Brockschmidt C, Kaltenmeier C, Köksal E, Mayer B, Henne-Bruns D, Wittau M
Department of General and Visceral Surgery, University of Ulm, Ulm, Germany.
Department of General and Visceral Surgery, University of Ulm, Ulm, Germany.
Transplant Proc. 2014 Jun;46(5):1286-9. doi: 10.1016/j.transproceed.2013.12.064.
During the last 15 years, there was tremendous progress in minimally invasive surgery and minimal-access surgery. Many conventional surgical procedures were replaced by these techniques, resulting in a wide range of benefits for the patients. In kidney transplantation, many centers choose an approach to the iliac fossa through an oblique or J-shaped incision. This might have possible disadvantages due to the extent of tissue trauma. Thus, we introduced a minimal-access kidney transplantation technique (MAKT) as a transplantation method in our center. We retrospectively analyzed this technique used for 11 living-donor kidney transplants and report here our experience.
From April 2008 to July 2011, 11 living-donor kidney recipients were subjected to the MAKT and were matched (age, sex) with a historical group from our center from 2000 to 2007. To analyze the assumption of noninferiority of the MAKT in comparison to the standard approach, a matched case-control study design was chosen, with creatinine level at 1 year after transplantation as the primary outcome variable. We used a Wilcoxon signed rank test; 1-sided significance level was 2.5%.
Eleven recipients were included. Both groups were almost similar regarding age and body mass index. Characteristics of the procedure were significantly different only for cold ischemic time (114 minutes MAKT vs 77 minutes historical group). In the MAKT group, there were no reinterventions necessary, no wound infections, no incisional hernia, no acute rejection episodes, no graft losses, and 2 lymphoceles occurred. Further, no urinary leakage or ureteral stenosis and no vascular complications were observed. The statistical analysis of the primary endpoint revealed a noninferiority of the MAKT technique (P = .0005).
Considering the fact that this is an initial series and a retrospective analysis, the applied MAKT technique seems to be safe in terms of both graft function after 1 year and surgical complications.
在过去15年中，微创手术和小切口手术取得了巨大进展。许多传统外科手术被这些技术所取代，给患者带来了广泛益处。在肾移植中，许多中心选择通过斜切口或J形切口进入髂窝。由于组织创伤程度，这可能存在潜在缺点。因此，我们在本中心引入了一种小切口肾移植技术（MAKT）作为移植方法。我们回顾性分析了该技术用于11例活体供肾移植的情况，并在此报告我们的经验。
2008年4月至2011年7月，11例活体供肾受者接受了MAKT手术，并与本中心2000年至2007年的一个历史组（年龄、性别匹配）进行比较。为分析MAKT与标准方法相比的非劣效性假设，选择了匹配病例对照研究设计，将移植后1年的肌酐水平作为主要结局变量。我们使用了Wilcoxon符号秩检验；单侧显著性水平为2.5%。
纳入11例受者。两组在年龄和体重指数方面几乎相似。手术特征仅在冷缺血时间上有显著差异（MAKT组为114分钟，历史组为77分钟）。在MAKT组中，无需再次干预，无伤口感染、切口疝、急性排斥反应、移植肾丢失，发生了2例淋巴囊肿。此外，未观察到尿漏、输尿管狭窄和血管并发症。主要终点的统计分析显示MAKT技术具有非劣效性（P = 0.0005）。
考虑到这是一个初始系列且为回顾性分析，就1年后的移植肾功能和手术并发症而言，所应用的MAKT技术似乎是安全的。
