The Early Experience of Video-assisted Minilaparotomy Surgery (VAMS) / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Video-assisted minilaparotomy surgery (VAMS) is a hybrid of conventional open and laparoscopic surgeries, which combines the benefits of both techniques. Our initial experiences with 33 cases were analyzed to assess the feasibility of VAMS. MATERIALS AND METHODS: Between May 2004 and April 2006, a total of 33 patients underwent VAMS-radical (n=20) and VAMS-live donor nephrectomies (n=13). The results of each operation were analyzed in terms of patient age, operation time, blood loss during surgery, time of oral intake and full ambulation, post operative stay period and amount of analgesic use. RESULTS: The mean age of the patients that had undergone the VAMS- radical and VAMS donor nephrectomies were 55.9 12.4 and 36.0 8.6 years, respectively. The mean results of the VAMS radical nephrectomy and VAMS donor nephrectomy with regard to the operative time, blood losses, time to oral intake, time to ambulation, postoperative length of stay and postoperative length of analgesics use were 225+/-72 / 253+/-67 minutes, 378+/-254 / 447+/-208cc, 2.1+/-0.7 / 1.4+/-0.5 days, 2.1+/-1.1 / 1.6+/-0.7 days, 6.2+/-1.1 / 6.2+/-1.0 days and 1.7+/-0.8 / 1.6+/-0.5 days, respectively. The mean warm ischemic time of VAMS donor nephrectomy was 2.4+/-0.8 minutes. The mean operation time of the 10 earliest cases of VAMS radical nephrectomy was 283 minutes; whereas, that of the last 10 cases decreased to 166 minutes. The mean operation time of the 7 earliest cases of VAMS donor nephrectomy was 299 minutes, which decreased to 206 minutes in the last 6 cases. Complications included 3 wound extensions in 5 patients experiencing massive intraoperative bleeding, 1 pneumonia, 1 wound dehiscence and 1 postoperative bleeding, all of which occurred in the 8 earliest cases. CONCLISIONS VAMS could be a safe and feasible minimally invasive surgical procedure as experience is accumulated; when the initial learning curve has been overcome.