Zhao L, Ma L L, Zhang H X, Hou X F, Liu L, Fu Y, Kou Y G, Song Y M
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Oct 18;49(5):867-871.
To summarize our experience of retroperitoneal laparoscopic living donor nephrectomy, our continuous technical improvements and refinement of this skill and standardization of each procedure of this operation.
Having approved by hospital ethical committee and local government administration, a total of 193 living donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec.2003 to Feb. 2016 in our department. Under general anaesthesia, the operation was performed through 3 lumbar ports. After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney, the renal artery and vein were blocked with endo-cut or hem-o-lok separately and then severed. Then the kidney was taken out quickly and flushed with 4 °C kidney preserving fluid immediately, the donor kidneys were then preserved in iced saline until kidney transplantation. Clinical data about operation time, volume of blood loss, perioperative complications, renal function of both donors and recipients before and after operation were collected.
The 193 retroperitoneal laparoscopic living donor nephrectomy operations were successful with only one operation was converted to open living donor nephrectomy because of hemorrhage and unclear operation field during the operation. The average operation time was 85 min (55-135 min), the average blood loss was 60 mL (20-200 mL), and no donor needed blood transfusion during or after operation. Three donors were found to have hematoma of renal fossa after operation and none of them required further treatment. The average hospital stay after operation was 5.7 days (4-9 days). In the study, 162 donors were followed up for an average of 42 months (1-58 months) and they were all healthy. Two kidney recipients had urinary bladder anastomosis leakage after operation and both needed surgical repair, a new anastomosis of ureter and bladder were made. Three kidney recipients had kidney subcapsular hematoma but required no further treatment. One kidney recipient had delayed graft function and recovered finally and the renal function of other recipients were all normal. Renal function of both donors and recipients during the follow up period were normal.
Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable technique, it may become a standardized operation for living kidney transplantation after continuous technical improvement. Precautions must be taken to avoid complications and a skilled hand is necessary for success.
总结我们在腹膜后腹腔镜活体供肾肾切除术方面的经验、该技术的持续改进与完善以及该手术各步骤的标准化。
经医院伦理委员会和当地政府行政部门批准，2003年12月至2016年2月期间，我科共有193例活体供者接受了腹膜后腹腔镜活体供肾肾切除术。在全身麻醉下，通过3个腰部切口进行手术。在充分游离肾脏并在肾下极下方7 - 8 cm处切断输尿管后，分别用endo - cut或hem - o - lok阻断肾动脉和静脉，然后切断。然后迅速取出肾脏，立即用4℃肾保存液冲洗，供肾随后保存在冰盐水中直至肾移植。收集手术时间、失血量、围手术期并发症、供受者术前及术后肾功能等临床资料。
193例腹膜后腹腔镜活体供肾肾切除术均获成功，仅1例因术中出血、术野不清而改行开放活体供肾肾切除术。平均手术时间为85分钟（55 - 135分钟），平均失血量为60毫升（20 - 200毫升），术中及术后均无供者需要输血。3例供者术后发现肾窝血肿，均无需进一步治疗。术后平均住院时间为5.7天（4 - 9天）。本研究中，162例供者平均随访42个月（1 - 58个月），均健康。2例肾受者术后出现膀胱吻合口漏，均需手术修复，重新进行输尿管与膀胱吻合。3例肾受者出现肾包膜下血肿，但无需进一步治疗。1例肾受者出现移植肾功能延迟，最终恢复，其他受者肾功能均正常。随访期间供受者肾功能均正常。
腹膜后腹腔镜活体供肾肾切除术是一种安全可靠的技术，经过持续的技术改进后可能成为活体肾移植的标准化手术。必须采取预防措施以避免并发症，手术成功需要熟练的操作。
