Ganpule Arvind P, Mishra Shashikant, Sabnis Ravindra
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Indian J Urol. 2012 Jan;28(1):65-70. doi: 10.4103/0970-1591.94960.
A donor would prefer a minimally invasive procedure because of lesser morbidity, this may be the reason that laparoscopic donor nephrectomy (LDN) rates have exponentially increased. The rationale dictates that a virtually scarless surgery would be most beneficial to this patient subgroup. In this article, we review the approach, instrumentation, dissection and retrieval issues and the results of laparoendoscopic single-site donor nephrectomy (LESS-DN). The existing literature on LESS-DN was reviewed in Pubmed. The various access sites described for LESS-DN include the umbilicus and Pfannenstiel incision. The steps of LESS-DN duplicate those of standard LDN. There is a paucity of studies comparing LESS-DN with LDN, particularly randomized studies. The most challenging step of LESS-DN is graft retrieval. Authors have described a variety of methods for graft retrieval which include manual methods, and those using retrieval bags. In the majority of the studies, the graft retrieval time is longer in comparison to standard LDN. However, the graft outcome in recipients is comparable. In this article, we also allude to the complications mentioned in various series. LESS-DN is currently an evolving procedure. The procedure requires a high level of skills in laparoscopic surgery. The choice of access site, access site ports and the type of instruments to be used is a matter of surgeon preference. Although the warm ischemia time in most of the series is longer in LESS-DN, this has not translated into poor recipient outcomes. Further work needs to be done to make the retrieval quick.Current literature from comparative studies with standard LDN suggests that the results in terms of graft outcome are comparable.
由于发病率较低，供体更倾向于选择微创手术，这可能是腹腔镜供肾切除术（LDN）的比例呈指数级增长的原因。理论表明，几乎无疤痕的手术对该患者亚组最为有益。在本文中，我们回顾了经自然腔道内镜下单孔供肾切除术（LESS-DN）的入路、器械、解剖和取出问题以及结果。通过在Pubmed上检索关于LESS-DN的现有文献。LESS-DN所描述的各种入路部位包括脐部和耻骨上横切口。LESS-DN的步骤与标准LDN相同。比较LESS-DN与LDN的研究较少，尤其是随机研究。LESS-DN最具挑战性的步骤是移植物取出。作者描述了多种移植物取出方法，包括手动方法和使用取出袋的方法。在大多数研究中，与标准LDN相比，移植物取出时间更长。然而，受体的移植物结果相当。在本文中，我们还提及了各系列中提到的并发症。LESS-DN目前是一种不断发展的手术。该手术需要高水平的腹腔镜手术技能。入路部位、入路部位端口和使用的器械类型由外科医生自行选择。尽管在大多数系列中，LESS-DN的热缺血时间较长，但这并未导致受体预后不良。需要进一步开展工作以使取出过程更快。与标准LDN的比较研究的现有文献表明，移植物结果方面的结果相当。
