Abstract：
We report a case of retroperitoneal laparoscopic radical nephrectomy (LRN) in which the addition of a hand port was necessary and effective. A 52-year-old man with obesity (BMI 40.6 kg/m2) was diagnosed with a 52-mm left renal cell carcinoma (cT1bN0M0). To avoid thick subcutaneous and visceral fat in the abdomen, we selected LRN using a retroperitoneal approach with four ports in the kidney position. During surgery, a large amount of flank pad and perirenal fat prevented us from securing a sufficient surgical field through traction of the kidney with a retractor. A pure laparoscopic procedure was not feasible;therefore, we added a hand port. Subsequently, we removed the flank pad from the hand port and secured the surgical field by tracing the kidney manually. Finally, hand-assisted LRN was completed without an open conversion. In retroperitoneal LRN, we rarely encounter patients for whom a pure laparoscopic procedure is not feasible because of the large amount of flank pad or perirenal fat. It is important to preoperatively confirm not only the BMI but also the amount of flank pad and perirenal fat on imaging. Hand-assisted LRN via the retroperitoneal approach can be safely performed even in extremely obese patients. J. Med. Invest. 71 : 187-190, February, 2024.
摘要：
我们报告了一例腹膜后腹腔镜根治性肾切除术（LRN），其中增加手孔是必要且有效的。一名52岁的肥胖男性（BMI40.6kg/m2）被诊断出患有52毫米的左肾细胞癌（cT1bN0M0）。为了避免腹部厚厚的皮下和内脏脂肪，我们使用腹膜后入路选择了LRN，在肾脏位置有四个端口。手术期间,大量的侧腹垫和肾周脂肪使我们无法通过用牵开器牵引肾脏来确保足够的手术视野。单纯的腹腔镜手术是不可行的；因此，我们增加了一个手口。随后，我们从手口取下侧腹垫,并通过手动追踪肾脏来固定手术区域.最后,手辅助LRN在没有开放式转换的情况下完成。在腹膜后LRN中，我们很少遇到由于大量的侧腹垫或肾周脂肪而无法进行纯腹腔镜手术的患者。术前不仅要确认BMI，而且还要在影像学上确认侧腹垫和肾周脂肪的数量。即使在极度肥胖的患者中，也可以通过腹膜后方法安全地进行手辅助LRN。J.Med.投资。71:187-190,二月,2024.
