Department of Urology, Keio University School of Medicine, Tokyo, Japan.
J Endourol. 2012 Nov;26(11):1463-7. doi: 10.1089/end.2012.0274. Epub 2012 Sep 10.
To determine predictive factors for perioperative complications of laparoscopic adrenalectomy (LA) including single-site surgery performed or supervised by experienced laparoscopic surgeons.
We retrospectively reviewed 265 consecutive unilateral LAs performed at a single institution from 2001 to 2011. All surgical procedures were performed or supervised by one of two experienced laparoscopic surgeons. The transabdominal approach was used in 248 patients, while a retroperitoneal approach was used in 17 patients. Laparoendoscopic single-site adrenalectomy was performed in 58 patients. Predictive factors for postoperative complications were analyzed.
There were no postoperative deaths. At least one postoperative complication occurred in 12 (4.6%) patients. No patient underwent reoperation for a complication. Only one (0.4%) patient's procedure was converted to open surgery, and only this patient needed a blood transfusion during the operation. One patient who underwent laparoendoscopic single-site adrenalectomy had the procedure converted to conventional laparoscopic adrenalectomy. Multivariable logistic regression analysis showed that an American Society of Anesthesiologists-physical status grade 3 or above was the only predictive factor for perioperative complications.
American Society of Anesthesiologists-physical status grade 3 or above was a statistically significant factor for perioperative complications associated with laparoscopic adrenalectomy that involved laparoendoscopic single-site adrenalectomy, which was performed or supervised by an experienced laparoscopic surgeon. According to the findings of this retrospective study, single-site operation, obesity, adrenal tumor size, and tumor type may not be considered as risk factors for perioperative complications after LA performed or supervised by an experienced laparoscopic surgeon.
确定腹腔镜肾上腺切除术（LA）围手术期并发症的预测因素，包括由经验丰富的腹腔镜外科医生进行或监督的单部位手术。
我们回顾性分析了 2001 年至 2011 年在一家机构进行的 265 例连续单侧 LA。所有手术均由两位经验丰富的腹腔镜外科医生之一进行或监督。248 例患者采用经腹腔入路，17 例患者采用经腹膜后入路。58 例患者行腹腔镜单部位肾上腺切除术。分析术后并发症的预测因素。
无术后死亡病例。12 例（4.6%）患者至少发生 1 例术后并发症。无患者因并发症而再次手术。仅有 1 例（0.4%）患者的手术转为开放手术，且只有该患者在手术中需要输血。1 例行腹腔镜单部位肾上腺切除术的患者转为常规腹腔镜肾上腺切除术。多变量逻辑回归分析显示，美国麻醉医师协会（ASA）身体状况分级 3 级或以上是围手术期并发症的唯一预测因素。
ASA 身体状况分级 3 级或以上是与腹腔镜肾上腺切除术相关的围手术期并发症的统计学显著因素，涉及由经验丰富的腹腔镜外科医生进行或监督的腹腔镜单部位手术。根据这项回顾性研究的结果，单部位手术、肥胖、肾上腺肿瘤大小和肿瘤类型可能不被认为是由经验丰富的腹腔镜外科医生进行或监督的 LA 术后围手术期并发症的危险因素。
