Atlas I, Sert M B, Childers J M
Womens and Infants Hospital, Brown University, Providence, Rhode Island, USA.
J Am Assoc Gynecol Laparosc. 1998 Aug;5(3):283-7. doi: 10.1016/s1074-3804(98)80033-9.
We developed an extraperitoneal approach to laparoscopic infrarenal paraaortic lymphadenectomy in the porcine model, with the ultimate aim of shortening the long learning curve of this procedure in humans. Surgery was performed on four females pigs with three 10-mm cannulas placed along the midaxillary line in prone position. The first and second pigs underwent subsequent laparotomy to evaluate the adequacy of lymph node dissection and complications. In all four animals, complete infrarenal paraaortic lymphadenectomy was successful, retrieving between 6 and 11 lymph nodes (average 9). Laparotomy in the first two animals confirmed adequate lymphadenectomy. No complications occurred. Operating time was shortened dramatically with each procedure (180, 120, 50, 40 min). In the porcine model this approach provides excellent exposure to the entire paraaortic lymphatic chain, is safe, and has a remarkably short learning curve. Development of a similar technique in humans may have significant advantages, including short learning curve, feasibility in obese patients and those with peritoneal adhesions, decreased adhesion formation, and reduced bowel complications associated with postoperative adjuvant irradiation. Further studies are indicated.
我们在猪模型中开发了一种经腹膜后途径的腹腔镜肾下主动脉旁淋巴结清扫术，最终目的是缩短该手术在人体中的漫长学习曲线。对4只雌性猪进行手术，在俯卧位沿腋中线放置3个10毫米套管。第一只和第二只猪随后接受剖腹手术，以评估淋巴结清扫的充分性和并发症情况。在所有4只动物中，均成功完成了肾下主动脉旁淋巴结清扫，取出6至11个淋巴结（平均9个）。对前两只动物进行的剖腹手术证实淋巴结清扫充分。未发生并发症。每次手术的操作时间都大幅缩短（180、120、50、40分钟）。在猪模型中，这种方法能很好地暴露整个主动脉旁淋巴链，安全且学习曲线非常短。在人类中开发类似技术可能具有显著优势，包括学习曲线短、对肥胖患者和有腹膜粘连患者可行、减少粘连形成以及降低与术后辅助放疗相关的肠道并发症。有必要进行进一步研究。
