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| 新型Spider单孔腹腔镜平台下猪肾部分切除术 |
| 杨波1,王辉清1,RiccardoAutorino2,肖亮1,王林辉1,许传亮1,JihadH.Kaouk2,孙颖浩1* |
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(1. 第二军医大学长海医院泌尿外科，上海 200433
2. Section of Laparoscopic and Robotic Surgery,Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue Q10, 44195-Cleveland, Ohio, USA
*通信作者) |
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| 摘要: |
| 目的 在新型Spider单孔腹腔镜平台下进行猪肾部分切除术,评估新型Spider单孔腹腔镜平台的操作特点及人机工程学特性。方法 猪麻醉固定后切开2 cm长的皮肤切口,按Spider平台置入法建立通道。接气腹并置入5 mm观察镜,调整好角度后,固定在床边悬挂架上。按常规手术方式行肾脏部分切除术,其中肾脏缺损以2-0 V-loc带倒刺的可吸收缝线连续全层缝合。结果 成功完成猪左肾部分切除术2例,手术时间为100、102 min,肾脏温缺血23、28 min,出血20~50 ml,开放肾动脉后肾实质无继发性出血。结论 Spider单孔腹腔镜平台下猪肾部分切除术安全可行,较好地解决了单孔腹腔镜“交叉操作”的难题,器械碰撞干扰明显减少。但仍存在诸多缺陷,尤其是依靠内鞘管带动的可弯器械无法提供足够的牵拉力量,使得术中视野显露不够满意。 |
| 关键词: 单孔腹腔镜手术 外科器械 肾部分切除术 |
| DOI：10.3724/SP.J.1008.2011.01061 |
| 投稿时间：2011-02-22修订日期：2011-06-11 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115),军队临床高新技术重大项目(2010gxjs057). |
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| Laparoendoscopic single-site partial nephrectomy using a novel Spider surgical platform in pigs |
| YANG Bo1,WANG Hui-qing1,Riccardo Autorino2,XIAO Liang1,WANG Lin-hui1,XU Chuan-liang1,Jihad H. Kaouk2,SUN Ying-hao1* |
(1. Department of Urology,Changhai Hospital,Second Military Medical University, Shanghai 200433, China
2. Section of Laparoscopic and Robotic Surgery,Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue Q10, 44195-Cleveland, Ohio, USA
*Corresponding author.) |
| Abstract: |
| Objective To use Spider system, a novel laparoendoscopic single-site (LESS) platform, for partial nephrectomy in pigs, so as to evaluate the feasibility and ergonomic features of the Spider system. Methods A 2 cm incision was made on the lateral border of the rectus muscle; the subcutaneous tissues and muscle layer were dissected bluntly by the Kelly clamp. With the outside sheath the Spider system was introduced into the peritoneal cavity. After establishment of pneumoperitoneum, a 5 mm scopy was introduced. The whole Spider platform was fixed using the suspension system on the bedside. The procedures of partial nephrectomy were performed according to the conventional steps. Renal reconstruction was done by the 2-0 V-loc barbed suture using the knotless closure technique. Results The procedure of partial nephrectomy was successfully performed in 2 cases, with the operation time being 100 and 102 min, the docking time being 7 and 11 min, and the time periods of warm ischemia being 23 and 28 min. The V-loc barbed suture was used to close the defect of kidney without bleeding after unclamping the renal artery. Conclusion This novel Spider LESS platform is safe and feasible for partial nephrectomy in pigs, which better solves the problem of “cross manipulation” in single-port laparoscopy, avoiding external instrument clashing; but it still has many drawbacks like the lack of strength and precise maneuverability of the tips, which may hamper the visual field in the operation. |
| Key words: laparoendoscopic single-site surgery surgical instruments partial nephrectomy |
