病例報告: 腹腔鏡腎臟固定術: The sliding Clip Technique

張君愷¹、錢祖明¹、阮雍順²

高雄醫學大學附設中和紀念醫院 泌尿部¹; 高雄市立大同醫院 泌尿科²

Case report: Laparoscopic Nephropexy: The sliding Clip Technique

Chun-Kai Chang¹、 Tsu-Ming Chien¹、Yung-Shun Juan²

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan¹

Divisions of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan²

Nephroptosis is a clinical condition characterized by an abnormal caudal movement of the kidney that descends more than 2 vertebral bodies (or more than 5 cm) during a position change from supine to upright. In the last decade, the availability of laparoscopic surgery has led to a revival of interest in nephroptosis and nephropexy

Our case was a 31-year-old female without underlying disease. She presented right flank soreness for one year and then came to our outpatient department for help. This patient was successfully diagnosed as nephroptosis by ultrasonography and intravenous pyelography, both of which were performed in both supine and upright positions. The laparoscopic surgery was performed, through a retroperitoneal approach. The ptosic kidney was fixed using V-lock between the surface of the kidney and the psoas muscle. We have applied a technical modification to facilitate laparoscopic fixation by utilizing suture and nonabsorbable polymer clips Hem-o-lok clip ("sliding clip" technique). Hem-o-Lok clip was applied proximally to the knots. Once the suture was passed through the kidney surface and the muscle, another Hem-o-Lok clip was applied and slided using the needle holder. Finally, an additional Hem-o-Lok clip secured the tension of the suture.

Nephropexy is considered a technically demanding procedure. One major difficulty is the need to place tight triangulation sutures between the abdominal wall and the renal capsule in a confined working space. We applied a simple point of technique to facilitate suturing and avoid excessive tension on renal parenchyma. The ‘‘sliding clip’’ technique is widely used for renorrhaphy during partial nephrectomy and most urologists are familiar with its principle.