단일 기관에서 시행한 복강경 근치적 신적출술에서 수술 방법에 따른 술기 비교: 경복막 접근법과 후복막 접근법 및 손을 이용한 접근법
Comparison of Techniques for Laparoscopic Radical Nephrectomy in a Single Center: Transperitoneal vs. Retroperitoneal vs. Hand-Assisted
하정민, 김태효, 조원열, 정세일, 성경탁, 윤진한,
소속 상세정보
하정민 ( Ha Jung-Min )
동아대학교 의과대학 비뇨기과학교실
김태효 ( Kim Tae-Hyo )
동아대학교 의과대학 비뇨기과학교실
조원열 ( Cho Won-Yeol )
동아대학교 의과대학 비뇨기과학교실
정세일 ( Jung Se-Il )
동아대학교 의과대학 비뇨기과학교실
성경탁 ( Sung Gyung-Tak )
동아대학교 의과대학 비뇨기과학교실
윤진한 ( Yoon Jin-Han )
동아대학교 의과대학 비뇨기과학교실
KMID : 0358320090500070675
Abstract
Purpose: Laparoscopic surgery has become the standard method of radical nephrectomy within the urological community. We compared the safety and efficacy of different techniques for laparoscopic radical nephrectomy (LRN) in a single medical center.
Materials and Methods: Between June 2002 and August 2007, we performed LRN for renal cell cancer in 45 cases by a transperitoneal approach (TLRN), in 21 cases by a retroperitoneal approach (RLRN), and in 32 cases by a hand-assisted approach (HLRN), and the results of each approach were compared. Surgical results such as operative time, estimated blood loss (EBL), transfusion rate, hospital stay, complications, and pathologic results were reviewed retrospectively and analyzed by one-way ANOVA.
Results: There were no significant differences in demographic data among the 3 groups. The pathologic reports showed clear cell type in 97 cases and chromophobe type in 1 case. For each group (TLRN vs. RLRN vs. HLRN), the mean operative time was 207.9±57.06 vs. 211.8±52.85 vs. 184.4± 49.43 minutes, respectively (p=0.03); the EBL was 135.0±29.40 vs. 153.8± 45.59 vs. 183.4±89.25 ml, respectively (p=0.14); time to oral intake was 2.3± 0.79 vs. 1.2±0.54 vs. 2.6±0.84 days, respectively (p＜0.01); and the hospital stay was 6.7±0.77 vs. 5.4±0.73 vs. 8.2±1.51 days, respectively (p＜0.01). There were no severe complications. The pathologic surgical margins were all negative.
Conclusions: LRN can be performed efficiently and effectively with the transperitoneal, retroperitoneal, and hand-assisted techniques. Operators may select the technique for LRN according to their own preferences. In our experience, RLRN may protect the organ from injury and promote the recovery of lifestyle because of the early recovery of bowel movement.
키워드
Renal cell carcinoma; Laparoscopy; Nephrectomy
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