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首页> 外文期刊>BJU international >An update on experience with the single-instrument port laparoscopic nephrectomy.
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An update on experience with the single-instrument port laparoscopic nephrectomy.

机译：单仪器端口腹腔镜肾切除术的经验更新。

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OBJECTIVE: To describe a modification of the posterior prone retroperitoneoscopic nephrectomy, which allows the entire operation to be performed through a single instrument port. PATIENTS AND METHODS: With the patient prone, a retroperitoneal working space is created using a custom-made balloon lateral to the sacrospinalis muscle. One instrument port is placed at the tip of the 11th rib under direct vision. The laparoscope and working instrument can both be held by the operating surgeon. Gerota's fascia is incised and the kidney reflected anteriorly. The vessels are identified and divided. The remaining dissection is completed with a harmonic scalpel and the specimen is placed in an endo-catch bag. Care must be taken to avoid even minor bleeding, to keep the operating field clear. RESULTS: The technique was successful in 54 children with a mean (range) age of 4.5 (0.25-14) years; the mean operative duration was 52 (35-96) min. Blood loss was minimal and there were no open conversions. Most children (51) were discharged the day after surgery, and the cosmetic outcome has been excellent in all cases. CONCLUSIONS: Compared with the traditional approach, the single-instrument port laparoscopic (SImPL) nephrectomy approach avoids instrument crowding and maximizes the restricted retroperitoneal working space. Avoiding the second port might improve cosmesis and reduce cost. The technique is quickly mastered by both the experienced laparoscopist and trainee, and is feasible and safe.
机译：目的：描述后腹膜后腹腔镜肾切除术的一种改良形式，它允许通过单个器械端口进行整个手术。患者和方法：俯卧患者，通过使用pin棘肌外侧的定制气球创建腹膜后工作空间。在直视下，一个仪器端口位于第11肋骨的尖端。腹腔镜和工作器械都可以由手术医生持有。切开Gerota筋膜，并向前方反射肾脏。识别并划分船只。剩余的解剖用和声手术刀完成，并将标本放入内陷袋中。必须注意避免轻微的出血，以保持手术区域的清洁。结果：这项技术在54名平均（范围）年龄为4.5（0.25-14）岁的儿童中获得了成功。平均手术时间为52（35-96）分钟。失血很少，没有公开转换。大多数儿童（51岁）在术后第二天出院，所有情况下的美容效果都非常好。结论：与传统方法相比，单器械腹腔镜（SImPL）肾切除术可避免器械拥挤并最大程度地限制腹膜后腔的工作空间。避开第二个端口可能会提高美观度并降低成本。该技术由经验丰富的腹腔镜医师和受训者迅速掌握，既可行又安全。

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