单孔后腹腔镜根治性肾切除手术研究

目的：验证单孔后腹腔镜肾根治切除的可行性、安全性，减少手术切口和瘢痕。方法：2011年4～6月对15例肾肿瘤患者行自制单孔后腹腔镜肾根治性切除术，肿瘤最大径3．0～10．1cm，平均4．88Cn3。患者体重指数21．48～33．33，平均25．52。在腋后线12肋下向前作5～6cm切171，应用自制单孔多通道操作器械，放入常规腹腔镜操作器械进行后腹腔镜根治性切除，由操作通道切口取出标本。结果：本组15例手术均获成功，术中出血20~80ml，手术时间2～3h，平均145min。标本重量290～632g，平均409．09g。所有病理结果均为‘肾透明细胞癌。结论：该术式安全可行，手术时间随着手术例数的增加和经验的积累而逐渐缩短。手术操作通道和取标本切口为同一个切口，减少创伤和瘢痕。

Primary Report on Retroperitoneal Laparoendoscopic Single-site Radical Nephrectomy

Objective：To present our initial experience with single-port laparoscopic radical nephrectomy via the retroperitoneal by using a homemade single port device. Method： Between April and June 2011,15 patients with re- nal cancer in our center underwent retroperitoneal laparoendoscopic single-site radical nephrectomy by using a homemade single-port device. The mean tumor size was 4.88 cm（range 3.0-10.1 cm）. The mean body mass index of the patients was 25.52（range 21.48-33.33）. An incision the size of 5-6 cm was made from the posterior axillary line under the lower margin of the 12 th rib. Two control loops were inserted into a powder-free latex surgical glove （size 8） ,then the glove was enfolded 2 times along the loops,thus making a single-port device with multiple manip- ulation channels,through which the routine laparoscopic instruments could pass. Retroperitoneal laparoscopic radi- cal nephrectomy was performed, and the resected kidney was pulled out through the incision. Result .. Retroperitoneal laparoendoscopic single-site radical nephrectomy were performed successfully on all the 15 patients. The mean operative time was 145 minutes（range 2-3 hours）. The estimated blood loss ranges from 20-80 ml. The average weight of the resected en-bloc specimens was 409.09 g（range 290-632 g）. Pathological diagnosis showed clear cell renal cell carcinoma in all patients. Conclusion= It appears to be a feasible and safe surgical strategy to perform ret- roperitoneal laparoscopic radical nephrectomy using our homemade single-port device with multiple manipulation channels. The average operation time will decrease with increasing cases and experience accumulation. The resected kidney could be pulled out through the incision, which also served as the solo manipulation channel, compared with additional two ports needed during classic retroperitoneal laparoscopy. The patients will benefit from this single port technique when addressing cosmetic considerations because only one skin scar left postoperation.