パドル電極を用いたソフト凝固による腎部分切除術

Usefulness and safety of soft coagulation with a paddle-shaped electrode in partial nephrectomy

　小径の限局性腎癌に対する腎部分切除術（PN）は標準的術式とされ，根治性のみならず腎機能温存と予後との関連が重視されている。しかしながら手術手技に習熟を要し，十分な普及には課題が残る。当科では2010年6月よりパドル電極によるソフト凝固を導入し，止血操作の改良を試みている。これまで9例のPNを行い，阻血時間の短縮や輸血の回避が可能であった。術中の腎盂解放を1例認めたが，止血凝固後に縫合し閉鎖可能であった。全例で後出血，尿瘻などの合併症は認めず，腎機能も術前・術後1か月で有意差なく良好に温存されていた。PNにおいてパドル電極を用いたソフト凝固による止血は有用であり，安全に施行可能と考えられた。

Surgical removal of small renal masses suspicious for malignancy has recently been performed by partial nephrectomy（PN） rather than by radical nephrectomy（RN）. A major benefit of PN over RN is greater preservation of kidney function. In order to minimize ischemic time and morbidity,we have used a paddle-shaped electrode applying soft coagulation in open PN since June 2010. Soft coagulation is characterized by more reliable hemostasis compared to conventional coagulation. The paddle-shaped electrode,which became available recently,provides efficient dissection and coagulation of renal parenchyma. Nine patients were successfully treated by the PN with paddle-shaped electrode without any severe complications. Mean blood loss during operation was 188 ml and no patient required blood transfusion. Mean ischemic time was as short as 10 minutes and preservation of total renal function was excellent in all cases. Laceration of the collecting system was noted only in one patient,which was easily closed using 3-0 absorbable sutures after hemostasis.