当院における単孔式腹腔鏡下腎盂形成術

Laparoendoscopic single-site pyeloplasty for ureteropelvic junction obstruction

◆要旨：腎盂尿管移行部狭窄症に対する腹腔鏡下手術は標準術式となってきた．さらなる低侵襲性を目指して，近年単孔式腹腔鏡下腎盂形成術（LESS-P）が取り組まれている．当科では，2014年9月から2016年6月までに16例に本手術を施行したので報告する．手術は臍横を半円状に切開し，アクセスポートを装着して腹腔鏡下手術を行っており，3mmポートを縫合用に追加している．腎盂尿管吻合はdismembered pyeloplasty法で行っている．平均手術時間は226分で，出血量は平均54.1mlであった．全例でLESS-Pが完遂できており，周術期合併症は認めなかった．成功率は100％で，再手術を要した症例もない．本術式は諸家の報告とも遜色なく安全に施行できており，整容性においても有用であると考える．

Laparoscopic surgery for ureteropelvic junction obstruction（UPJO） has become increasingly popular. Recently, laparoendoscopic single-site surgery（LESS）, a minimally invasive approach providing excellent cosmetic results, has been adopted in several surgical procedures for treating UPJO. From September 2014 to June 2016, laparoendoscopic single-site surgery for UPJO（LESS-P） was performed on 16 patients at our institution. A semicircular skin incision was made around the umbilicus. LESS-P procedures were performed around the umbilicus using a single port device, and suturing was assisted by a 3-mm accessory port. The mean operative time was 226 minutes and estimated blood loss was 54.1ml. LESS-P was successfully completed in all patients without complications, yielding a 100％ success rate. LESS-P is feasible and safe, and is also useful for cosmesis.