A comparison of laparoendoscopic single-site surgery versus conventional procedures for laparoscopic donor nephrectomy: a Japanese multi-institutional retrospective study

A comparison of laparoendoscopic single-site surgery versus conventional procedures for laparoscopic donor nephrectomy: a Japanese multi-institutional retrospective study
复制标题

腹腔镜单部位手术与腹腔镜供肾切除术传统手术的比较：日本多机构回顾性研究

DOI：
10.1007/s00464-019-07119-9
复制
发表时间：
2020
期刊：
Surgical Endoscopy
影响因子：
--
通讯作者：
LESS and RPS Research Group in Japanese Society of Endourology
LESS and RPS Research Group in Japanese Society of Endourology
中科院分区：
--
文献类型：
--
作者：
Shigeta Keisuke;Hasegawa Masanori;Kikuchi Eiji;Yasumizu Yota;Kosaka Takeo;Mizuno Ryuichi;Mikami Shuji;Miyajima Akira;Kufe Donald;Oya Mototsugu;LESS and RPS Research Group in Japanese Society of Endourology

文献摘要

相似文献

目的腹腔镜下单部位供肾切除术（LESSDN）因其无创性和良好的美容效果而成为一种可行和有效的手术方法。然而，很少有由多名外科医生对LESSDN进行的多机构研究。我们回顾性比较了日本多个研究所的LESSDN和传统腹腔镜供体肾切除术（LDN）的临床资料和结果。材料与方法收集2009 - 2015年10个研究所223例LESSDN和151例LDN的临床资料。所有lessdn均经腹腔进行，而ldn在75例患者中经腹腔（P-LDN）进行，在76例患者中经腹膜后（R-LDN）进行。结果在LESSDN组中，155例（69.5%）患者的单切口位于直肠旁，65例（29.1%）患者的单切口位于脐旁。多名外科医生（每个研究所一至八名）执行LESSDN。在估计失血量和热缺血时间方面，三组之间没有观察到显著差异。LESSDN组手术时间明显短于R-LDN组（p= 0.018）。在输血、开放转换、内脏损伤和术后并发症的发生率方面，没有观察到显著差异。此外，镇痛药的剂量和移植物功能延迟率没有显著差异。1例患者因肾动脉损伤需要开腹手术。肾移植后1年受者血清中位肌酐水平高于1.27 mg/dL，选择LESS手术并不是一个独立的危险因素。结论与标准ldn相比，LESSDN在多机构、多医生的环境下具有技术可行性。一些观察到的不可忽略的并发症和LESSDN患者血清肌酐水平明显升高表明，当外科医生没有足够的LESS手术经验时，应谨慎使用该手术。
PurposeLaparoendoscopic single-site donor nephrectomy (LESSDN) is a feasible and effective procedure because of its non-invasiveness and better cosmetic outcomes. However, there have been few multi-institutional studies conducted by multiple surgeons on LESSDN. We retrospectively compared the clinical data and outcomes between LESSDN and conventional laparoscopic donor nephrectomy (LDN) at multiple institutes in Japan.Materials and methodsFrom 2009 to 2015, the clinical data of 223 donors who underwent LESSDN and 151 donors who underwent LDN were collected from 10 institutes. All LESSDNs were performed transperitoneally, whereas LDNs were performed transperitoneally (P-LDN) in 75 patients and retroperitoneally (R-LDN) in 76 patients.ResultsIn the LESSDN group, the single-incision site was pararectal in 155 (69.5%) patients and umbilical in 65 (29.1%) patients. Multiple surgeons (one to eight per institute) performed the LESSDN. No significant differences were observed between the three groups regarding estimated blood loss and warm ischemic time. The operative time was significantly shorter in the LESSDN group than in the R-LDN group (p= 0.018). No significant differences were observed regarding the rates of blood transfusion, open conversion, visceral injuries, and postoperative complications. Furthermore, no significant differences were observed regarding the dose of analgesic and the rate of delayed graft function. One patient required open conversion due to injury to the renal artery. Selection of LESS procedure was not an independent risk factor for the median serum creatinine level of above 1.27 mg/dL in recipients at 1 year after kidney transplantation.ConclusionThe results showed the technical feasibility of LESSDN compared with the standard LDNs in a multi-institutional and multi-surgeon setting. A few observed non-negligible complications and the significantly higher levels of serum creatinine in patients who underwent LESSDN indicate that this procedure should be employed cautiously when performed by surgeons without ample experience in performing LESS procedures.