Nasrallah Georges, Souki Fouad G
Department of Anesthesiology, Jackson Memorial Hospital, University of Miami, 1611 NW 12th Ave, DTC 318, Miami, FL, 33136, USA.
Curr Urol Rep. 2018 Jan 18;19(1):1. doi: 10.1007/s11934-018-0757-4.
Laparoscopic kidney surgery is commonly used for living donor, partial, and total tumor nephrectomy. The successful emergence of laparoscopic technique was justified by the many benefits offered such as reduced blood loss, tissue trauma, pain, and hospital stay. However, this comes at the expense of physiologic changes and complications secondary to pneumoperitoneum, surgical technique, and patient positioning with significant challenges in anesthetic management.
A variety of laparoscopic approaches (transperitoneal, retroperitoneal, hand-assisted, robotic) are used with some having advantages over others. The kidneys are particularly sensitive to hemodynamic changes and pneumoperitoneum. Controversies in perioperative fluid administration exist. New modalities for postoperative pain control have been suggested. Laparoscopic kidney surgery is associated with multiple physiologic changes and adverse events but offers advantages of reduced postoperative pain, faster recovery, and shorter hospital stay. Understanding these physiologic changes and related anesthetic considerations is key for safe patient outcome.
腹腔镜肾脏手术常用于活体供肾、部分及全肿瘤肾切除术。腹腔镜技术的成功出现得益于其带来的诸多益处，如减少失血、组织创伤、疼痛以及缩短住院时间。然而，这是以生理变化及气腹、手术技术和患者体位导致的并发症为代价的，给麻醉管理带来了重大挑战。
多种腹腔镜手术方式（经腹腔、腹膜后、手辅助、机器人辅助）被采用，其中一些比其他方式具有优势。肾脏对血流动力学变化和气腹特别敏感。围手术期液体管理存在争议。已提出术后疼痛控制的新方法。腹腔镜肾脏手术会引起多种生理变化和不良事件，但具有术后疼痛减轻、恢复更快和住院时间缩短的优势。了解这些生理变化及相关麻醉注意事项是确保患者安全的关键。
