自制单孔多通道平台后腹腔镜技术在肾脏手术中的应用

Application of a Self-made Single-port Device in Retroperitoneal Laparoendoscopic Single-site Renal Surgery

目的：探讨自制单孔多通道平台后腹腔镜技术在肾脏手术中应用的安全性和可行性。方法2011年5月～2014年4月，采用自制单孔多通道平台，利用常规腹腔镜器械完成87例后腹腔镜肾脏手术，包括14例亲属活体供肾切取术，10例肾部分切除术，63例肾癌根治术。结果14例亲属活体供肾切取术的手术时间、术中出血量、热缺血时间分别为（146．6±30．6）min （110～207 min），（66．7±90．6）ml（20～350 ml），（2．6±0．8）min（1．9～4 min）；10例肾部分切除术和63例肾癌根治术的手术时间、术中出血量分别为（126．5±5．7） min（118～130 min）和（131．7±13．9） min（120～150 min），（30．0±20．4）ml（15～60 ml）和（36．9±9．7）ml（30～50 ml）。无中转行常规腹腔镜和开放手术，无输血，仅肾癌根治术组发生2例并发症（心房纤颤、切口愈合延迟）。结论采用自制单孔多通道平台的后腹腔镜肾脏手术技术可行，术式安全可靠，无须使用专用的特殊腹腔镜器械，降低了学习难度。

Objective To investigate the feasibility and safety of using a self-made single-port device in retroperitoneal laparoendoscopic single-site （ LESS） renal surgery. Methods From May 2011 to April 2014, by using a self-made single-port device and conventional laparoscopic instruments, we conducted 87 consecutive LESS renal surgery through retroperitoneal access, including 14 cases of LESS live donor nephrectomy, 10 cases of retroperitoneal LESS partial nephrectomy, and 63 cases of retroperitoneal LESS radical nephrectomy. Results In the LESS donor nephrectomy group, the mean operative time, estimated blood loss, and warm ischemia time were 146.6 ±30.6 min （range, 110-207 min）, 66.7 ±90.6 ml （range, 20-350 ml）, and 2.6 ±0.8 min （range, 1.9-4.0 min）, respectively.In the LESS partial nephrectomy group, the mean operative time and estimated blood loss were 126.5 ±5.7 min （range, 118-130 min） and 30.0 ±20.4 ml （range, 15-60 ml）, respectively.In the LESS radical nephrectomy group, the mean operative time and estimated blood loss were 131.7 ±13.9 min （ range, 120-150 min） and 36.9 ±9.7 ml （range, 30-50 ml）, respectively.All the procedures were completed smoothly and no complications happened, except in the radical nephrectom group 1 patient had atrial fibrillation and 1 patient had delayed wound healing of incision. Conclusions The retroperitoneal LESS renal surgery using our self-made single-port device was technically feasible and safe.It can be utilized without using specialized instruments by the surgeons who are only experienced in standard laparoscopic nephrectomy.