Division of Urology, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.
J Pediatr Urol. 2012 Feb;8(1):35-9. doi: 10.1016/j.jpurol.2010.12.007. Epub 2011 Jan 13.
Very limited literature exists on minimally invasive adrenalectomy in children. Retroperitoneoscopic adrenalectomy (RPA) has the advantage of avoiding intra-abdominal organ retraction, but concerns have been expressed regarding RPA on the right side. Herein, we describe the second reported experience with the anterior approach to RPA in children, which appears to overcome the limitations previously ascribed to right RPA.
Two children, aged 8 and 14-years, presented with incidental right adrenal masses. Both patients were placed in the lateral decubitus position with lumbar hyper-extension. A 5-mm, 3-port approach was used, as demonstrated in the video.
Pathology revealed a 7-cm ganglioneuroma and a 5-cm pheochromocytoma with intact surgical margins. Operative time with these large masses and first experience with this technique was 5 h in the first case and 3.5 h in the second. No intraoperative or postoperative complications were noted, with minimal blood loss and a hospital stay of 36 h in both cases.
The anterior approach to RPA is feasible even in children with a smaller retroperitoneal space and a large adrenal mass. It provides excellent exposure of the adrenal gland and vein, even on the right side.
关于儿童微创肾上腺切除术的文献非常有限。后腹腔镜肾上腺切除术 (RPA) 的优点是避免了腹腔内器官的牵拉，但人们对右侧 RPA 表示担忧。在此，我们描述了儿童经前路 RPA 的第二次报道经验，该方法似乎克服了之前归因于右侧 RPA 的局限性。
两名年龄分别为 8 岁和 14 岁的儿童因偶然发现右侧肾上腺肿块而就诊。两名患者均取侧卧位并腰椎伸展。使用视频中所示的 5mm 三孔入路。
病理显示 7cm 神经节瘤和 5cm 嗜铬细胞瘤，手术切缘完整。在首例病例中，手术时间为 5 小时，在第二例病例中，手术时间为 3.5 小时，手术时间较长，这与这些大肿块和首次使用该技术有关。术中及术后均无并发症，出血量少，住院时间均为 36 小时。
即使对于后腹膜空间较小和肾上腺肿块较大的儿童，前路 RPA 也是可行的。即使在右侧，它也能提供肾上腺和静脉的良好暴露。
