Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Ann Transplant. 2020 Jun 16;25:e922602. doi: 10.12659/AOT.922602.
BACKGROUND Minimally invasive surgery (MIS) has rapidly advanced, but its use in transplant patients has lagged. We share our experience of MIS for patients after kidney and liver transplantation and compare our results with similar studies in the literature. MATERIAL AND METHODS This study included 14 MIS (12 laparoscopic, 2 transvaginal) procedures for 13 transplant cases (6 liver and 7 kidney) done from May 2006 to May 2018. Gastrointestinal surgery was performed in 6 cases: appendectomy performed 8 months after liver transplant and 16 months after kidney transplant in 2 cases, radical right hemi-colectomy performed 6 weeks after liver transplant in 1 case; exploration for chylous ascites 6 months after liver transplant in 1 case, sleeve gastrectomy performed 3 years after kidney transplant in 1 case, and partial hepatectomy performed 12 years after kidney transplant in 1 case. For urological problems, 2 patients received ipsilateral right-side nephroureterectomy performed 10 and 12 years after kidney transplant, and 1 patient received contralateral left-side nephroureterectomy performed 12 years after kidney transplant. The 2 liver transplant patients with huge incisional hernias received repair approximately 3 and 2 years after liver transplant. Three patients underwent gynecological surgery: 2 transvaginal for pelvic floor reconstruction in 1 patient with liver transplant and 1 hysterectomy in a kidney transplant patient, and 1 laparoscopic-assisted hysterectomy in a kidney transplant patient. We retrospectively analyzed the clinical presentation, operative findings, operation time, postoperative complications, and length of stay. RESULTS The postoperative course was uneventful, with early resumption of oral intake, including immunosuppressants administered the same as in the non-transplant patients. All surgical procedures in these transplant patients were achieved without conversion, showed stable kidney and liver function, had better surgical outcomes in comparison with traditional surgery, and most of them were discharged within 1 week. CONCLUSIONS Laparoscopic and non-laparoscopic MIS surgery are feasible and safe for abdominal organ transplant patients and are helpful for timely intervention in cases with acute abdomen. No adjustment of immunosuppressant is usually needed, as oral intake can be resumed very soon after surgery.
微创外科（MIS）发展迅速，但在移植患者中的应用却滞后。我们分享了我们对肾移植和肝移植后患者进行 MIS 的经验，并将我们的结果与文献中的类似研究进行了比较。
这项研究包括了 14 例 MIS（12 例腹腔镜，2 例经阴道）手术，涉及 13 例移植病例（6 例肝移植，7 例肾移植），手术时间为 2006 年 5 月至 2018 年 5 月。胃肠道手术 6 例：2 例肝移植后 8 个月和 16 个月行阑尾切除术，1 例肝移植后 6 周行根治性右半结肠切除术；1 例肝移植后 6 个月因乳糜性腹水行探查术，1 例肾移植后 3 年行袖状胃切除术，1 例肾移植后 12 年行部分肝切除术。对于泌尿外科问题，2 例患者接受了同侧右侧肾输尿管切除术，分别在肾移植后 10 年和 12 年进行，1 例患者接受了对侧左侧肾输尿管切除术，在肾移植后 12 年进行。2 例肝移植后巨大切口疝的患者在肝移植后约 3 年和 2 年接受了修复。3 例患者接受了妇科手术：2 例经阴道用于肝移植患者的盆底重建，1 例肾移植患者行子宫切除术，1 例肾移植患者行腹腔镜辅助子宫切除术。我们回顾性分析了临床症状、手术发现、手术时间、术后并发症和住院时间。
术后过程顺利，早期恢复口服饮食，包括与非移植患者相同的免疫抑制剂。这些移植患者的所有手术均无需转换，显示出稳定的肾功能和肝功能，与传统手术相比具有更好的手术结果，大多数患者在 1 周内出院。
腹腔镜和非腹腔镜 MIS 手术对腹部器官移植患者是可行且安全的，有助于及时干预急腹症。通常不需要调整免疫抑制剂，因为手术后很快就能恢复口服饮食。
