Feasibility of Transvaginal Natural Orifice Transluminal Endoscopic Surgery-Assisted Living Donor Nephrectomy: Is Kidney Vaginal Delivery the Approach of the Future?
Feasibility of Transvaginal Natural Orifice Transluminal Endoscopic Surgery-Assisted Living Donor Nephrectomy: Is Kidney Vaginal Delivery the Approach of the Future?
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DOI：
10.1016/j.eururo.2011.03.021
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发表时间：
2011-06-01
期刊：
影响因子：
23.4
通讯作者：
Ribal, Maria J.
中科院分区：
文献类型：
--
作者：
Alcaraz, Antonio;Musquera, Mireia;Ribal, Maria J.
背景：自然腔道经腔内镜手术（NOTES）使用自然腔道进入腹腔。我们适应NOTES进行经阴道NOTES辅助腹腔镜肾切除术在living donor.Objective：评估这一过程的可行性和可重复性，并将其与传统的腹腔镜活体供肾切除术（LLDN）进行比较设计，设置和参与者：从2009年7月至2010年10月，20名妇女进行了经阴道NOTES辅助活体供肾切除术（LDN）在我们的中心。我们比较了前瞻性收集的临床数据，每个捐助者与同期配对的传统LLDNs（40捐助者）。手术程序：该程序是使用三个腹部套管针和一个套管针通过阴道wall.Measurements：变量评估捐助者的程序长度，失血量，热缺血时间（WIT），并发症，住院时间，和第一个月肌酐最低点。在经阴道LDN组中，在手术前后用女性性功能指数问卷评估性功能。接受者的评估变量是并发症，移植功能，和肌酐evolution.Results和局限性：在所有情况下完成的程序。除WIT外，两组的手术变量相似，经阴道LDN组WIT较长（p < 0.001），对移植物功能无影响。1例经阴道LDN病例术后出血，需要立即开放手术。所有经阴道LDN供体均报告手术后性功能未改变，并对结果表示满意。所有受者均立即排尿，并且在最后随访时，除经阴道LDN组的一名受者需要移植切除术外，所有受者均具有功能性移植物。尽管有希望的结果，随机对照研究，随访时间较长，有必要进一步阐明这种新technology.Conclusions的潜力：经阴道NOTES辅助LDN似乎是一种可行的和可重复的手术技术。经阴道组的WIT较长，短期随访后对移植物功能没有影响。(C)2011年欧洲泌尿外科协会。Elsevier B.V.出版，保留所有权利。
Background: Natural orifice transluminal endoscopic surgery (NOTES) uses natural orifices to access the abdominal cavity. We adapted NOTES to perform transvaginal NOTES-assisted laparoscopic nephrectomy in living donors.Objective: To assess the feasibility and reproducibility of this procedure and compare it with conventional laparoscopic living donor nephrectomy (LLDN).Design, setting, and participants: From July 2009 to October 2010, 20 women underwent transvaginal NOTES-assisted living donor nephrectomy (LDN) in our centre. We compared the prospectively collected clinical data of each donor with those of a contemporaneous matched pair of conventional LLDNs (40 donors).Surgical procedure: The procedure was performed using three abdominal trocars and one trocar through the vaginal wall.Measurements: Variables evaluated for donors were procedure length, blood loss, warm ischaemia time (WIT), complications, hospital stay, and first-month creatinine nadir. In the transvaginal LDN group, sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. Variables evaluated for recipients were complications, graft function, and creatinine evolution.Results and limitations: The procedure was completed in all cases. Operative variables were similar for both groups except for WIT, which was longer in the transvaginal LDN group (p < 0.001) without consequences for graft functioning. One transvaginal LDN case had postoperative bleeding requiring immediate open surgery. All transvaginal LDN donors reported unaltered sexual function after surgery and satisfaction with the results. All recipients had immediate urine output, and all had a functioning graft at last follow-up except for one recipient of the transvaginal LDN group who required transplantectomy. Despite promising results, randomised controlled studies with longer follow-up are warranted to further elucidate the potential of this novel technique.Conclusions: Transvaginal NOTES-assisted LDN appears to be a feasible and reproducible surgical technique. The WIT was longer in the transvaginal group, and there was no effect on graft function after the short follow-up. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.