经脐单孔多通道腹腔镜手术治疗良性肾脏疾病的初步体会

目的 探讨经脐单孔多通道腹腔镜手术治疗良性肾脏疾病的可行性和安全性.方法 2008年12月至2009年5月,应用Triport单孔多通道平台完成无功能肾切除1例、肾盂旁囊肿1例和单纯性肾囊肿去顶减压术11例.在脐上缘切开2 cm,开放切开法直接进入腹腔,置入Triport.使用5 mm一体式腹腔镜、可弯抓钳、可弯分离钳和传统腹腔镜器械完成操作.使用血管直线切割器离断肾蒂.无功能肾脏标本装袋后由切口取出,不留置引流管.结果 手术均顺利完成,未增加另外工作通道.其中肾切除术耗时85 min,出血50 ml;肾盂旁囊肿去顶术耗时110 min,出血30 ml;单纯性肾囊肿去顶术平均耗时35(25～55)min.术后平均住院2.8(2～5)d,术后均无明显手术瘢痕.结论 经脐单孔多通道腹腔镜手术治疗良性肾脏疾病创伤小、美容效果好,效果满意,在适应可弯器械后手术难度明显减低.

Single-port transumbilical laparoscopic surgery for the treatment of benign renal diseases: initial experience

Objective To evaluate the safety and efficacy of single-port transumbilical 1aDaro-scopic surgery for the treatment of benign renal diseases. Methods From Deeember 2008 to Mav 2009，13 cases of benign renal disease were treated with Tri-Port system single-port transumbilical laparoscopic surgery，including nonfunctional nephrectomy(1 case)，decortication of simple tenal cyst (11 eases)and parapelvic cyst(I case).Tri-Port placed from a transumbilical incision was used in all cases.A flexible grasper and a S-mm 30-degree camera were used in addition to standard laparoscopic equipment or flexible scissors.Renal pedicle was secured and divided by Endoscopic Linear Stapling. Nonfunctioning kidney was extracted through the transumbilical incision without leaving drainage. Results All surgeries were completed successfully，no conversion tO standard laparoscopic approach and no additional trocar added.The operative time of nonfunctional nephrectomy was 85 min and esti- mated blood loss was 50 m1.The operative time of decortication of parapelvic cyst was 1 10 rain and es- timated blood loss was 30 m1.The mean operative time of decortication of simple renal cvst was 35 min.The mean hospital stay after surgery was 2.8 d. Conclusions Single-port laparoscopic surgery is safe and feasible in the treatment of benign renal diseases.It has the advantages of 1ess trauma and more cosmetic benefit than traditional laparoscopic surgery.However，more specific instruments and longer learning curving need to improve the skills during the single-port surgery.