Adiyat Kishore Thekke, Tharun B K, Shetty Abijit, Samavedi Srinivas
Deapartment of Urology, Medical Trust Hospital, Cochin, Kerala, India.
Indian J Urol. 2013 Jul;29(3):184-7. doi: 10.4103/0970-1591.117279.
We compare the outcome of three different methods of graft extraction after a laparoscopic donor nephrectomy.
AFTER A CONVENTIONAL FIVE PORT LAPAROSCOPIC DONOR NEPHRECTOMY, SPECIMEN WAS EXTRACTED THROUGH ONE OF THREE APPROACHES: 1. Iliac fossa (IF) incision and hand extraction, 2. Midline (MD) periumbilical with a lower polar fat stitch incorporating gonadal vein for traction while retrieval, and 3. Pfannensteil (PF) with Gel port extraction. Estimated blood loss, operating time, warm ischemia time, incision length, pain score, analgesic consumption, hospital stay, wound complications, graft complications and recipient creatinine at 6 weeks were analyzed.
Warm ischemia time was significantly reduced in PF group when compared to other groups. Length of the incision was less in the MD group compared to other groups. Wound complications were significantly less in PF group when compared to other groups. Graft extraction complications were significantly high in MD group compared to other two groups.
Based on the results obtained, our current method of preference is by Pfannensteil incision. A controlled extraction with the use of a hand assist device would be best for donor safety and to avoid graft related complications.
我们比较了腹腔镜供肾切除术后三种不同移植物取出方法的结果。
在进行传统的五孔腹腔镜供肾切除术后，通过以下三种方法之一取出标本：1. 髂窝（IF）切口并手动取出；2. 脐周中线切口，在取出时采用包含性腺静脉的下极脂肪缝线进行牵引；3. 经耻骨上横切口（PF）并使用凝胶端口取出。分析了估计失血量、手术时间、热缺血时间、切口长度、疼痛评分、镇痛药物用量、住院时间、伤口并发症、移植物并发症以及术后6周时受者的肌酐水平。
与其他组相比，PF组的热缺血时间显著缩短。与其他组相比，MD组的切口长度较短。与其他组相比，PF组的伤口并发症显著较少。与其他两组相比，MD组的移植物取出并发症显著较高。
基于所获得的结果，我们目前首选的方法是经耻骨上横切口。使用手辅助装置进行控制性取出对于供者安全以及避免移植物相关并发症最为有利。
