1st Surgical Department, S. Gerardo Hospital, University of Milan Bicocca, Via Pergolesi 33, 20052, Monza, Italy.
Langenbecks Arch Surg. 2010 Feb;395(2):111-4. doi: 10.1007/s00423-009-0563-z. Epub 2009 Nov 25.
In literature, few papers compare different hemostatic devices in laparoscopic adrenalectomy. This sequential cohort study analyzes the outcomes of laparoscopic adrenalectomy performed by different hemostatic instruments, to evaluate if any of them has any advantage over the other and as secondary endpoints, the impact of body mass index (BMI) and tumor size on the indication, and the outcome of laparoscopic adrenalectomy.
Forty-six patients, aged 54.6 +/- 46 years, underwent laparoscopic adrenalectomy over 5 years. Mean BMI was 27 +/- 4.8 kg/m(2). Twenty-four patients had a left tumor, and 22 had a right one. Patients were divided into two groups according to the hemostatic device: Ultracision was used in 26 patients, and Ligasure was used in 20. Groups were well matched for histology, tumor size and site, BMI, gender, and age.
Mean operating time was 126.5 +/- 52 min, blood losses were 101 +/- 169 mm, conversion rate was 6.5%, morbidity was 26%, and hospitalization was 5.3 +/- 2.5 days. Groups did not differ for surgical time, blood losses, complications, and conversion rate; BMI and length of surgery were not related. Tumor side and size did not affect surgical time, regardless of the hemostatic tool. Patients submitted to left adrenalectomy bled more (p = 0.007) and had more complications (p = 0.016) than those undergone operation on the right side.
Obesity (BMI > 30) and large masses do not contraindicate laparoscopic adrenalectomy. Left adrenalectomies bleed more and have a higher morbidity. Hemostatic device choice is up to surgeon's preference.
在文献中，很少有论文比较腹腔镜肾上腺切除术的不同止血设备。这项序贯队列研究分析了不同止血器械进行腹腔镜肾上腺切除术的结果，以评估它们中是否有任何一种优于其他器械，作为次要终点，评估体重指数（BMI）和肿瘤大小对腹腔镜肾上腺切除术适应证和结果的影响。
46 名年龄 54.6 ± 46 岁的患者在 5 年内接受了腹腔镜肾上腺切除术。平均 BMI 为 27 ± 4.8kg/m²。24 例患者为左侧肿瘤，22 例为右侧肿瘤。根据止血器械将患者分为两组：26 例患者使用超声刀，20 例患者使用 Ligasure。两组在组织学、肿瘤大小和部位、BMI、性别和年龄方面匹配良好。
平均手术时间为 126.5 ± 52 分钟，失血量为 101 ± 169mm，中转开腹率为 6.5%，发病率为 26%，住院时间为 5.3 ± 2.5 天。两组在手术时间、失血量、并发症和中转开腹率方面无差异；BMI 和手术时间无相关性。无论使用何种止血工具，肿瘤侧别和大小均不影响手术时间。左侧肾上腺切除术患者出血更多（p=0.007），并发症更多（p=0.016）。
肥胖（BMI>30）和大肿瘤不排除腹腔镜肾上腺切除术。左侧肾上腺切除术出血更多，发病率更高。止血器械的选择取决于术者的偏好。
