单孔腹腔镜根治性肾切除术治疗肾细胞癌

目的探讨应用单孔腹腔镜手术(laparo endoscopic single-site surgery,LESS)行根治性肾脏切除术治疗肾脏肿瘤的临床安全性及可行性。方法 2010年11月至2011年4月,我们应用单孔4通道(Quadport)单孔腹腔镜根治性肾脏切除术技术治疗3例肾脏肿瘤,1例为右侧中央型4.2cm肾肿瘤,另两例分别为左侧肾下极7.4cm和肾中部4.5cm肾肿瘤。经脐部切口将Quadport置入腹腔,采用5mm头部可弯腹腔镜和标准腹腔镜直器械实施标准经腹腔途径腹腔镜根治性肾脏切除术。记录患者手术时间、估计术中出血量、术中并发症、留置引流管时间、术后住院时间和术后病理等临床资料,并对结果进行分析。结果本组3例手术均由LESS完成,无加辅助通道、无转标准腹腔镜手术或开放手术完成病例。仔细实施手术步骤,避免过度钝性分离组织造成术中出血是手术顺利进行的基础。采用Quadport减少了器械间的相互干扰。根治性肾脏切除术手术操作时间分别为215、230、170min,估计术中出血量分别为100、100、150ml。本组手术无术中严重并发症。术后留置引流时间分别为4、3、2d,术后住院时间分别为8、10、8d。本组术后无继发性出血和切口感染病例。病理结果示肾透明细胞癌2例,肾嫌色细胞癌1例,无淋巴结转移,病理分期分别为pT1bN0M02例,pT2aN0M01例。本组未见肿瘤侵及肾周围组织。结论 LESS根治性肾脏切除术治疗肾脏肿瘤是安全可行的,但需要更多的研究来进一步验证。

Laparoendoscopic single-site radical nephrectomy: A single center of 3 case report

Objective To verify the safety and feasibility of applying laparoendoscopic single-site surgery (LESS) radical nephrectomy in the treatment of kidney tumors. Methods From Nov. 2010 to April 2011, we had used LESS radical nephrectomy technique to treat 3 kidney tumor cases, one right central 4.2cm kidney tumor and another two left lower pole 7.4 cm and 4.5 cm kidney tumors. Quadport was inserted through a transumbilical incision. Standard laparoscopic instruments and flexible tip 5 mm laparoscope was used. The standard laparoscopic transperitoneal nephrectomy technique was performed. Application of Quadport reduced the clash of instruments. Step by step performing surgery and avoiding blunt dissection reducing intraoperative bleeding is the cornerstone of success. We evaluated this technique in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay and pathological results. Results The 3 procedures in this group were completed successfully with LESS radical nephrectomy. There was no additional trocar added, no conversion to standard laparoscopic or open surgery. The operative time were 215,230 and 170 min,estimated blood loss were 100, 100 and 150 ml. There was no severe intraoperative complication. The VAPS in the first post-operative day were 1, 2 and 2. The drainage time were 4 , 3 and 2 d, post-operative hospital stays were 8, 10 and 8 d. There was no secondary bleeding or wound infection.Pathological results showed that case No. 1 and 3 were renal clear cell carcinoma in pT1bN0M0 and case No. 2 was renal chromophobic cell carcinoma in pT2aN0M0, respectively. All the specimens in this group were surgical margin negative. Conclusions LESS radical nephrectomy is a safe and feasible treatment choice for the treatment of kidney tumors but need further clinical investigation in comparison to establish the standard LESS radical nephrectomy technique.