Chiruvella Mallikarjuna, Tamhankar Ashwin Sunil, Ghouse Syed Mohammed, Bendigeri Mohammed Taif, Reddy Kondakindi Purna Chandra, Ragoori Deepak
Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India.
Indian J Urol. 2018 Oct-Dec;34(4):254-259. doi: 10.4103/iju.IJU_231_18.
Though the overall safety of laparoscopic nephrectomy (simple or radical) is well established, for a novice it remains a challenge. The classical description of laparoscopic nephrectomy entails dissection either from caudal to cephalad side or vice versa. Herein we describe our "two window technique" for managing renal hilum during laparoscopic (simple/radical) nephrectomy. Our main intention in description of this technique is to reduce the level of apprehension for a novice urologist for performing laparoscopic nephrectomy. After colon mobilization, sequential lower and upper windows are created around the hilum following which hilar vessels are dissected circumferentially when the hilum is at a stretch by traction from either of the window. There are multiple potential advantages of this method which includes easier and safer dissection especially for novice in this field by giving a safety window of application of vascular clamp in cases of vascular bleeds. Intrahilar dissection in stretched condition becomes safer with vision from all around 360° for safe application of Hem-o-lok® clips. Due to the widely exposed field, injuries to adrenal vein and lumbar veins would be minimized and the chances of missed accessory vessel would be minimized. En mass hilar control with vascular clamp in cases of partial nephrectomy is possible with same approach as well as the en block stapling is feasible in cases of nephrectomy. This needs a validation across multiple centers with comparative studies before considering it as a standard of practice. We sincerely believe that this is safe and easily reproducible by a novice.
尽管腹腔镜肾切除术（单纯性或根治性）的总体安全性已得到充分证实，但对于新手来说，它仍然是一项挑战。腹腔镜肾切除术的经典描述是从尾侧向头侧或反之进行解剖。在此，我们描述我们在腹腔镜（单纯性/根治性）肾切除术中处理肾门的“双窗口技术”。我们描述这项技术的主要目的是降低新手泌尿外科医生进行腹腔镜肾切除术的担忧程度。在游离结肠后，在肾门周围依次创建下窗口和上窗口，然后当通过任一窗口的牵引使肾门处于伸展状态时，沿圆周方向解剖肾门血管。这种方法有多个潜在优点，包括更容易和更安全的解剖，特别是对于该领域的新手，因为在血管出血的情况下提供了应用血管夹的安全窗口。在伸展状态下进行肾门内解剖会更安全，因为可以从360°全方位观察，以便安全应用Hem-o-lok®夹。由于视野广泛暴露，肾上腺静脉和腰静脉的损伤将降至最低，遗漏副血管的可能性也将降至最低。在部分肾切除术中，采用相同方法使用血管夹进行整块肾门控制是可行的，在肾切除术中进行整块吻合钉合也是可行酌。在将其视为标准做法之前，需要通过多中心的比较研究进行验证。我们真诚地相信，这对新手来说是安全且易于重复操作的。
