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Bilateral Hand-Assisted Laparoscopic Renal Surgery in the Supine Positions The Spleen at Risk

机译：仰卧位双侧手辅助腹腔镜肾手术脾脏处于危险状态

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Objective: We evaluated the safety of simultaneous bilateral renal procedures performed using hand-assisted lap-aroscopy (HAL) with the patient in the supine position.Materials and Methods: After securely strapping the patient to the table, a hand-port device is placed via a 7-cm supraumbilical or peri-umbilical incision with two to four 5-mm to 12-mm trocars placed bilaterally. During a 3-year period, 8 bilateral HAL renal operations were initiated (upper pole partial nephrectomies, 3 nephroureter-ectomies, 3 bilateral nephrectomies, and right nephrec-tomy with left adrenalectomy).Results: Mean patient age was 41 years. One patient with ADPKD required conversion to open due to failure to progress secondary to excessive perirenal fat and 22-cm kidneys. The other 7 were completed successfully with a mean operative time of 417 minutes and mean EBL of 336cc. Two patients received transfusions. Two small splenic lacerations, managed conservatively, were the only complications.Conclusions: Bilateral hand-assisted laparoscopic renal surgery with the patient in the supine position (rolling the table side to side) is feasible in the majority of patients. However, very large kidneys (eg, ADPKD) may be better approached with the patient in the lateral decubitus position or via an open subcostal incision. Importantly, the spleen appears to be at increased risk for capsular injury due to apparent increased difficulty of left colon mobilization in the "rolled" or "airplaned" supine position.
机译：目的：我们评估了在患者仰卧位时使用手辅助腹腔镜（HAL）进行的同时双侧肾脏手术的安全性。材料与方法：将患者牢固地绑在桌子上后，放置一个手口装置通过在脐带上或脐带周围7厘米的切口，两侧放置2至4根5毫米至12毫米的套管针。在三年内，开始了8例双侧HAL肾手术（上极部分肾切除术，3例肾癌切除术，3例双侧肾切除术和左肾上腺切除术的右肾切除术）。结果：平均患者年龄为41岁。一名ADPKD患者由于肾周脂肪过多和22厘米的肾脏继发性进展而无法进行开放手术。其他7例均已成功完成，平均手术时间为417分钟，平均EBL为336cc。两名患者接受了输血。仅有的两个保守的小脾裂伤是唯一的并发症。结论：在大多数患者中，双侧手辅助腹腔镜肾手术，患者仰卧位（将手术台并排放置）是可行的。然而，将患者置于外侧卧位或通过开放性肋下切口可能会更好地接近非常大的肾脏（例如ADPKD）。重要的是，由于左结肠动员在“滚动”或“飞机上”的仰卧位中明显增加了难度，脾脏似乎有发生囊膜损伤的风险增加。

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