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Objective To introduce the advantages,incision designing methods and surgical procedures of spigelius' line incision in retroperitoneal laparoscopic living donor nephrectomy.Methods Among the 114 donors,39 were obtained by spigeliu'line incision (13 males and 26 females),with an average age of 35 years,35 left kidneys and 4 right kidneys.Gibson incision was performed in 75 patients (28 males and 47 females),with an average age of 31 years,73 left kidneys and 2 right kidneys.The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively.The operation was performed by laparoscopic surgery to separate the ureter,renal vessels and perirenal fat.Finally,the renal vessels were removed and the kidneys were removed with hand-assistant.75 cases were taken out of the kidney through the inguinal parallel incision (Gibson incision),while the other 39 cases used the spigelius' line incision (Through the linea pararectalis,the anterior sheath is cut opened at the margin of the rectus sheath (spigelius' line) and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space).The intraoperative data were collected.Results All the operations were not converted to open surgery.The incision length of the spigelius' line incision group was (6.8 ± 0.6) cm,and the incision length of the Gibson incision group was (7.0 ± 0.4) cm,P =0.02.The blood loss of the operation of the spigelius' line incision group was (59.2 ± 33.4) ml,while the Gibson incision group was (80.7 ± 32.8) ml,P =0.002.The warm ischemia time of the spigelius'line incision group was (2.8 ± 1.1) min,while the Gibson incision group was (3.1 ± 1.7) min,P =0.31.The operation time of the spigelius' line incision group was (160.8 ± 30.7) min,while the Gibson incision group was (162.5 ± 28.1) min,P =0.77.There was no significant difference between the two groups in the warm ischemia time and the operation time.No incisional hernia was found in these two groups.Conclusions Compared with Gibson incision,the spigelius' line incision is safe.It can completely avoid to cut the abdominal muscles,and effectively avoid the abdominal nerves injury.Without damaging the integrity of the peritoneum,it can avoid abdominal organ injury.
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Objective To explore the operating skills of finding and dissecting renal pedicle in retroperitoneosocpic radical nephrectomy.Methods From April 2011 to April 2015,224 patients with renal tumors were treated by retroperitoneosocpic radical nephrectomy.Along the ureteral ascending methodis used to find renal pedicle for 126 cases(the research group):First found ureter in the iliac crest,the ureter was nearest psoas major here and waseasy to find.Along the ureteral upward until to the renal pelvis and the superior border of renal pelvis is the renal pedicle.77 male and 49 female cases,Age 42 to 84 years,(56.6 ± 9.0) years old on average.Sixty-nine tumors were located in left kidney,and 59 in the right kidney.The mean diameter of renal tumor was(5.3 ± 1.1)cm.There were 25 cases of T1a N0 M0,75 T1b N0 M0,23 of T2 N0 M0,3 of T1bN1M0.Over the same period uplift in he kidney central method is used to find renal pedicle for 98 cases.64 male and 34 female cases,Age 27 to 81 years,(57.9 ± 8.3)years old on average.52 tumors were located in left kidney,and 46 in the right kidney.The mean diameter of renal tumor was (5.5 ± 1.4)cm.There were 19 cases of T1aN0M0,61 T1bN0M0,16 of T2N0M0,2 of T1bN1 M0.Results The differences were significant for Looking for renal pedicle time(2.2 ± 1.1 vs.4.5 ±2.0) min,operation time (73.7 ±67.3 vs.90.1 ±87.5)min,hemorrhage volume(69.8 ±42.7 vs.89.7 ±89.2) ml,the incidence of complications (3 vs.9) between the study group and the control group (P ＜ 0.05).The difference were not significant in postoperative hospital stay (7.5 ± 0.8 vs.7.3 ± 0.8) d,exhaust time (2.1 ± 0.6 vs.2.2 ± 0.6) d between two group.All the operations were performed successfully in the research group,with no conversion to open and transfusion.Major complications included 3 cases of vessel injury.Hemostasis was performed with metal clips and suture.In the control group,ena cava rupture in 3 cases,left lumbar veins rupture in 3 cases,retroperitoneal hematoma in 2 case,mild pulmonary embolism in 1 case.two case performed open operation owing to vena cava rupture.The vena cava rupture transit open surgery in 2 cases,and Hemostasis was performed with metal clips in 1 case of vena cava rupture and on the left side of the lumbar veins rupture was managed by suture,titanium clips and bipolar electrocautery;Retroperitoneal hematoma improved by conservative treatment;Pulmonary embolism improved by medical consultation after thrombolysis.Conclusions Retroperitoneosocpic radical nephrectomy with the method of along the ureteral ascending was safe and could quickly locate and ligate the renal pedicle,and shorten operation time,reduce postoperative complications.
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Objective To study the endoscopic anatomical structures in retroperitoneal space and to share experiences of retroperitoneoscopic radical nephrectomy. Methods Between January 2006 and March 2008, a total of 85 patients underwent retroperitoneoscopic radical nephrectomy. Thirty-eight tumors were on the left kidney and 47 on the right side. The mean tumor size was 5.5± 1.7 cm in diameter (2.5 to 10.5 cm). There were 74 cases in clinical stage T1N0M0 and 11 cases in T2N0M0. Following the principle of radical nephrectomy outside the renal fascia, the whole surgical procedure was performed along "2 spaces" and "2 poles". The ventral attachment of the kidney was dissected in anterior pararenal space between peritoneum and anterior renal fascia. The dorsal attachment was dissected in anterior psoas space between posterior renal fascia and psoas fascia. The cepha-lic attachment was dissected up to the subdiaphragmatic and down to iliac fosse. During the proce-dure, important anatomic structures such as parietal peritoneum and its reflexion, anterior renal fasci-a, lateroeonal fascia, posterior renal fascia, psoas muscles, greatvessels and their branches were care-fully identified. Results One case was converted to open surgery because of severe and extensive ad-hesion of the right kidney to the adjacent tissues. The other 84 procedures were successfully comple-ted. The median operative time was 65 rain (range 50 to 165 min) and median estimated blood loss was 58 ml (range 25 to 600 ml). Of all operations, peritoneum perforation occurred in 5 cases and small vessel injuries around renal pedicles were observed in 6 cases. Major complication such as great vessel injury was not observed. Mean follow-up of all 85 patients was 10 months (range 2 to 25 months). No local recurrence and port site tumor seeding was found. Conclusion During retrope-ritoneoscopic radical nephrectomy, studying anatomical features of renal area and recognizing impor-tant anatomic structures will help to improve the safety of the surgery and reduce morbidities.
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Objective To introduce the technique and evaluate the clinical effect of retroperito-neoscopic anatomical radical nephrectomy. Methods One hundred and sixty-eight patients under-went retroperitoneoscopic anatomical radical nephrectomies. The average tumor size was 4.7 cm (ran-ging from 2.0-6.9 era) in diameter. There were 87 tumors in the left kidney and 81 tumors in right kidney. Ninety-two eases were in cli.nieal stage T1a. N0 M0 and 76 in T1b N0 M0. Retroperitoneal space was created routinely at lateral decubitus position. Four relatively bloodless planes were orderly entered for exposure and separation of the kidney outside Gerota's fascia. The first dissection plane was be-tween the psoas and posterior Gerota's fascia. The renal pedicle was found in this plane. The following dissections proceeded in the plane between posterior Gerota's fascia and fusion fascia. The third dissec-tion plane was between adrenal gland and the upper pole of kidney or between the adrenal gland and di-aphragma. The fourth dissection plane was in the bottom of Gerota's fascia. Results All operations were successfully completed. The mean operative time was 138:J:46 min and estimated blood loss was 90±30 ml. The average day of resuming oral intake was 1.3 d and time of ambulation was 1.2 d. The mean postoperative hospital stay was 5.8 d. Peritoneum injuries happened in 14 patients. Omalgia oc-curred in 18 patients and disappeared 2 d after operation. One hundred and twenty-three patients were followed up, they all survived during the average follow-up of 8 months (ranging from 6-18 months);, .Conclusions Retroperitoneoscopie anatomical radical nephrectomy is a safe and effective procedure. It can decrease operation time, blood loss and complication rate remarkably. It is a good option for patients needing radical nephrectomy.
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Objective To evaluate the safety and efficacy of retroperitoneal laparoscopic resec-tion and reconstructive surgeries in urology. Methods Retroperitoneal laparoseopic resection and re-constructive surgeries were performed on 245 patients including 17 cases of adrenalectomies, 32 cases of radical nephrectomies, 12 cases of partial nephrectomies, 53 cases of nephrectomies, 5 cases of nephroureterectomies, 6 cases of unroofing of peripelvie renal cysts, 46 cases of unroofing of renal cysts, 4 cases of unroofing of polyeystic kidneys, 12 cases of pyeloplasties, 58 cases of ureterolithoto-roles. Results All 245 surgeries were successfully completed. The mean operation time was 59 (20-250) min and the estimated blood loss was 5-300 ml with no transfusion. There was no serious complication during perioperative period. Conclusion Retroperitoneal laparoscopic resection and re-conatruetive surgery in urology is safe and effective with the advantages of minimal invasion, quick re-covery and few complications.