Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy.
Comfortable suture angle with optimized trocar position aids renorrhaphy during retroperitoneal laparoscopic partial nephrectomy.
复制标题
在后腹腔镜肾部分切除术中，舒适的缝合角度和优化的套管针位置有助于肾缝合。
DOI：
10.21037/tau-20-1126
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发表时间：
2021-03
影响因子：
2
通讯作者：
Shao P
中科院分区：
文献类型：
--
作者：
Qian J;Zhang Q;Cao Q;Jiang J;Li P;Bao M;Qin C;Wang Z;Hua L;Shao P
本研究探讨了一种舒适的缝合角（CSA）与优化的套管针位置，用于在后腹腔镜肾部分切除术（LPN）中闭合肾缝合缺损。针对不同肿瘤类型，确定了采用改良套管针位置实现CSA的可行性、有效性和安全性。针对不同的肿瘤类型，引入了两种优化的穿刺器位置。根据浅表软组织缺损的肿瘤平面和持针保持器形成的线确定缝合角度。初步手术模拟确定了一种CSA，其结合了最少的缝合时间和最大的性能便利性。在106例接受腹膜后LPN的入组患者的肾缝合术中尝试实现CSA。收集并分析患者的特征、手术特征和随访信息。89例（83.96%）患者成功达到CSA，实质恢复。其余17例患者成功缝合，但尝试实现CSA失败。对于CSA组，缝合、夹紧和总手术时间显著少于非CSA患者。两组在估计失血量、手术切缘阳性、肾小球滤过率降低和并发症发生率方面相似。单变量分析确定肿瘤位置、生长模式和RENAL肾功能测定评分（RNS）可能影响该方法的成功。多因素分析表明，只有肿瘤部位和RNS是影响CSA成功实现的独立因素。通过不同的肾脏位置变化，CSA可用于简化缝合过程。在LPN期间使用优化的穿刺器位置进行CSA是可行和安全的。肿瘤位置和RNS可能影响CSA的获取途径。
This study investigated a comfortable suture angle (CSA) with optimized trocar position for closing the defect during renorrhaphy in retroperitoneal laparoscopic partial nephrectomy (LPN). The feasibility, usefulness, and safety of achieving the CSA with modified trocar position were determined for different tumor types. Two optimized trocar positions were introduced for different tumor types. A suture angle was based on the tumor plane of the superficial parenchyma defect and the line formed by the needle holder. Preliminary surgical simulations determined a CSA that combined the least suture time with the greatest ease of performance. Achieving the CSA was attempted during renorrhaphy of 106 enrolled patients undergoing retroperitoneal LPN. Patients’ characteristics, operative features, and follow-up information were collected and analyzed. For 89 (83.96%) patients, a CSA was successfully reached and parenchyma recovered. The remaining 17 patients were successfully sutured, but the attempt to achieve a CSA failed. For the CSA group, the suture, clamping, and overall operative times were significantly less than that of the non-CSA patients. The groups were similar regarding estimated blood loss, positive surgical margin, and rates of glomerular filtration reduction and complications. Univariable analyses determined that tumor location, growth pattern, and R.E.N.A.L. nephrometry score (RNS) may influence the success of this approach. Multivariable analyses indicated that only tumor location and RNS were independent factors affecting successful achievement of the CSA. Through different kidney position changes, the CSA could be used to ease the suture process. It is feasible and safe to perform a CSA with optimized trocar position during LPN. Tumor location and RNS may influence the approach to get a CSA.
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