The technique of transperitoneal laparoscopic nephrectomy, adrenalectomy and nephroureterectomy.
The technique of transperitoneal laparoscopic nephrectomy, adrenalectomy and nephroureterectomy.
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经腹腔镜肾切除术、肾上腺切除术和肾输尿管切除术的技术。
DOI：
10.1159/000474647
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发表时间：
1993
期刊：
影响因子：
23.4
通讯作者：
P. Alken
中科院分区：
文献类型：
--
作者：
J. Rassweiler;T. Henkel;D. Potempa;M. Coptcoat;P. Alken
在传统的肾脏位置，在建立气腹后插入三个套管针：脐周10 mm（端口I），肋下10/12 mm（端口II）和乳头线中髂棘上方12/10 mm（端口III）。侧结肠切开后，将结肠从外侧壁剥离。此后，将两个5 mm套管针（端口IV、V）平行于部分II和III插入侧腹壁。在卵巢（精索）静脉的夹闭和分离后，输尿管被分离和切开。然后将输尿管的头侧部分用作牵开器，暴露肾门，以便分离肾血管。使用内窥镜吻合器械（Endo-GIA，白色杂志）分别分离主肾动脉和主肾静脉。最后，将包括Gerota筋膜的肾脏与肾上腺和上腹膜分离。用专门设计的袋（Lap-sac）进行器官包埋。将袋的颈部带到腹部表面上（通过端口II/III），允许用袋内的食指进行指状分碎，并将器官分成几块取出。我们已经在上腹膜后腔应用了17例手术：9例经腹腔镜肾切除术（TLN）治疗良性疾病（5例肾积水，3例肾血管疾病，1例慢性肾盂肾炎），3例根治性TLN，包括肾细胞癌（T2 G2）的肾上腺切除术，1例肾上腺皮质瘤的肾上腺切除术，1例肾输尿管切除术，1例诊断性输尿管松解术和2例改良腹膜后淋巴结切除术治疗I期睾丸癌。手术时间2-5 h，平均4 h;术后住院时间4-12 d，平均6 d。（250字处删节）
In the traditional kidney position three trocars are inserted after creation of a pneumoperitoneum: 10 mm periumbilical (port I), 10/12 mm subcostal (port II) and 12/10 mm above the iliac spine (port III) in the mamillary line. After laterocolic incision the colon is dissected away from the lateral wall. Thereafter two 5-mm trocars (ports IV, V) are inserted into the lateral abdominal wall parallel to parts II and III. Following clipping and dissection of the ovarian (spermatic) vein, the ureter is isolated and incised. Then the cranial part of the ureter is used as a retractor exposing the renal hilum for dissection of the renal vessels. The main renal artery and vein are dissected separately by use of an endoscopic stapling device (Endo-GIA, white magazine). Finally, the kidney including Gerota's fascia is isolated from the adrenal and the upper peritoneum. Entrapment of the organ is performed with a specially designed bag (Lap-sac). The neck of the bag is brought out onto the surface of the abdomen (via port II/III) allowing digital morcellation with index finger inside the bag and removal of the organ in several pieces. We have applied this technique for 17 procedures in the upper retroperitoneum: 9 transperitoneal laparoscopic nephrectomies (TLN) for benign disease (5 hydronephrosis, 3 renovascular disease, 1 chronic pyelonephritis), 3 radical TLN including adrenalectomy for renal cell carcinoma (T2G2), 1 adrenalectomy for a cortical adrenaloma, 1 nephroureterectomy, 1 diagnostic ureterolysis and 2 modified retroperitoneal lymphadenectomies for stage I testicular cancer. The mean operation time was 4 h (2-5), the mean postoperative hospital stay 6 days (4-12).(ABSTRACT TRUNCATED AT 250 WORDS)