Résumé
Objective To analyze the clinical efficacy of multiple renal arteries on outcomes of renal donors and recipients in hand-assisted retroperitoneoscopic donor nephrectomy.Method From 2012 to 2014,121 patients underwent hand-assisted laparoscopic donor nephrectomy,including 92 cases of a single renal artery and 29 cases of multiple arteries.Donor and recipient outcomes for single artery and multiple arteries allografts were compared.Result The study included 121 pairs of donors and recipients.The demographic characteristics between multiple renal artery group and single renal artery group had no significant difference.The operative time,blood loss,postoperative complications,and hospital stay had no significant difference between two groups.Cold ischemia time and warm ischemia time in multiple renal artery group were longer than single donor renal artery group (128.5 ± 13.2 vs.50.2 ± 17.3 min,P＜0.001;196.0 ± 63.3 vs.154.1 ± 55.2 min,P=0.002,respectively).The operative time in multiple renal artery group was longer than in single renal artery group (213.5 ± 28.2 vs.182.2 ± 31.1 min,P＜0.001).There was no significant difference in blood loss,vascular complications and ureternal complications between two groups.The renal functions of two groups were likewise within one year.Conclusion There was no statistically significant difference in clinical efficacy between hand-assis-ted retroperitoneoscopic donor nephrectomy with multiple renal arteries and single artery.The use of these grafts was safe for both recipients and donors.
Résumé
The safety and efficacy of retroperitoneoscopic microwave ablation (MWA) in the treatment of renal hamartoma were evaluated. From July 2007 to July 2009, a total of 16 cases of renal hamartoma were treated with retroperitoneoscopic MWA. Peri- and post-operative findings were observed. Middle-term efficacy was assessed by contrast-enhanced computerized tomography (CT) in follow-up period. All patients received MWA of 1-5 points. The mean operative time was 85 min and the mean blood loss was 65 mL. During a median follow-up of 16 months, no evidence of disease recurrence was observed despite of incomplete ablation in 1 case. Retroperitoneoscopic MWA is a relatively simple procedure with less impact to renal function and less complication. The outcome of middle-term follow-up is satisfactory. Thus, retroperitoneoscopic MWA appears to be a safe and effective technique for renal hamartoma in selected patients.
Résumé
Objective To explore the operative approach, method,indication,and clinical feasibility of laparoscopic or retroperitoneoscopic treatment of ploycystic kidney.Methods The renal cyst unroofing(bilateral,9 cases;unilateral,4 cases) was performed under laparoscope(2 cases) or retroperitoneoscope(11 cases).The renal adipose capsule was dissected with a harmonic scalpel to fully visualize the whole kidney.According to preoperative positioning results,the cysts at all sizes were exposed.Then all visible cysts were unroofed or fenestrated with a margin 0.5 cm from the renal parenchyma.The cystic fluid was drawn out as much as possible.Results The operations were completed smoothly in the 13 cases.Pneumatothorax developed on the day of laparoscopic operation in 1 case,and then was cured by closed thoracic drainage.The operation time was 50～240 min(mean,139 min),and the blood loss was 10～200 ml(mean,58 ml).Patients began out-of-bed activities in 1～2 days after operation and were discharged from hospital at 3～10 days.The pathological findings were in accordance with changes of ploycystic kidney.Follow-up examinations were carried out for 1～30 months(mean,14.3 months).Back pain was relived in 8 out of 11 cases.In 3 patients with a high blood pressure,the systolic pressure was decreased by 16～19 mm Hg at 9 months after operation.Ten patients presented normal hepatic and renal functions,while the remaining 3 patients with preoperative increased creatinine levels of 194～301 ?mol/L had a drop by 20～40 ?mol/L.Conclusions Treatment of cyst unroofing under laparoscope or retroperitoneoscope is a safe and effective method in the treatment of ploycystic kidney,being worthy of clinical recommendation.
Résumé
Conventional laparoscopic surgery requires definite leaming curve, and must be converted to an open procedure in the event of a large vessel injury. The usage of carbon dioxide gas for securing operative field is generally accepted, but such field rapidly disappears when air pressure decreases. To overcome these shortcomings without sacrificing advantages of excellent cosmetic results and reduced wound pain of laparoscopy without using the gas insufflation, various urologic operations utilizing incisions 2 to 5 cm long were made without cutting abdominal musculature with the help of specially designed retractors and video systems used in conventional laparoscopic surgery. It can be performed in familiar anatomical settings and all the surgical skills of open procedures can be utilized. We have performed 3 living donor nephrectomies, 6 simple nephrectomies, 2 partial nephrectomies, 9 pyeloplasties, 16 ureterolithotomies, 1 ureteroureterostomy, and 2 renal cyst marsupializations. Mean operative time and hospital stay were 185 minutes and 7 days for living donor nephrectomies, 150 minutes and 6.7 days for simple nephrectomies, 255 minutes and 7.5 days for partial nephrectomies, 130 minutes and 4.8 days for pyeloplasties, 85 minutes and 4.1 days for ureterolithotomies, 90 minutes and 5 days for ureteroureterostomy, and 75 minutes and 5.5 days for renal cyst marsupializations, respectively. Immediate wound pain was severe probably due to intense traction of abdominal musculature, but the recovery of such pain was remarkably rapid. No postoperative wound paresthesia was seen and early discharge was possible. In conclusion, the gasless retroperitoneoscopically assisted surgery can take advantage of both conventional open and laparoscopic surgery, and it can be a valid option to conventional open surgery for any surgical procedures in retroperitoneum, including kidney, ureter, and bladder.