Laparoendoscopic Single-Site Partial Nephrectomy Without Hilar Clamping Using a Microwave Tissue Coagulator.
Laparoendoscopic Single-Site Partial Nephrectomy Without Hilar Clamping Using a Microwave Tissue Coagulator.
复制标题
使用微波组织凝固器进行腹腔内镜单部位肾部分切除术，无需钳夹肺门。
DOI：
10.1089/end.2013.0135
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发表时间：
2014
影响因子：
2.7
通讯作者：
Kohri Kenjiro
中科院分区：
文献类型：
--
作者：
Kawai Noriyasu;Ando Ryosuke;Tozawa Keiichi;Kohri Kenjiro
目的：报告我们的初步经验，并评估应用微波组织凝固剂进行非门钳腹腔镜单部位（LESS）部分肾切除术的可能性。患者和方法：2010年12月至2012年5月，所有外生性、孤立性、增强性小（≤4.0 cm）肾肿块患者接受研究治疗。多通道通道提供腹膜后和经腹膜入路。在不夹门的情况下，使用刚性的关节装置进行解剖、肿瘤暴露、组织凝固和切除。分析病理和血液学资料、疼痛的主观评价和疤痕外观。结果：7例患者采用微波组织凝固器行非门钳LESS部分肾切除术（平均手术时间208 min，平均失血量39 mL，平均肾肿块大小1.7 cm）；有一例出血不受控制的手术需要转为传统的腹腔镜部分肾切除术。不需要输血。病理检查显示6例肾细胞癌和1例嗜瘤细胞瘤。血红蛋白水平平均下降1.1 g/dL。患者没有抱怨疼痛，他们对结果非常满意。平均住院时间为13.8天。结论：采用微波组织凝血器对肾肿物行较少程度的肾部分切除术，不需肾门夹紧是可行的，其术后效果与标准手术相当，并能保证患者的满意度。使用微波组织凝固器，不需要额外的套管针，可以通过单个端口完成较少的部分肾切除术，减少了侵入，提高了患者的美容满意度。
Purpose:To report our initial experience and evaluate the possibility of nonhilar clamp laparoendoscopic single-site (LESS) partial nephrectomy by using a microwave tissue coagulator.Patients and Methods:From December 2010 to May 2012, all patients with an exophytic, solitary, enhancing small (≤4.0 cm) renal mass were chosen to receive the study treatment. A multichannel port provided both a retroperitoneal and transperitoneal approach. A rigid, articulating apparatus was used to perform dissection, exposure of tumor, tissue coagulation, and resection without hilar clamping. Pathologic and hematologic data, subjective evaluation of pain, and scar appearance were analyzed.Results:Nonhilar clamp LESS partial nephrectomy by using a microwave tissue coagulator was performed in seven patients (mean operative time, 208 min; mean blood loss, 39 mL; mean renal mass size, 1.7 cm); one procedure with uncontrolled bleeding needed to be converted to conventional laparoscopic partial nephrectomy. No transfusion was necessary. Pathologic investigation demonstrated six renal-cell carcinomas and one oncocytoma. The hemoglobin level decreased by a mean of 1.1 g/dL. Patients did not complain about pain, and they had great satisfaction with the results. The mean duration of hospital stay was 13.8 days.Conclusions:LESS partial nephrectomy without hilar clamping by using a microwave tissue coagulator is possible for renal masses, confers postoperative outcomes comparable to the standard counterpart, and assures patient satisfaction. By use of a microwave tissue coagulator, additional trocars were not necessary, and LESS partial nephrectomy could be accomplished through a single port, which reduced invasion and increased the cosmetic satisfaction of the patients.