完全机器人腹腔镜腹膜后入路活体供肾切取术的临床应用

Totally robotic nephrectomy for living donation via retroperitoneal approach

目的探讨机器人腹腔镜腹膜后入路活体供肾切取的手术技术及安全性,总结临床经验。方法分析该院2017年1月所实施的3例机器人活体供肾切取术,供受体均为母子关系,供体年龄47~49岁,受体年龄23~29岁,其中取左肾2例,右肾1例,术前供体各项检查及伦理审批完全符合捐献条件,术前血管成像未发现血管变异,1例术中发现一支副肾动脉。结果 3例患者顺利完成供肾切取术,未行中转开放。术后未发生手术相关并发症,手术时间分别为115.0、120.0和140.0 min;术中出血量50、85及110 ml;热缺血时间2.0~4.0 min;3例患者均在术后第3天拨除引流管,术后第5天出院。移植肾均在血流开放后2.0 min内泌尿,术后1周内移植肾功能均恢复正常。结论采用经腹膜后入路行机器人活体供肾切取术是安全有效的,供体术后恢复快,对供肾也无不利影响,但高昂的手术费用制约了其广泛的临床应用。

Objective To explore the surgical technique and safety of totally robotic nephrectomy of living donation via retroperitoneal approach,and summarize its clinical experience.Methods To explore the surgical technique and safety of totally robotic nephrectomy of living donation via retroperitoneal approach,and summarize its clinical experience.Results All the 3 cases were completed successfully,no one was converted to open surgery.The operative time was 115.0 min,120.0 min and 140.0 min respectively,blood loss in operation was 50 ml,85 ml and 110 ml respectively.The donor kidney warm ischemic time was from 2.0~4.0 min,no operation-related complications occurred.All the drainage tubes were removed 3 d after operation,and all the donors discharged at 5 d after operation.Transplant kidneys urinated within 2.0 min after blood flow recovery,all transplant kidneys function reached to normal within one week.Conclusion Totally robotic nephrectomy for living donation via retroperitoneal approach is safe and feasible,with rapid postoperative recovery for donors,and no extra adverse effect on transplant kidneys.But the high cost of operation limits its extensive clinical application.