Pak Chul-Ho, Baik Seung, Kim Chul Sung
Department of Urology, Chosun University College of Medicine, Gwangju, Korea.
Korean J Urol. 2011 Dec;52(12):842-6. doi: 10.4111/kju.2011.52.12.842. Epub 2011 Dec 20.
To report our initial clinical experience and perioperative outcomes of retroperitoneal laparoendoscopic single-site surgery (RLESS) for upper urinary tract surgery.
Between June 2009 and October 2010, we performed RLESS in 23 patients for various indications including radical nephrectomy (n=4), nephroureterectomy (n=2), simple nephrectomy (n=10), and renal cyst ablation (n=7). RLESS was performed with a homemade single-port device with a conventional rigid laparoscopic instrument and laparoscope. The parameters analyzed were age, body mass index, operative time, estimated blood loss, transfusion, time of oral intake, visual analogue pain scale score (VAPS), length of hospital stay, and complications.
One case of simple nephrectomy was converted to open nephrectomy because of severe adhesion and inadequate surgical exposure. RLESS was completed in 23 patients. Mean operative time was 168.7±29.2, 227.5±50.0, 230.0±56.5, and 70.5±8.9 minutes for simple nephrectomy, radical nephrectomy, nephroureterectomy, and renal cyst ablation, respectively. Estimated blood loss was 113.0±149.8, 170.0±156.8, 400.0±141.4, and 22.8±16.0 ml. The time to oral intake after surgery was 1.4±0.5, 1.2±0.5, 1.5±0.7, and 1.1±0.3 days. The mean VAPS score was 1.1±0.2, 2.1±0.5, 2.0±0.5, and 1.0±0.0 of 10 (range, 0.8 to 2.6). The hospital stay was 4.6±1.5, 3.7±0.5, 6.0±1.4, and 3.2±1.7 days. No major perioperative complications were observed.
The initial outcomes of our experience suggest that RLESS is a technically feasible and safe procedure for upper urinary tract surgery. Prospective comparative studies with conventional retroperitoneal laparoscopic surgery are needed to confirm the potential benefits of RLESS.
报告我们在上尿路手术中应用腹膜后腹腔镜单孔手术（RLESS）的初步临床经验及围手术期结果。
2009年6月至2010年10月，我们对23例患者实施了RLESS手术，适应证包括根治性肾切除术（n = 4）、肾输尿管切除术（n = 2）、单纯肾切除术（n = 10）和肾囊肿消融术（n = 7）。RLESS手术使用自制单孔装置及传统硬性腹腔镜器械和腹腔镜进行。分析的参数包括年龄、体重指数、手术时间、估计失血量、输血情况、经口进食时间、视觉模拟疼痛量表评分（VAPS）、住院时间及并发症。
1例单纯肾切除术因严重粘连及手术视野暴露不佳中转开放手术。其余23例患者成功完成RLESS手术。单纯肾切除术、根治性肾切除术、肾输尿管切除术和肾囊肿消融术的平均手术时间分别为168.7±29.2、227.5±50.0、230.0±56.5和70.5±8.9分钟。估计失血量分别为113.0±149.8、170.0±156.8、400.0±141.4和22.8±16.0毫升。术后经口进食时间分别为1.4±0.5、1.2±0.5、1.5±0.7和1.1±0.3天。平均VAPS评分为1.1±0.2、2.1±0.5、2.0±0.5和1.0±0.0（满分10分，范围0.8至2.6）。住院时间分别为4.6±1.5、3.7±0.5、6.0±1.4和3.2±1.7天。未观察到重大围手术期并发症。
我们的初步经验表明，RLESS在上尿路手术中是一种技术上可行且安全的手术方法。需要进行与传统腹膜后腹腔镜手术的前瞻性对比研究，以证实RLESS的潜在优势。
