对于传统腹腔镜手术的优势可能有限。然而，就活体供肾切除术而言，腹腔镜单部位手术的优势可能有助于降低活体器官捐献的障碍。
