Department of Surgery, Hygeia' Hospital, 4 Erythrou Stavrou Street and Kifissias Avenue, Marousi, 15123 Athens, Greece.
Surg Endosc. 2011 Nov;25(11):3584-9. doi: 10.1007/s00464-011-1762-6. Epub 2011 Jun 3.
Posterior retroperitoneoscopic adrenalectomy has substituted its anterior laparoscopic counterpart as the treatment of choice in the management of adrenal tumors at the authors' institution. The authors present their comparative results between these operative techniques, demonstrating the reasons for this change.
From May 2008 to September 2010, 30 patients underwent posterior retroperitoneoscopic adrenalectomy. Operative time, complications, hospital stay, postoperative pain, and cost were compared with those of 30 selected laparoscopic control subjects treated from 2005 to 2010. Statistical analysis was based on Chi-square, the Mann-Whitney U test, the independent-samples t-test, and the Wilcoxon matched pairs test, as appropriate.
The median tumor size was 3.8 cm (range, 1.5-8.0 cm) in the retroperitoneoscopic group and 4.9 cm (range, 2.4-8.0 cm) in the laparoscopic group. The median operative time was similar between the two groups (90.0 min; range, 60-165 min vs. 77.5 min; range, 55-120 min; P = 0.138). It was, however, significantly reduced after the 20th case (97.5 min; range, 80-165 min vs. 70 min; range, 60-110 min; P < 0.001) in the retroperitoneoscopic group. The median visual analog pain scores were significantly lower in the retroperitoneoscopic group on both the first and the third postoperative days, respectively (1; range, 0-1 vs. 4; range, 3-6; P < 0.001 and 0; range, 0-1 vs. 3; range, 2-6; P < 0.001). The median postoperative hospital stay also was shorter in the retroperitoneoscopic group (2 days; range, 2-3 days vs. 4 days; range, 3-6 days; P < 0.001). The cost of the posterior approach was significantly less than that of the laparoscopic technique (P < 0.001).
Posterior retroperitoneoscopic adrenalectomy compared with laparoscopic adrenalectomy was safe, fast, and vastly superior in terms of postoperative pain and hospital stay in this series. Because of the ability to reproduce such excellent operative results, the impressive patient recovery, and the significantly reduced operative cost, the authors suggest that the retroperitoneoscopic approach should become the method of choice in minimally invasive adrenal surgery.
在后腹腔镜肾上腺切除术已取代其前腹腔镜对应作为管理的选择在作者的机构的治疗肾上腺肿瘤。作者提出了他们之间的手术技术的比较结果，证明了这种变化的原因。
从 2008 年 5 月至 2010 年 9 月，30 例患者接受了后腹腔镜肾上腺切除术。手术时间、并发症、住院时间、术后疼痛和成本进行比较，与 30 例选择腹腔镜对照从 2005 年至 2010 年治疗。统计分析是基于卡方检验、曼-惠特尼 U 检验、独立样本 t 检验和 Wilcoxon 匹配对检验，适当的。
在经后腹腔镜组肿瘤大小中位数为 3.8 厘米（范围 1.5-8.0 厘米）和腹腔镜组 4.9 厘米（范围 2.4-8.0 厘米）。两组之间的手术时间中位数相似（90.0 分钟；范围 60-165 分钟对 77.5 分钟；范围 55-120 分钟；P = 0.138）。它是，但是，在经后腹腔镜组第 20 例后显著降低（97.5 分钟；范围 80-165 分钟对 70 分钟；范围 60-110 分钟；P <0.001）。在术后第一天和第三天，经后腹腔镜组的视觉模拟疼痛评分中位数分别明显较低（1；范围 0-1 对 4；范围 3-6；P <0.001 和 0；范围 0-1 对 3；范围 2-6；P <0.001）。在经后腹腔镜组的术后住院时间中位数也较短（2 天；范围 2-3 天对 4 天；范围 3-6 天；P <0.001）。后入路的成本明显低于腹腔镜技术（P <0.001）。
后腹腔镜肾上腺切除术与腹腔镜肾上腺切除术相比，在本系列中，在术后疼痛和住院时间方面是安全、快速和优越的。由于能够复制如此出色的手术结果，令人印象深刻的患者恢复和显著降低手术成本，作者建议经后腹腔镜入路应成为微创肾上腺手术的首选方法。
