机器人辅助肾上腺切除术：与侧入路经腹膜腹腔镜肾上腺切除术相比有哪些优势？

Robotic-assisted adrenalectomy: what advantages compared to lateral transperitoneal laparoscopic adrenalectomy?

作者信息

Brunaud Laurent, Bresler Laurent, Ayav Ahmet, Zarnegar Rasa, Raphoz Anne-Laure, Levan Than, Weryha Georges, Boissel Patrick

机构信息

Department of General and Endocrine Surgery, CHU Nancy (Hopital Brabois Adultes), University of Nancy, School of Medicine, 11 allee du morvan, 54511 Vandoeuvre les Nancy, France.

出版信息

Am J Surg. 2008 Apr;195(4):433-8. doi: 10.1016/j.amjsurg.2007.04.016.

DOI:10.1016/j.amjsurg.2007.04.016

PMID:18304514

Abstract

BACKGROUND

This study evaluates the perioperative outcomes of robotic-assisted adrenalectomy (RA) compared with lateral transperitoneal laparoscopic adrenalectomy (LA).

METHODS

Prospective evaluation of 50 patients who underwent unilateral RA versus 59 patients who underwent unilateral LA.

RESULTS

RA was associated with lower blood loss (49 mL) but longer operative times (104 minutes) (P < .001). However, the difference in operative time was not significant after the learning curve of 20 cases. In patients with body mass index (BMI) > or = 30 kg/m(2), mean operative time was longer in the LA group (90 vs 78 minutes, P = .03) but not in the RA group. In patients with large tumors (> or = 55 mm), mean operative time was longer in the LA group (100 vs 80 minutes, P = .009) but not in the RA group. Conversion rate, morbidity, and hospital stay were similar in both groups.

CONCLUSIONS

After a learning curve of 20 cases, RA has similar perioperative outcomes compared to lateral transperitoneal LA. Several criteria (previous laparoscopic expertise, first assistant's skill and tumor side) remain determinative on RA operative time.

摘要

背景

本研究评估机器人辅助肾上腺切除术（RA）与经侧腹膜腹腔镜肾上腺切除术（LA）的围手术期结果。

方法

对50例行单侧RA的患者与59例行单侧LA的患者进行前瞻性评估。

结果

RA的失血量较低（49毫升），但手术时间较长（104分钟）（P <.001）。然而，在完成20例的学习曲线后，手术时间的差异并不显著。在体重指数（BMI）≥30 kg/m²的患者中，LA组的平均手术时间较长（90对78分钟，P =.03），而RA组则不然。在肿瘤较大（≥55毫米）的患者中，LA组的平均手术时间较长（100对80分钟，P =.009），而RA组则不然。两组的转换率、发病率和住院时间相似。