Wu Zhonghua, Xu Youming, Yu Jianhua, Chen Jiushun, Liu Jin, Wang Shaoliang, Chen Kan
Department of Urology, Hubei Provincial Corps Hospital , Chinese People's Armed Police Forces, Wuhan, China .
J Endourol. 2014 Nov;28(11):1328-32. doi: 10.1089/end.2014.0279. Epub 2014 Jul 21.
To report our experience and assess the feasibility and safety of laparoendoscopic single-site (LESS) retroperitoneoscopic nephrectomy for giant hydronephrosis.
Between July 2011 and April 2013, 22 patients underwent LESS retroperitoneoscopic nephrectomy for giant hydronephrosis with nonfunctioning kidneys. A reusable elastic single-port device was inserted through the 2.5-cm incision at the midpoint between the costal arch and iliac crest on the midaxillary line. A rigid, 10-mm, 30° extra-long laparoscope was introduced for monitoring, and a combination of lengthened prebent and conventional laparoscopic instruments was used for handling. The operation procedure was similar to the conventional retroperitoneal laparoscopic nephrectomy.
LESS retroperitoneoscopic nephrectomy was completed in all patients without conversion to open surgery and the additional placement of ports. The mean operative time was 98 minutes (range 77-146), and estimated blood loss was 45 mL (range 20-120). No major intraoperative complications occurred. The postoperative period was uneventful in all patients and the mean hospital stay was 3.4 days (range 2-7).
LESS retroperitoneoscopic nephrectomy for giant hydronephrosis is technically feasible and safe for selected patients. The combination of conventional and prebent laparoscopic instruments represents an attractive option for retroperitoneoscopic LESS.
报告我们对于巨大肾积水患者行腹腔镜下单点（LESS）后腹腔镜肾切除术的经验，并评估其可行性和安全性。
2011年7月至2013年4月期间，22例巨大肾积水且患肾无功能的患者接受了LESS后腹腔镜肾切除术。通过腋中线肋弓与髂嵴中点处2.5厘米的切口插入一个可重复使用的弹性单孔装置。引入一个10毫米、30°的硬质超长腹腔镜用于监测，并使用加长预弯腹腔镜器械和传统腹腔镜器械相结合的方式进行操作。手术步骤与传统后腹腔镜肾切除术相似。
所有患者均成功完成LESS后腹腔镜肾切除术，无一例转为开放手术或额外增加穿刺孔。平均手术时间为98分钟（范围77 - 146分钟），估计失血量为45毫升（范围20 - 120毫升）。术中无重大并发症发生。所有患者术后恢复顺利，平均住院时间为3.4天（范围2 - 7天）。
对于部分合适的患者，LESS后腹腔镜肾切除术治疗巨大肾积水在技术上是可行且安全的。传统腹腔镜器械与预弯腹腔镜器械相结合是后腹腔镜LESS的一个有吸引力的选择。
