經腹腔與後腹腔單孔腹腔鏡活體腎臟捐贈手術之比較

林崇裕¹、李經家¹、柯宏龍¹、溫聖辰¹

高雄醫學大學附設醫院 泌尿部

Comparison of Transperitoneal and Retroperitoneal Laparoendoscopic Single Site Donor Nephrectomy

Chung-Yu Lin, Ching-Chia Lee¹, Hung-Long Ko¹, Sheng-Chen Wen¹

Department of Urology¹, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Purpose: Laparoscopic living donor nephrectomy is the standard technique at high-volume renal transplant centres, and laparoendoscopic single-site donor nephrectomy(LESS-DN) is a relatively novel minimally invasive approach. The surgery can be differed to transperitoneal and retroperitoneal approach. We present a retrospective analysis of our single-institution donor nephrectomy series comparing the transperitoneal to retroperitoneal LESS-DN with regards to operative outcomes.

Materials and Methods: From 2017–2019, a total 10 patients that underwent LESS-DN were enrolled at our centre. All cases were performed by the same surgeon. The two approaches were compared retrospectively and evaluated for differences in peri-operative outcomes, included operation time, console time, blood loss, graft warm ischemia time, post-operative pain, length of stay(LOS), and wound size.

Results: A total of 5 patients underwent transperitoneal LESS-DN and 5 patients underwent retroperitoneal LESS-DN. Total operating time was significantly longer in the transperitoneal group (315 vs 191 min, P < 0.05), There was no significantly difference in other parameters, but we demonstrate obvious shorter console time(224 vs 110 min, P = 0.35), shorter ischemia time(245 vs 149 sec, P = 0.83), and shorter LOS(8.4 vs 4.8 days, P = 0.102) in the retroperitoneal group.

Conclusions: In experienced hands, retroperitoneal LESS-DN results in peri-operative outcomes similar to transperitoneal LESS-DN without compromising donor safety, while providing a faster operation and console time and shorter length of hospital stay.