Urology Unit, Hospital "Pugliese Ciaccio," Catanzaro, Italy.
Institute of Urology, University Hospital "Ospedali Riuniti," Marche Polytechnic University, Ancona, Italy.
Urologia. 2021 Feb;88(1):14-20. doi: 10.1177/0391560320921728. Epub 2020 Jun 2.
The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery.
We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups.
Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; = 0.363), length of stay (4.1 vs 3.8 days; = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; = 0.234), and rate of complications ( = 0.121). However, operative time ( = 0.003) and length of stay ( < 0.001) were greater in patients with versus those without previous open cholecystectomy.
Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.
本研究旨在评估经腹腔腹腔镜肾部分切除术治疗既往腹部手术患者保肾手术的安全性和可行性。
我们回顾性分析了接受经腹腔腹腔镜肾部分切除术治疗肾肿块的患者。所有患者均被诊断为 cT1a 肾外生肿块（≤5cm）。患者分为两组，有既往腹部手术史组和无既往腹部手术史组。本研究排除了孤立肾或重大既往腹部手术的患者。记录手术时间、估计失血量、住院时间、手术并发症和切缘阳性率，以比较两组的结果。
在纳入本研究的 157 例患者中，71 例（45.3%）有腹部手术史（第 1 组），其余 86 例（54.7%）无腹部手术史（第 2 组）。胆囊切除术是最常见的临近肾窝的既往手术。有既往腹部手术史的患者手术时间延长（111.5 比 83.2 分钟； = 0.001）。然而，两组之间估计失血量（122.1 比 114.4 毫升； = 0.363）、住院时间（4.1 比 3.8 天； = 0.465）、中转开放手术率（2.8%比 2.3%； = 0.234）和并发症发生率（ = 0.121）无统计学差异。然而，与无既往开放性胆囊切除术的患者相比，有既往胆囊切除术的患者手术时间（ = 0.003）和住院时间（ < 0.001）更长。
我们的结果表明，对于接受保肾手术的肾肿块、低肾体积评分的选择性患者，在接受轻微既往腹部手术的情况下，腹腔镜肾部分切除术是安全可行的。然而，对于接受右腹腔镜肾部分切除术的患者，既往胆囊切除术会增加中转开放手术的风险和住院时间延长的风险。
