腹腔鏡下ドナー腎採取術における血管切離時の腎バッグ収納の有用性

Kidney in a bag method : A useful procedure for managing renal vessels in laparoscopic donor nephrectomy

◆要旨：腹腔鏡下ドナー腎採取術は，安全・低侵襲で整容性も良好な手技と考えられる．しかし，腎血管切離時に腎を適切な位置に保持するのに困難な印象があり，また単孔式ポートを使用する場合は，単孔部から用手的に採取する際に腎を圧迫する危惧があった．そこで，腎血管切離前に腎をバッグに収納する方法を試みた．腎動静脈のみ開口部から出るようにバッグで腎を包み，助手の鉗子で腎をバッグごと挙上し動静脈を切離した後に，ワイヤーを利用し単孔部より採取した．バッグ内の腎は挙上しやすく回転しないため，安定した術野の保持が可能であり，また容易に単孔部を通過した．本法が温阻血時間の短縮・腎静脈の長さの確保・採取時の腎損傷の予防になると思われる．

Laparoscopic donor nephrectomy is a safe and minimally invasive surgery. While this procedure is very useful, it seems difficult to keep the kidney in an appropriate position during transecting renal vessels. In addition, there is a concern of compressing the kidney with fingers when retrieving it by hand from the port site. To overcome these issues, we here introduce a method we attempted putting the kidney in a bag in advance before transecting renal vessels. The bagged kidney was kept elevated in an appropriate position using forceps of the assistant and the operator transected the renal vessels. The kidney was retrieved using the wire of the bag. It was easy to keep the bagged kidney elevated during the transection without it being rotated, and it passed through the port orifice smoothly. This procedure can be recommended for surgeons to perform laparoscopic donor nephrectomy more safely.