Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Urology. 2012 Mar;79(3):577-83. doi: 10.1016/j.urology.2011.09.052.
To assess the feasibility, safety, and efficacy of transperitoneal laparoendoscopic single-site (LESS) adrenalectomy and determine whether it shows any objective advantage compared with standard laparoscopy.
From August 2009 to May 2011, 13 transperitoneal LESS adrenalectomies were performed through a 2-3-cm skin incision using the TriPort access system. This cohort was compared with a contemporary 1:2 matched-pair group of 26 patients undergoing standard laparoscopic adrenalectomy by the same urologist. The perioperative outcomes, including cosmetic satisfaction scores, were statistically analyzed.
The 2 groups were comparable with respect to patient demographics, estimated blood loss, and postoperative hospitalization (P > .05). The LESS procedures had a longer mean operative time (148.5 vs 112.9 minutes, P = .032) but a significantly lower postoperative visual analog pain scale score (2.3 vs 3.7, P = .001), fewer patients requiring analgesics (30.8% vs 73.1%, P = .011), and an earlier resumption of oral intake (21.6 vs 26.0 hours, P = .002). The mean length of the scar in the LESS group was much smaller (2.3 vs 5.9 cm, P < .0001) with a statistically significant greater mean cosmetic satisfaction score (9.5 vs 9.1, P = .042).
The perioperative outcomes of transperitoneal LESS adrenalectomy for small adrenal tumors were comparable to those with the standard laparoscopic approach. It also provides better postoperative pain control, faster recovery of bowel function, and better cosmetic satisfaction than standard laparoscopy, albeit with a longer operative time.
评估经腹腔腹腔镜单部位（LESS）肾上腺切除术的可行性、安全性和疗效，并确定其与标准腹腔镜相比是否具有任何客观优势。
2009 年 8 月至 2011 年 5 月，通过 2-3cm 的皮肤切口使用 TriPort 通道系统完成了 13 例经腹腔 LESS 肾上腺切除术。通过相同的泌尿科医生将这一组与同期的 26 例接受标准腹腔镜肾上腺切除术的 1:2 匹配对患者组进行比较。对包括美容满意度评分在内的围手术期结果进行了统计学分析。
两组患者的人口统计学、估计失血量和术后住院时间具有可比性（P＞.05）。LESS 手术的平均手术时间较长（148.5 分钟比 112.9 分钟，P=.032），但术后视觉模拟疼痛评分明显较低（2.3 分比 3.7 分，P=.001），需要止痛药的患者较少（30.8%比 73.1%，P=.011），并且更早恢复口服摄入（21.6 小时比 26.0 小时，P=.002）。LESS 组的疤痕平均长度要小得多（2.3 厘米比 5.9 厘米，P＜.0001），且美容满意度评分显著更高（9.5 分比 9.1 分，P=.042）。
对于小的肾上腺肿瘤，经腹腔 LESS 肾上腺切除术的围手术期结果与标准腹腔镜方法相当。它还提供了更好的术后疼痛控制、更快的肠道功能恢复和更好的美容满意度，尽管手术时间较长。
