Halving ischemia time during laparoscopic partial nephrectomy
Halving ischemia time during laparoscopic partial nephrectomy
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DOI：
10.1016/j.juro.2007.09.086
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发表时间：
2008-02-01
影响因子：
6.6
通讯作者：
Gill, Inderbir S.
中科院分区：
文献类型：
--
作者：
Nguyen, Mike M.;Gill, Inderbir S.
目的：腹腔镜肾部分切除术的肾功能和5年肿瘤学结局与开放性肾部分切除术相当。腹腔镜肾部分切除术的另一个缺点是缺血时间比开放手术长10分钟。我们提出了一种早期开放腹腔镜肾部分切除术的技术，减少缺血时间超过50%。材料和方法：在标准腹腔镜肾部分切除术中，肾重建完全在缺血条件下进行。在我们的早期开放技术中，只有最初的肾实质吻合术是在缺血的情况下进行的，其余的支撑性肾缝合术是在血管化的肾脏中进行的。在100例连续非随机化患者中，最初的50例接受标准腹腔镜肾部分切除术（第1组），随后的50例接受早期开放式腹腔镜肾部分切除术（第2组）。结果：基线人口统计学（体重指数，平均肿瘤大小和中央/肝门肿瘤位置）和术中参数（需要进行肾盂肾盏修复，失血量和手术时间）在各组中相似。然而，第2组的热缺血时间显著较短（31.1 vs 13.9分钟，p < 0.0001）。在I组和2组中，60%的患者缺血时间为30分钟或更长，而0%的患者缺血时间为30分钟或更长（p < 0.0001）。与第I组总体并发症（22% vs 16%）相比，第2组的术后肾出血（4% vs 2%）和再次介入率（16% vs 6%）趋势较低（p =不显著）。没有病人有一个积极的癌症边缘，需要开放转换或显示renal dysfunction.Conclusions：这种早期unclamping腹腔镜肾部分切除术技术显着减少缺血时间超过50%，并减少并发症的趋势。我们目前的平均缺血时间小于14分钟，低于或等于当代开放性肾部分切除术系列。
Purpose: Laparoscopic partial nephrectomy has demonstrated renal functional and 5-year oncological outcomes equivalent to those of open partial nephrectomy. A remaining critique of laparoscopic partial nephrectomy is its 10-minute longer ischemia time compared to open surgery. We present an early unclamping laparoscopic partial nephrectomy technique that decreases ischemia time by more than 50%.Materials and Methods: During standard laparoscopic partial nephrectomy renal reconstruction is completely performed under ischemic conditions. In our early unclamping technique only the initial parenchymal suturing is performed under ischemia with the remainder of bolstered renorrhaphy performed in the revascularized kidney. Of 100 consecutive nonrandomized patients the initial 50 underwent standard laparoscopic partial nephrectomy (group 1) and the subsequent 50 underwent early unclamping laparoscopic partial nephrectomy (group 2).Results: Baseline demographics (body mass index, mean tumor size and central/hilar tumor location) and intraoperative parameters (need for pelvicaliceal repair, blood loss and operative time) were similar in the groups. However, warm ischemia time was significantly lower in group 2 (31.1 vs 13.9 minutes, p < 0.0001). In groups I and 2 ischemia time was 30 minutes or greater in 60% vs 0% of patients (p < 0.0001). Compared to group I overall complications (22% vs 16%), postoperative renal hemorrhage (4% vs 2%) and the re-intervention rate (16% vs 6%) trended lower in group 2 (p = not significant). No patient had a positive cancer margin, required open conversion or showed renal dysfunction.Conclusions: This early unclamping laparoscopic partial nephrectomy technique significantly decreases ischemia time by more than 50% and also trends toward decreased complications. Our current mean ischemia time of less than 14 minutes is lower than or equivalent to that in contemporary open partial nephrectomy series.