單孔腹腔鏡腎臟部份切除
李經家1、2、3、葉信志1、2、3、李香瑩1、2、3、蔡嘉駿1、2、3、闕光瞬1、2、3、侯念庭1、2、3、林月惠1、2、3、柯宏龍2、3、黃俊農2、3、周以和2、3、吳文正1、2、3
1高雄市立大同醫院泌尿科
2高雄醫學大學附設醫院泌尿科
3高雄醫學大學醫學系
Laparoendoscopic single site(LESS) partial nephrectomy
Ching-Chia Li, Hsin-Chih Yeh, Hsiang-Ying Lee, Chia-Chun Tsai, Kuang-Shun Chueh, Nien-Ting Hou, Yueh-Huei Lin, Hung-Lung Ke, Chun-Nung Huang, Yii-Her Chou, Wen-Jeng Wu
1 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital
2 Division of Urology, Department of OO, Kaohsiung Medical University Hospital
3 Department of Medical, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Purpose: Laparoscopic or robotic-assisted partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoendoscopic single site partial(LESS) partial nephrectomy is still a technically demanding surgery to this day. We present our technique of LESS partial nephrectomy, one that is performed with limited warm ischemic time.
Materials and Methods: From March 2012 to March 2016, fifteen patients of Kaohsiung Medical University Hospital and Kaohsiung Municipal Ta-Tung Hospital with localized renal parenchymal tumor (stage T1) were included. Our procedure involves the covering of renal defect layer by layer by FloSeal, Tisseel and a fat pad after mono-polar coagulation. Commercial single ports—Lagiport( Lagis,Taiwan) were used in our operation.
Results: Fifteen patients were included in this study. Mean patient age was 61.3 years (range47-76). Mean tumor size was 3.0 cm (range 1.7-6.3). Mean RENAL nephrometry score was 5.1 (range 4-7). The average operation time was 191.0 minutes (range 160-245). The average warm ischemic time was 15.6 minutes (range 9-26). Mean estimated blood loss was 230 ml (range 30-650). No recurrent tumor can be identified at a mean follow-up of 19 months postoperatively.
Conclusions: Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional and cosmetic outcomes without impacting oncological results. With this technique, LESS partial nephrectomy will be a safe and effective technique for patients with stage T1 tumor.