Hirasawa Yosuke, Miyajima Akira, Hattori Seiya, Miyashita Kazutoshi, Kurihara Isao, Shibata Hirotaka, Kikuchi Eiji, Nakagawa Ken, Oya Mototsugu
Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan,
Surg Endosc. 2014 Oct;28(10):2911-9. doi: 10.1007/s00464-014-3553-3. Epub 2014 May 23.
Conventional laparoscopic adrenalectomy (LA) is the gold standard procedure for benign adrenal tumors. Laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as an extension of standard laparoscopic minimally invasive procedures.
This retrospective study compared the first experience of one surgeon with 70 LESS-A to 140 LA cases with respect to evaluating the influence of the inexperience on surgical outcomes and to assess this surgeon's learning curve for LESS-A.
Age, gender, BMI, percentage of patients with prior abdominal surgery, tumor laterality, and tumor size were all comparable between the two groups. There were no statistically significant differences in any surgical outcomes, including mean operative time, pneumoperitoneum time, estimated blood loss, transfusion requirements, hemoglobin decrease at postoperative day 1, analgesic requirements, postoperative day of oral intake, conversion rate, or morbidity between the two groups. The one exception was hospital stay. There were no mortalities or reoperations in either group. The morbidity rates in the LESS-A group and LA group were 4.2 and 6.4%, respectively (p = 0.528). LESS-A appears to have a steep learning curve and the operative time of the initial 70 cases decreased markedly and remained stable when the experience level exceeded 12 cases. There was no morbidity or conversion in these first 12 LESS-A cases. Multiple regression analysis revealed that surgeon experience (p = 0.008) and tumor size (p = 0.001) were independent predictors of prolonged operative time.
Surgical outcomes of LESS-A were equivalent to those of LA without compromising safety. The introduction of LESS-A at our hospital was smooth and safe. While the indication for LESS-A has been controversial, LESS-A was a useful procedure, especially for cases in which cosmesis is of paramount importance.
传统腹腔镜肾上腺切除术（LA）是治疗良性肾上腺肿瘤的金标准术式。腹腔镜单孔肾上腺切除术（LESS - A）是作为标准腹腔镜微创手术的扩展而发展起来的。
本回顾性研究比较了一位外科医生的70例LESS - A手术的首次经验与140例LA手术，以评估经验不足对手术结果的影响，并评估该外科医生LESS - A手术的学习曲线。
两组患者的年龄、性别、体重指数、既往腹部手术患者百分比、肿瘤位置和肿瘤大小均具有可比性。两组在任何手术结果方面均无统计学显著差异，包括平均手术时间、气腹时间、估计失血量、输血需求、术后第1天血红蛋白下降情况、镇痛需求、术后开始经口进食时间、中转率或发病率。唯一的例外是住院时间。两组均无死亡病例或再次手术病例。LESS - A组和LA组的发病率分别为4.2%和6.4%（p = 0.528）。LESS - A似乎有一条陡峭的学习曲线，最初70例手术的手术时间显著缩短，当经验水平超过12例时保持稳定。前12例LESS - A手术中无并发症或中转情况。多元回归分析显示，外科医生经验（p = 0.008）和肿瘤大小（p = 0.001）是手术时间延长的独立预测因素。
LESS - A的手术结果与LA相当，且不影响安全性。LESS - A在我院的引入顺利且安全。虽然LESS - A的适应证一直存在争议，但LESS - A是一种有用的术式，尤其对于美容至关重要的病例。
