Chueh Shih-Chieh, Chen Jun, Chen Shyh-Chyan, Liao Chun-Hou, Lai Ming-Kuen
Department of Urology, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
J Urol. 2002 Jan;167(1):39-42; discussion 42-3. doi: 10.1016/s0022-5347(05)65378-5.
We describe our experience with clipless laparoscopic adrenalectomy using needlescopic instruments. We compared the results with those of a contemporary series of conventional laparoscopic adrenalectomy.
In 12 patients clipless laparoscopic adrenalectomy was performed with needlescopic instruments in an 8-month period. The technique included 2 or 3 subcostal 2 mm. ports and 1 umbilical 5/12 mm. port for the telescope and ultimate specimen extraction. Adrenal vessels were controlled by bipolar coagulation without endoscopic clips. Outcome data were retrospectively compared with those on 20 recent conventional laparoscopic adrenalectomies done at the same institution. The 2 types of laparoscopic adrenalectomy were performed transperitoneally.
Patients in the clipless group had a lower mean analgesic requirement (7.5 versus 15.3 mg. morphine sulfate equivalent, p = 0.02), lower mean pain and scar scores (3.1 versus 5.3 and 1.1 versus 4.2, respectively, p <0.05) and more rapid convalescence (1.6 versus 3.3 weeks, p <0.01) but longer operative time (183 versus 136 minutes, p = 0.04). Similar blood loss, time to oral intake and hospital stay were noted in the 2 groups. No major complications, open conversions or postoperative secondary bleeding occurred in either group. A 2 mm. port was converted to a 10 mm. port in only 1 case in the clipless group due to the inability to retract a bulky liver properly with a needlescopic instrument.
Clipless laparoscopic adrenalectomy with needlescopic instruments is feasible for most benign adrenal tumors. In addition to the benefits of conventional laparoscopic surgery, clipless needlescopic laparoscopic adrenalectomy further decreased postoperative pain, shortened convalescence and improved wound cosmesis.
我们描述了使用针式腹腔镜器械进行无夹腹腔镜肾上腺切除术的经验。我们将结果与同期一系列传统腹腔镜肾上腺切除术的结果进行了比较。
在8个月的时间里，对12例患者使用针式腹腔镜器械进行了无夹腹腔镜肾上腺切除术。该技术包括2或3个肋下2毫米的端口和1个脐部5/12毫米的端口，用于放置腹腔镜和最终取出标本。肾上腺血管通过双极电凝控制，无需内镜夹。将结果数据与同一机构最近进行的20例传统腹腔镜肾上腺切除术的结果进行回顾性比较。两种类型的腹腔镜肾上腺切除术均经腹腔进行。
无夹组患者的平均镇痛需求量较低（7.5毫克硫酸吗啡当量对15.3毫克，p = 0.02），平均疼痛和疤痕评分较低（分别为3.1对5.3和1.1对4.2，p <0.05），康复更快（1.6周对3.3周，p <0.01），但手术时间更长（183分钟对136分钟，p = 0.04）。两组的失血量、开始经口进食时间和住院时间相似。两组均未发生重大并发症、中转开腹或术后继发性出血。无夹组仅1例因针式腹腔镜器械无法正确牵拉肿大的肝脏，将2毫米的端口转换为10毫米的端口。
对于大多数良性肾上腺肿瘤，使用针式腹腔镜器械进行无夹腹腔镜肾上腺切除术是可行的。除了传统腹腔镜手术的益处外，无夹针式腹腔镜肾上腺切除术进一步减轻了术后疼痛，缩短了康复时间，并改善了伤口美观度。
