以腎臟鏡輔助無套管腹腔鏡腹膜透析管植入
林明鴻^1,3,4、林軒名²、魏照軒²、王柏棠^2
1臺南市立安南醫院-委託中國醫藥大學興建經營 外科部 泌尿科；²內科部 腎臟科；
³國立中興大學 生物醫學研究所；⁴三軍總醫院 外科部 泌尿外科
Trocar-less laparoscopy using nephroscope for placement of peritoneal dialysis catheters
Ming-Hung Lin^1,3,4, Hsuan-Ming Lin⁴, Chao-Hsuan Wei⁴, Bo-Tang Wang⁴
Division of Urology, Department of Surgery, An Nan Hospital, China Medical University, Tainan, Taiwan¹;
Division of Nephrology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan²
Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan ^3;
Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan⁴

Purpose: There are several procedures for catheter placement of peritoneal dialysis (PD), including percutaneous insertion, open surgery, and laparoscopic surgery. The optimal approach for catheter placement for PD remains controversial. We modified the laparoscopic PD catheter placement with trocar-less nephroscope-assist procedure and reviewed the postoperative outcomes.

Materials and Methods: Total 26 consecutive patients underwent trocar-less nephroscope-assist PD catheter placement between January 2016 and March 2019 in our institute, and that were performed by a single surgeon. Data were collected and analyzed to compare the characteristics of the patients, including age and gender, along with surgical outcomes and complications.

Results: Twenty-six patients underwent trocar-less nephroscope-assist PD catheter placement procedures. The mean operative time was 21.4 ± 11.3 minutes. The catheter 1-year and 2-year survival rates were 92.3% and 88.5%. No catheter migration happened. One case had dialysis leakage. Two cases had repeated peritonitis and received removal of PD catheter after 3 and 7 months of operation.

Conclusions:

         The trocar-less nephroscope-assist PD catheter placement was a safe and efficacy procedure. Compared to laparoscopic surgery, our procedures were simple and no need of trocar that significantly save on medical expenses.