Micali Salvatore, Zordani Alessio, Galli Riccardo, Martorana Eugenio, Piccoli Micaela, Cappelli Gianni, Bianchi Giampaolo
Policlinico di Modena, Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena 41124, Italy.
BMC Urol. 2014 Oct 13;14:80. doi: 10.1186/1471-2490-14-80.
Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the morbidity and scarring associated with laparoscopic surgery. In patients in whom there are indications to perform a laparoscopic renal biopsy, LESS surgery is a valid alternative to mini invasive surgery and is becoming more common. We report our experience on 14 renal biopsy procedures performed in a retroperitoneal LESS.
LESS renal biopsy was performed in 14 patients 18 to 80 years old (mean age 58.3 years) during a 36 month period. All procedures were performed by a single operator. The patient was in a standard flank position. The procedure was performed using a 2.5 cm, single incision via a retroperitoneal access at the Petit's triangle. A 5 mm biopsy forceps was used to collect the specimen under direct vision, and haemostasis was obtained with an Argon beam probe and the application of oxidized regenerated cellulose gauze.
Biopsy was performed successfully in all cases. Mean operative time was 52.64 min, blood loss was minimal, and the hospital stay ranged from 12 to 24 hours. None of the patients required narcotics or additional analgesia in the postoperative period. No postoperative complications occurred.
The LESS technique is safe, reliable (100% success), easy to learn, and offers subjective cosmetic benefits to the patient. Minimal hospitalization requirement following retroperitoneal LESS biopsy is an additional timely advantage over laparoscopic renal biopsy. We think that with the right indications (marked obesity, failure of previous percutaneous biopsy attempts, a solitary kidney and coagulopathy) LESS renal biopsy is a good alternative to laparoscopy. Our next step will be a randomized prospective study of LESS compared with laparoscopy for renal biopsy to support our findings.
腹腔镜单孔手术（LESS）的发展旨在进一步降低与腹腔镜手术相关的发病率和瘢痕形成。对于有腹腔镜肾活检指征的患者，LESS手术是微创外科手术的有效替代方法，并且越来越普遍。我们报告了在腹膜后LESS下进行的14例肾活检手术的经验。
在36个月期间，对14例年龄在18至80岁（平均年龄58.3岁）的患者进行了LESS肾活检。所有手术均由一名术者完成。患者取标准侧卧位。经Petit三角处的腹膜后入路，通过一个2.5cm的单一切口进行手术。使用5mm活检钳在直视下采集标本，并用氩气刀探头和氧化再生纤维素纱布进行止血。
所有病例均成功进行了活检。平均手术时间为52.64分钟，出血量极少，住院时间为12至24小时。术后无患者需要使用麻醉剂或额外镇痛。未发生术后并发症。
LESS技术安全、可靠（成功率100%）、易于学习，且对患者有明显的美容益处。腹膜后LESS活检后住院需求极少，这是相对于腹腔镜肾活检的又一及时优势。我们认为，在合适的指征下（明显肥胖、既往经皮活检尝试失败、孤立肾和凝血功能障碍），LESS肾活检是腹腔镜检查的良好替代方法。我们的下一步将是进行一项LESS与腹腔镜肾活检对比的随机前瞻性研究，以支持我们的发现。
