García-Tello Ana, Cabrera Pedro M, Cáceres Felipe, Ramón de Fata Fernando, Mateo Erika, Angulo Javier C
Department of Urology, Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid , Madrid , Spain.
Scand J Urol. 2014 Jun;48(3):301-8. doi: 10.3109/21681805.2013.876096. Epub 2014 Jan 21.
The aims of this study were to present cumulative experience with umbilical laparoendoscopic urological surgery using a reusable device and to evaluate outcomes and complications in the first 100 patients.
Patients undergoing umbilical surgery with the KeyPort system and DuoRotate instruments (Richard Wolf, Knittlingen, Germany) were evaluated prospectively. Demographic, intraoperative and postoperative data were assessed.
Between October 2011 and July 2012, 79 pelvic (66 radical prostatectomy, 10 radical cystectomy, one diverticulectomy, one bilateral orchiectomy, one ureter reimplantation) and 21 renal (seven radical nephrectomy, six partial nephrectomy, five nephroureterectomy, two pyeloplasty, one pyelolithotomy) surgeries were performed through the umbilicus using this platform. Follow-up was 56.7 ± 12.6 weeks (mean ± SD). Mean age was 64.3 ± 10.3 years, body mass index 29 ± 4.6 kg/m(2), operative time 232 ± 106 min and estimated blood loss 260 ± 95 ml. Conversion to standard multiport laparoscopy was not necessary. An accessory port was used in 87 cases to facilitate suturing and conduct drainage extraction. Postoperative complications occurred in 24 cases (six Clavien grade I, 12 grade II, one grade IIIa, two grade IIIb, two grade IVa, one grade IVb). Mean hospital stay was 4.2 ± 4 days. Total transfusion rate was 10%. Mean visual analogue pain scale at day 2 was 2.1 ± 1.3 (0-10). Visual analogue wound satisfaction scale at month 1 was 9.2 ± 0.6 (0-10). No cancer-related events occurred during follow-up. Late complications (4%) were not related to the surgical approach.
Umbilical KeyPort surgery is technically feasible for a great variety of procedures, both ablative and reconstructive. This access offers adequate surgical outcomes, scarce postoperative pain and security for the patient in the short term. Its reusable nature implies a noticeable economic advantage.
本研究旨在介绍使用可重复使用设备进行脐部腹腔镜泌尿外科手术的累积经验，并评估前100例患者的手术效果及并发症。
对采用KeyPort系统和DuoRotate器械（德国克尼廷根的理查德·沃尔夫公司）进行脐部手术的患者进行前瞻性评估。评估人口统计学、术中及术后数据。
2011年10月至2012年7月期间，使用该平台经脐部进行了79例盆腔手术（66例根治性前列腺切除术、10例根治性膀胱切除术、1例憩室切除术、1例双侧睾丸切除术、1例输尿管再植术）和21例肾脏手术（7例根治性肾切除术、6例部分肾切除术、5例肾输尿管切除术、2例肾盂成形术、1例肾盂切开取石术）。随访时间为56.7±12.6周（均值±标准差）。平均年龄为64.3±10.3岁，体重指数为29±4.6kg/m²，手术时间为232±106分钟，估计失血量为260±95ml。无需转为标准多端口腹腔镜手术。87例患者使用了辅助端口以方便缝合和引流管拔除。24例患者发生术后并发症（6例Clavien I级、12例II级、1例IIIa级、2例IIIb级、2例IVa级、1例IVb级）。平均住院时间为4.2±4天。总输血率为10%。术后第2天视觉模拟疼痛量表平均评分为2.1±1.3（0-10分）。术后第1个月视觉模拟伤口满意度量表评分为9.2±0.6（0-10分）。随访期间未发生与癌症相关的事件。晚期并发症发生率为4%，与手术方式无关。
脐部KeyPort手术在技术上对于多种消融性和重建性手术均可行。这种入路方式可提供良好的手术效果，术后疼痛轻微，短期内对患者安全。其可重复使用的特性具有显著的经济优势。
