Mandressi A, Buizza C, Antonelli D, Chisena S, Servadio G
Unitá Operativa di Urologia, Ospedale Generale, Busto Arsizio, VA, Italy.
Ann Urol (Paris). 1995;29(2):91-6.
From October 1992 to June 1994, 12 nephrectomies (all for benign diseases), one nephropexy and 7 adrenalectomies (one pheochromocitoma, three adenomas, one cyst) were performed. In all the cases the retroperitoneal working space was created with direct CO2 insufflation (without balloon) with the patient in prone position. Four 10-12 mm ports were always inserted in the lumbar area. Eighteen procedures were successful (90%), 2 failed (one nephrectomy and one adrenalectomy) and underwent open surgery. Twelve procedures were carried out with the patients in prone position, six (one nephropexy and 5 nephrectomies) were performed with the patients in lateral de cubitus. The removal of organs was managed either through an enlarged port (phi 2 cm.) or by joining vertically the stabs of the two ports lateral to the sarcospinalis muscle. The average operative time was 4.10 hours) range 2.30-5.20). Both CO2 absorption and blood loss were negligible. No major complications were observed. Postoperative pain never required medications. All patients were able to stand on the 1st postoperative day. Mean postoperative hospitalisation was 4 days. Direct retroperitoneal approach provides optimal access for laparoscopic renal, proximal ureteral and adrenal surgery, avoiding extensive dissection and handling of intraperitoneal structures.
1992年10月至1994年6月，共进行了12例肾切除术（均为良性疾病）、1例肾固定术和7例肾上腺切除术（1例嗜铬细胞瘤、3例腺瘤、1例囊肿）。所有病例均在患者俯卧位时通过直接二氧化碳气腹（无球囊）建立腹膜后工作空间。总是在腰部插入4个10 - 12毫米的端口。18例手术成功（90%），2例失败（1例肾切除术和1例肾上腺切除术）并转为开放手术。12例手术在患者俯卧位时进行，6例（1例肾固定术和5例肾切除术）在患者侧卧位时进行。器官切除通过扩大端口（直径2厘米）或通过垂直连接骶棘肌外侧两个端口的切口来完成。平均手术时间为4.10小时（范围2.30 - 5.20小时）。二氧化碳吸收和失血均可忽略不计。未观察到重大并发症。术后疼痛从未需要用药。所有患者术后第1天即可站立。平均术后住院时间为4天。直接腹膜后入路为腹腔镜肾、近端输尿管和肾上腺手术提供了最佳入路，避免了广泛的解剖和对腹腔内结构的处理。
