腹腔镜保留肾单位.pptVIP

JEndourol.?2011Oct14.[Epubaheadofprint]RadiofrequencyCoagulation-Assisted?Laparoscopic?Partial?Nephrectomy?WithoutHilarClamping:AFeasibleTechniqueWithExcellentOutcomesinHighlySelectedPatients.PatelHD,?PierorazioPM,?MullinsJK,?HyamsES,?AllafME.SourceBradyUrologicalInstitute,JohnsHopkinsUniversity,Baltimore,Maryland.AbstractAbstractBackgroundandPurpose:TheHabibradiofrequencycoagulation(RFC)devicecoagulatesbleedingsurfacesandmayeliminatetheneedforhilarclamping,thuseliminatingwarmischemiatimeanddecreasingthetechnicalcomplexityof?laparoscopic?partial?nephrectomy?(LPN).WeretrospectivelyreviewaseriesofpatientswhounderwentclamplessLPNwithRFCtostudythesafetyandfeasibilityofthisapproach.PatientsandMethods:TheInstitutionalReviewBoard-approved,JohnsHopkinsMinimallyInvasiveUrologicSurgeryDatabase(1994-2011)wasqueriedforpatientsundergoingclamplessLPNwithRFCbetweenSeptember2008andJanuary2010byasinglesurgeon(MEA).Respectinga0.5-cmsurgicalmargin,thelesionwascircumscribedwiththeRFCdevicetocreateanavascularplane,andstandard?laparoscopic?shearswereusedtoexcisethetumorinabloodlessfieldwithouthilarclamping.Patientoutcomeswereanalyzedforsafetyandfeasibilityofthisapproach.Results:FifteenpatientsunderwentRFCLPN.Mediantumordiameterinourpatientswas1.6?cm(range1-7.3?cm).Seven(46.7%)tumorswereexophyticinnature,andtheremainderweremesophytic.Mediannephrometryscorewas5(range4to7).Medianoperativetimewas155minutes(range100-210?min),andmedianestimatedbloodlosswas100?mL(50-500?mL).Therewerenopositivemargins,andtwopostoperativecomplications(urineleakandclotretention)wereencountered.Norecurrenceswerenotedwithshort-termfollow-up.Conclusion:ClamplessRFCLPNcanbeperformedsafelyincarefullyselectedpatientswithfavorablypositionedtumors.Inthisinitial