Laparoscopic live donor nephrectomy: outcomes equivalent to open surgery.
Laparoscopic live donor nephrectomy: outcomes equivalent to open surgery.
复制标题
腹腔镜活体供体肾切除术：结果与开放手术相当。
作者：
Benjamin R. Lee;George K. Chow;Lloyd E. Ratner;L. Kavoussi
肾脏捐献者的短缺引起了人们对腹腔镜活体捐献肾切除术的兴趣。使用三个经腹膜端口，以及 AESOP 机器人。为了维持尿液流动，供体在手术过程中保持体积扩张，并将气腹压力降至最低。手术中最关键和危险的部分是肾动脉和静脉的解剖。应保留丰富的输尿管周围组织以保护血液供应。右肾的收获更加困难。将提取切口置于右上象限，并在肾静脉起点使用 Satinsky 夹代替吻合装置，将提供最大的静脉长度，并有助于防止同种异体移植物术后血栓形成。在约翰·霍普金斯大学的前 175 例腹腔镜肾采集手术中，并发症发生率为 14%，开放性中转率为 2%，3% 的患者需要输血。这些比率随着经验的增加而提高。与开腹肾收获后观察到的同种异体移植物的性能或受体的恢复情况没有显着差异。腹腔镜肾采集的更广泛接受将增加捐赠者的数量，并将有助于缩短学习曲线的方法和设备的开发。
A shortage of kidney donors has contributed to the interest in laparoscopic live-donor nephrectomy. Three transperitoneal ports are used, as is an AESOP robot. To maintain urine flow, the donor is kept volume expanded during the procedure, and the pneumoperitoneum pressure is minimized. The most critical and hazardous part of the surgery is dissection of the renal artery and vein. Abundant periureteral tissue should be left to protect the blood supply. Harvest of the right kidney is more difficult. Placing the extraction incision in the right upper quadrant and using a Satinsky clamp instead of a stapling device at the origin of the renal vein will provide maximum venous length and help prevent postoperative thrombosis of the allograft. In the first 175 laparoscopic renal harvest procedures at Johns Hopkins, the complication rate was 14%, the rate of open conversion was 2%, and 3% of the patients required transfusions. These rates improved with experience. There was no significant difference in the performance of the allografts or the recovery of the recipients from what is seen after open kidney harvest. Wider acceptance of laparoscopic renal harvest will increase the number of donors and will be helped by development of methods and devices that shorten the learning curve.