Hagiuda Jun, Masuda Tsukasa, Takahashi Ryohei, Tamaki Satoshi, Nakagawa Ken
Urology, Tokyo Dental College, Ichikawa General Hospital, Chiba, JPN.
Cureus. 2024 Aug 25;16(8):e67763. doi: 10.7759/cureus.67763. eCollection 2024 Aug.
Laparoendoscopic single-site surgery is performed during laparoscopic donor nephrectomy (LDN) to reduce donor invasiveness. However, the procedure is difficult and does not improve cosmesis when the incision is made at the umbilicus. Therefore, we proposed a minimally invasive LDN with a Pfannenstiel incision using size-reduced trocars (mLDN) to achieve cosmesis and operability and aimed to assess its efficacy and safety.
A total of 27 patients who underwent mLDN were recruited. Data on estimated blood loss, operative time, pneumoperitoneum time, warm ischemic time (WIT), complication rate, non-steroidal anti-inflammatory drugs (NSAIDs) used, and recipient serum creatinine levels were collected retrospectively. In mLDN, the Pfannenstiel position was incised to approximately 6 cm to retrieve the kidney, and three size-reduced trocars were placed in the left upper abdomen (2.5 mm and 5 mm) and umbilicus (5 mm).
The median operation time and pneumoperitoneum time were 245 and 194 minutes, respectively. The median WIT was 276 seconds, and the serum creatinine levels of the recipients at seven days and one, three, six, and 12 months were significantly improved compared with baseline. No intra- and postoperative complications (Clavien-Dindo grade ≥ 2) were observed, and no patients used additional NSAIDs after the operation. The scarring in the mLDN group was unnoticeable postoperatively.
mLDN can be performed safely, with high cosmesis, and with operability similar to that of conventional LDN. Although the WIT tended to be long, the function of the harvested kidney was maintained, and the use of analgesic NSAIDs was lower in this procedure. Our procedure should be considered as an option for LDN.
在腹腔镜供肾切除术（LDN）期间进行腹腔镜单孔手术以减少供体的侵袭性。然而，当在脐部做切口时，该手术操作困难且不能改善美观效果。因此，我们提出了一种采用尺寸减小的套管针经耻骨上横切口的微创LDN（mLDN），以实现美观和可操作性，并旨在评估其有效性和安全性。
共招募了27例行mLDN的患者。回顾性收集估计失血量、手术时间、气腹时间、热缺血时间（WIT）、并发症发生率、使用的非甾体抗炎药（NSAIDs）以及受体血清肌酐水平的数据。在mLDN中，耻骨上位置切口约6 cm以取出肾脏，三个尺寸减小的套管针分别置于左上腹（2.5 mm和5 mm）和脐部（5 mm）。
中位手术时间和气腹时间分别为245分钟和194分钟。中位WIT为276秒，与基线相比，受体在术后7天以及1、3、6和12个月时的血清肌酐水平显著改善。未观察到术中及术后并发症（Clavien-Dindo分级≥2级），术后无患者使用额外的NSAIDs。mLDN组术后瘢痕不明显。
mLDN能够安全进行，美观性高，并且具有与传统LDN相似的可操作性。尽管WIT往往较长，但所获取肾脏的功能得以维持，且该手术中NSAIDs的使用量较低。我们的手术方法应被视为LDN的一种选择。
