Breish Mohamed O, Whiting Danielle, Sriprasad Seshadri
Urology, Darent Valley Hospital, Dartford, GBR.
Cureus. 2020 Feb 14;12(2):e6991. doi: 10.7759/cureus.6991.
Laparoscopic nephrectomy is a minimally invasive procedure that provides significant benefits to the patient, such as reduced analgesic requirements and shorter recovery time. While the popularity of laparoscopy has grown substantially, there are associated risks of injury to the blood vessels and/or viscera during the insertion of the laparoscopic ports. Such injuries can lead to a significant increase in mortality rates. Patients who have had previous abdominal surgery have a higher risk of adhesions; this has been shown to increase the risk of complications from port placement. Consequently, previous abdominal surgery was viewed as a relative contraindication to laparoscopic surgery. However, studies have demonstrated the advantages of laparoscopic surgery over an open radical approach; hence, previous abdominal surgery is no longer viewed as a contraindication. Here, we describe the case of a 62-year-old man who presented with an incidental finding of right renal cell carcinoma (RCC). We performed a radical nephrectomy on this patient who had undergone multiple previous abdominal surgeries. During this procedure, a small bowel injury occurred. Herein, we review the available evidence and describe the risk factors and techniques to avoid injury from laparoscopic port-site placement in patients undergoing nephrectomy with a history of previous abdominal surgery.
腹腔镜肾切除术是一种微创手术，能为患者带来显著益处，如减少镇痛需求和缩短恢复时间。虽然腹腔镜检查的普及程度大幅提高，但在插入腹腔镜端口时存在血管和/或内脏损伤的相关风险。此类损伤可导致死亡率显著上升。既往有腹部手术史的患者发生粘连的风险较高；这已被证明会增加端口放置并发症的风险。因此，既往腹部手术曾被视为腹腔镜手术的相对禁忌证。然而，研究表明腹腔镜手术优于开放根治性手术；因此，既往腹部手术不再被视为禁忌证。在此，我们描述了一名62岁男性患者的病例，该患者偶然发现右肾细胞癌（RCC）。我们对这名曾接受多次腹部手术的患者进行了根治性肾切除术。在此过程中，发生了小肠损伤。在此，我们回顾现有证据，并描述在有既往腹部手术史的肾切除术患者中避免腹腔镜端口部位放置损伤的危险因素和技术。
