Laparoscopic specimen extraction: morcellation
Laparoscopic specimen extraction: morcellation
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DOI：
10.1111/j.1464-410x.2005.05194.x
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发表时间：
2005-03-01
影响因子：
4.5
通讯作者：
Jarrett, TW
中科院分区：
文献类型：
--
作者：
Varkarakis, I;Rha, K;Jarrett, TW
CATETIVESTo回顾我们的经验完整的提取和粉碎肾切除术标本，和粉碎的优点和缺点，目前的reports.Patients和METHODS在以前的研究中，56例连续进行根治性和简单的经腹腔镜肾切除术的患者进行了前瞻性评价。在脐部或侧孔部位提取了粉碎标本（33例），并通过脐下切口提取了完整标本（23例）。收集病理学、麻醉剂用量、住院时间、并发症、估计失血量、术前影像学检查肾肿块大小、标本重量和取出切口长度等资料。平均切口长度分碎组为1.2cm，完整组为7.1cm（P< 0.001）。两组之间在疼痛或恢复方面没有显著差异。在两例肿瘤肾切除术中，完整标本组肾周脂肪组织的显微镜下浸润从临床T1到PT 3a疾病;基于此信息，患者治疗没有变化。该标本可以进行组织学评价，但不能进行病理分期，限制了其在移行细胞癌中的应用。端口部位种植是罕见的，并没有出现比开放性肾切除术更频繁。尽管粉碎术是更理想的美容术，但在手术时间、疼痛或住院时间方面没有显著优势。拔牙方法的选择取决于外科医生的偏好和患者的选择。
OBJECTIVESTo review our experience with intact extraction and morcellation of nephrectomy specimens, and the advantages and disadvantages of morcellation indicated by current reports.PATIENTS AND METHODSIn a previous study, 56 consecutive patients undergoing radical and simple transperitoneal laparoscopic nephrectomy were prospectively evaluated. Morcellation specimens (33) were extracted at the umbilical or lateral port sites and intact specimens (23) through an infraumbilical incision. Data were obtained on pathology, narcotic requirements, hospital stay, complications, estimated blood loss, size of renal mass based on preoperative imaging, specimen weight and extraction incision lengthRESULTSThe mean incision length was 1.2 cm in the morcellation group and 7.1 cm in the intact group (P< 0.001). There were no significant differences in pain or recovery between the groups. In two cases of tumour nephrectomy, microscopic invasion of the perinephric adipose tissue in the intact specimen group were up-staged from clinical T1 to pT3a disease; there was no change in patient treatment based on this information.CONCLUSIONSWith proper technique, morcellation is safe for extracting renal tumours. The specimen can be evaluated for histology but not for pathological staging, limiting its use with transitional cell carcinoma. Port-site seeding is rare, and does not appear to be more frequent than with open nephrectomy. Although morcellation is cosmetically more desirable, there was no significant advantage in operating time, pain or duration of hospital stay. The choice of extraction method depends on the surgeon's preference and patient choice.