UO Chirurgia Trapianti Renali, Azienda Ospedaliero-Universitaria Senese, Viale Bracci 14, 53100 Siena, Italy.
JSLS. 2021 Jan-Mar;25(1). doi: 10.4293/JSLS.2020.00107.
Laparoscopic nephrectomy is now considered a feasible surgical approach, even for large kidneys. In the case of massive kidneys, laparoscopy can be problematic, so that some authors suggest an open approach. However, previous studies have shown that hand-assisted laparoscopic nephrectomy (HALN) may represent a useful compromise.We describe our hand-assisted laparoscopic technique for nephrectomy of large kidneys (> 2500 g) to encourage the use of laparoscopy for nephrectomy in autosomal dominant polycystic kidney disease.
We retrospectively analyzed data from 26 nephrectomies in 17 patients who underwent HALN for ADPKD and compared them to a group of 22 nephrectomies in 18 patients with open surgical technique.
The duration of the procedure was significantly longer in the laparoscopic group, with a median of 180 minutes versus 90 minutes for the unilateral nephrectomies, and 240 minutes versus 122 minutes for the bilateral procedures. The median kidney weight in the open group was 2500 g (range 1300 - 4500 g), while the median weight in the HALN group was 2375 g (range 1000 - 4700 g). The median hospital stay was comparable. No significant differences were recorded in the intra- and postoperative complication rate.
Hand-assisted laparoscopic nephrectomy can be considered a technique of choice for patients suffering from ADPKD requiring nephrectomy, also with massive kidneys weighing more than 3500 g. Compared to open nephrectomy, HALN can be performed safely, with reasonably longer operating times and without major complications, and offers a significant reduction in hospitalization time, pain and postoperative discomfort.
腹腔镜肾切除术现在被认为是一种可行的手术方法，即使是对于大肾脏也是如此。对于巨大的肾脏，腹腔镜可能会出现问题，因此有些作者建议采用开放方法。然而，之前的研究表明，手助腹腔镜肾切除术（HALN）可能是一种有用的折衷方案。我们描述了我们用于大型肾脏（>2500 克）的手助腹腔镜肾切除术技术，以鼓励在常染色体显性多囊肾病中使用腹腔镜进行肾切除术。
我们回顾性分析了 17 例接受 HALN 治疗的 ADPKD 患者的 26 例肾切除术数据，并将其与 18 例接受开放手术治疗的 22 例肾切除术进行了比较。
腹腔镜组的手术时间明显更长，单侧肾切除术的中位数为 180 分钟，而开放组为 90 分钟；双侧手术的中位数分别为 240 分钟和 122 分钟。开放组的中位肾脏重量为 2500 克（范围 1300-4500 克），而 HALN 组的中位肾脏重量为 2375 克（范围 1000-4700 克）。中位住院时间相当。两组的术中及术后并发症发生率无显著差异。
对于需要肾切除术的 ADPKD 患者，手助腹腔镜肾切除术可作为首选技术，即使肾脏巨大，重量超过 3500 克也是如此。与开放性肾切除术相比，HALN 可以安全进行，手术时间较长，但无重大并发症，且可显著缩短住院时间、减轻疼痛和术后不适。
