Anatomic landmarks and time management during retroperitoneoscopic radical nephrectomy
Anatomic landmarks and time management during retroperitoneoscopic radical nephrectomy
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DOI：
10.1089/089277902753716133
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发表时间：
2002-04-01
影响因子：
2.7
通讯作者：
Gill, IS
中科院分区：
文献类型：
--
作者：
Sung, GT;Gill, IS
背景和目的：后腹腔镜并没有被广泛认为是腹腔镜根治性肾切除术治疗癌症的首选方法，部分原因是后腹腔镜解剖标志尚未明确。本研究的目的是提供有关后腹腔镜根治性肾切除术的解剖标志和顺序手术步骤时间管理的前瞻性、客观数据。材料和方法：设计了一个统一的数据库来前瞻性记录18例连续后腹腔镜根治性肾切除术中预定的术中参数。结果：采用三孔或四孔技术进行了10例左和8例右后腹腔镜根治性肾切除术。初始球囊扩张常规在Gerota筋膜外部和后方进行。腹腔镜首次插入时立即可见的解剖标志为：腰肌18例（100%），Gerota筋膜18例（100%），腹膜反折15例（83%），输尿管和/或性腺静脉11例（61%），肾动脉搏动10例（56%）。10例左肾根治术中9例（90%）可见主动脉搏动，8例右肾根治术中2例（25%）可见下腔静脉搏动。平均手术时间为203 +/- 52.9分钟（范围105-290分钟）。顺序手术步骤及其各自的时间分解为：输液港放置12：+/- 3.9分钟，肺门剥离63 +/- 29.1分钟，肾上腺活动49 +/- 12.1分钟，标本活动19 +/- 20.8分钟，标本截留和退出23 +/- 18.2分钟。结论：在后腹腔镜手术中，正确的腹膜后间隙的形成和解剖标志的识别是非常重要的。对后腹腔镜根治性肾切除术的手术步骤进行时间分析，是我们改进手术技术的重要自我评估工具。因此，我们的后腹腔镜根治性肾切除术的手术时间从早期的4- 5小时范围减少到目前的2- 3小时范围。
Background and Purpose: Retroperitoneoscopy has not been widely considered the preferred approach to laparoseopic radical nephrectomy for cancer, in part because the retroperitoneal anatomic landmarks have not been well defined. The aim of this study is to provide prospective, objective data on retroperitoneoscopic radical nephrectomy with regard to anatomic landmarks and time management of the sequential operative steps.Materials and Methods: A uniform database was devised to record predetermined intraoperative parameters prospectively in 18 consecutive retroperitoneoscopic radical nephrectomies.Results: A three- or four-port technique was employed to perform 10 left and 8 right retroperitoneoscopic radical nephrectomies. Initial balloon dilation was routinely performed outside of and posterior to Gerota's fascia. The anatomic landmarks visible immediately on initial insertion of the laparoscope were: psoas muscle in 18 cases (100%), Gerota's fascia in 18 (100%), peritoneal reflection in 15 (83%), ureter and/or gonadal vein in 11 (61%), and renal artery pulsations in 10 (56%). Aortic pulsations were seen in 9 of 10 left (90%) and the inferior vena cava in 2 of 8 right (25%) radical nephrectomies. The mean surgical time was 203 +/- 52.9 minutes (range 105-290 minutes). The sequential operative steps and their individual time breakdowns were: port placement 12 :+/- 3.9 minutes, hilar dissection 63 +/- 29.1 minutes, adrenal mobilization 49 +/- 12.1 minutes, specimen mobilization 19 +/- 20.8 minutes, and specimen entrapment and exit 23 +/- 18.2 minutes. When the initial balloon dilation resulted in visibility of four or more anatomic landmarks, the hilar dissection time was significantly shorter (P < 0.001).Conclusions: Proper development of the retroperitoneal space and identification of adequate anatomic landmarks is important during retroperitoneoscopy. This timed analysis of the sequential operative steps of retroperitoneoscopic radical nephrectomy has served as an important self-assessment tool for us in improving our surgical technique. As a result, our surgical time for retroperitoneoscopic radical nephrectomy has decreased from the earlier 4- to 5-hour range to the current 2- to 3-hour range.