Hora Milan, Eret Viktor, Stránský Petr, Trávníček Ivan, Urge Tomáš, Ferda Jiří, Petersson Fredrik, Hes Ondřej
Department of Urology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
Department of Radiology, Charles University in Prague, Faculty of Medicine, Faculty Hospital, Pilsen, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):371-9. doi: 10.5114/wiitm.2014.43019. Epub 2014 May 26.
One way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise.
To report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE).
In the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) - 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007-8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m(2), less advanced tumour).
We found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m(2) vs. 29.2 kg/m(2) (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher.
The LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m(2) and with low-stage tumours. The LESS NE is more expensive compared to LNE.
减少肾脏手术发病率并改善其美容效果的一种方法是单孔腹腔镜手术。这一概念已有相对充分的描述，但在临床实践中尚无明确的定位。
报告腹腔镜单孔手术（LESS）肾切除术（NE）的机构经验，并（通过配对病例对照研究）将其与标准腹腔镜肾切除术（LNE）进行比较。
在2011年8月至2013年10月期间，我们进行了183例微创肾切除术（132例为肿瘤，51例为良性病因）；其中45例（24.6%）为LESS，其余为LNE。LESS的主要但非绝对适应证为：非肥胖男性以及病情不太严重的肿瘤。在13例接受LESS-NE手术的患者（28.9%）中采用经脐入路。其余患者则行直肠旁切口，31.1%（14例）增加了辅助端口——左侧2/22例（9.1%），右侧12/23例（52.2%）。24例LESS-NE由经验更丰富的外科医生完成（平均手术时间（MOT）73.1分钟），21例LESS-NE由另外4名外科医生完成（MOT 132.8分钟）。将这24例与该外科医生在LESS开展之前（2007年1月至2011年8月）完成的43例LNE以及具有相似病例特征（体重指数（BMI）≤35 kg/m²，病情不太严重的肿瘤）的患者进行比较。
我们发现在所研究的任何参数方面均无统计学显著差异。平均手术时间73.1分钟对75.0分钟（p = 0.78），BMI 27.4 kg/m²对29.2 kg/m²（p = 0.08），失血量54.7对39.2（p = 0.47）。并发症发生率（4.2%对11.6%）仅为内源性。两组均无中转开腹情况。在LESS-NE中，肾门血管离断时更频繁地使用吻合器（比钛夹更昂贵）（70.8%对51.2%）。LESS-NE的平均费用高出367欧元。
经验丰富的外科医生进行的LESS NE是治疗BMI < 30 kg/m²且肿瘤分期较低的患者恶性和良性肾脏疾病的一种安全有效的手术方法。与LNE相比，LESS NE费用更高。
