He Bulang, Mou Lingjun, De Roo Ronald, Musk Gabrielle C, Hamdorf Jeffrey M
From the Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Perth, Australia; and the School of Surgery, The University of Western Australia, Perth, Australia.
Exp Clin Transplant. 2017 Oct;15(5):497-503. doi: 10.6002/ect.2016.0177. Epub 2017 Apr 27.
There are increased reports that kidney transplant can be performed by laparoscopic surgery. The further development of this technique could revolutionize human kidney transplant surgery. However, laparoscopic kidney transplant demands a high level of skill for vascular anastomoses. The emerging technology of the three-dimensional, high-definition laparoscopic system may facilitate the application of this technique. Therefore, in this study, we evaluated this system in performing kidney transplant surgery versus the two-dimensional laparoscopic system.
Four fresh-frozen human cadavers were used in this study, with 2 for the 3-dimensional and 2 for the 2-dimensional system. Kidneys were retrieved by using the retroperitoneoscopic technique for living donor nephrectomy from the same cadaver. The kidney graft was transplanted at the right iliac fossa using a laparoscopic technique by extraperitoneal approach. The procedure was recorded, and the vessel anastomotic time was analyzed.
Kidney transplant procedures were conducted successfully in the 3-dimensional, high-definition and the 2-dimensional groups. We recorded no significant differences in terms of vessel anastomotic time between the 2 groups. The total surgery time was shorter in the 3-dimensional, high-definition group than in the 2-dimensional group (P = .02).
This pilot study reinforces that kidney transplant with either the 3-dimensional, high-definition or 2-dimensional laparoscopy is feasible in a human cadaveric model. The operation was the same as open kidney transplant, but the procedure was performed by a laparoscopic approach with a smaller incision.
越来越多的报道称可通过腹腔镜手术进行肾移植。这项技术的进一步发展可能会彻底改变人类肾移植手术。然而，腹腔镜肾移植对血管吻合技术要求很高。三维高清腹腔镜系统这项新兴技术可能会促进该技术的应用。因此，在本研究中，我们对该系统与二维腹腔镜系统在肾移植手术中的应用进行了评估。
本研究使用了4具新鲜冷冻的人体尸体，其中2具用于三维系统，2具用于二维系统。采用后腹腔镜技术从同一尸体获取肾脏用于活体供肾切除术。通过腹膜外途径，使用腹腔镜技术将肾移植到右髂窝。记录手术过程，并分析血管吻合时间。
三维高清组和二维组均成功完成了肾移植手术。两组在血管吻合时间方面无显著差异。三维高清组的总手术时间比二维组短（P = 0.02）。
这项初步研究证实，在人体尸体模型中，使用三维高清或二维腹腔镜进行肾移植是可行的。手术与开放性肾移植相同，但通过腹腔镜途径进行，切口更小。
