Transplant Surgery Section, Surgery Department, King Faisal Specialist Hospital and Research Center, Jeddah, 21499, Kingdom of Saudi Arabia.
Transplant Surgery Section, Surgery Department, Armed Forces Hospital-Southern Regions, 101, Khamis Mushayt, Kingdom of Saudi Arabia.
Surg Endosc. 2019 Jun;33(6):1920-1926. doi: 10.1007/s00464-018-6474-8. Epub 2018 Sep 26.
We report our experience with laparoendoscopic single-site donor nephrectomy (LESS DN).
Retrospective comparative study of data from 200 Consecutive left LESS DN (group A) compared to 205 consecutive conventional laparoscopic donor nephrectomy (LDN) (group B). Standard laparoscopic instruments were used in all patients. Right nephrectomies were excluded.
From 05/2015 to 12/2017, 200 LESS DN (group A) and from 10/2011 till 04/2015, 205 LDN (group B) were performed. In group A and B, respectively, the mean operative time was 175.9 ± 24.9 versus 199.88 ± 37.06 min (p = 0.0001), the mean warm ischemia time was 5.2 ± 1.02 versus 3.64 ± 1.38 min (p = 0.0001), the mean BMI was 24.8 ± 4.5 versus 25.2 ± 4.7 kg/m, complex vascular anatomy was found in 60 (30%) and 68 (33.2%), average length of incision was 5.2 versus 7.7 cm (p = 0.001), scar satisfaction rate 8 versus 6 (p = 0.004), mean morphine equivalents 81.0 versus 70.5 mg; (p = 0.03), average timing for return to work was 42 versus 50 days; (p = 0.001). There was no conversion to open surgery in both groups. One case converted to hand-assisted laparoscopic nephrectomy in group A. Pure LESS-DN was successfully completed in 169 patients (84.5%). In group A, due to technical difficulties, additional 1 or 2, 5-mm port(s) was added in 21 and 10 cases, respectively. Two negative explorations were performed in the first post-operative week for picture of small bowel obstruction. We had port site hernia in one donor, superficial wound infection in three donors and blood transfusion was required in two donors in group A.
Our experience with LESS-DN is encouraging. LESSDN can be integrated as a standard approach for renal donation without additional donor risk. Moreover, LESS DN gives more flexibility by possibility to add one or more 5-mm ports in case of technical difficulties.
我们报告了腹腔镜单部位供肾切除术（LESS DN）的经验。
回顾性比较了 200 例连续左侧 LESS DN（A 组）与 205 例连续常规腹腔镜供肾切除术（LDN）（B 组）的数据。所有患者均使用标准腹腔镜器械。排除右侧肾切除术。
2015 年 5 月至 2017 年 12 月，行 200 例 LESS DN（A 组），2011 年 10 月至 2015 年 4 月，行 205 例 LDN（B 组）。A 组和 B 组的平均手术时间分别为 175.9±24.9 分钟和 199.88±37.06 分钟（p=0.0001），平均热缺血时间分别为 5.2±1.02 分钟和 3.64±1.38 分钟（p=0.0001），平均 BMI 分别为 24.8±4.5 千克/平方米和 25.2±4.7 千克/平方米，复杂血管解剖结构分别为 60 例（30%）和 68 例（33.2%），平均切口长度分别为 5.2 厘米和 7.7 厘米（p=0.001），瘢痕满意度分别为 8 例和 6 例（p=0.004），平均吗啡等效物分别为 81.0 毫克和 70.5 毫克（p=0.03），平均返回工作时间分别为 42 天和 50 天（p=0.001）。两组均无中转开放手术。A 组有 1 例转为手辅助腹腔镜肾切除术。A 组 169 例（84.5%）成功完成纯 LESS-DN。A 组由于技术困难，分别有 21 例和 10 例额外增加了 1 或 2 个 5mm 端口。在术后第一周，有 2 例因疑似小肠梗阻进行了两次阴性探查。A 组有 1 例供体发生切口疝，3 例供体发生浅表伤口感染，2 例供体需要输血。
我们的 LESS-DN 经验令人鼓舞。LESS-DN 可以作为一种标准的肾脏捐献方法，不会增加供体的风险。此外，在遇到技术困难时，通过增加一个或多个 5mm 端口，LESS-DN 具有更大的灵活性。
