Hora Milan, Ürge Tomáš, Stránský Petr, Trávníček Ivan, Pitra Tomáš, Kalusová Kristýna, Dolejšová Olga, Petersson Fredrik, Krčma Michal, Chlosta Piotr
Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic ; Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
Department of Urology, Faculty Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic.
Wideochir Inne Tech Maloinwazyjne. 2014 Dec;9(4):596-602. doi: 10.5114/wiitm.2014.46803. Epub 2014 Nov 12.
At our institution, laparoendoscopic single-site surgery (LESS) has been established as a technique for laparoscopic nephrectomy since 2011, and since 2012 in selected cases for adrenalectomy (AE) as well.
To compare LESS AE with standard laparoscopic AE (SLAE).
Between 3/2012 and 7/2014, 35 adrenalectomies were performed. In 18 (51.4%), a LESS approach was chosen. Indications were strictly non-complicated cases (body mass index (BMI) < 34 kg/m(2), tumour ≤ 7 cm, non-malignant aetiology, no previous surgery). All LESS procedures were done by one surgeon. Standard equipment was a 10 mm rigid 0° camera, Triport+, one pre-bent grasper, and a sealing instrument. The approach was pararectal in all cases except one (transumbilical in a slim man). Three patients with LESS were excluded (2 partial AEs only, one adrenal cancer converted to SLAE and then to open surgery). These 15 LESS AE procedures were compared to 15 SLAEs with similar characteristics chosen among 54 SLAEs performed in the period 1/2008-2/2012.
In 8 cases (53.3%) of LESS AE, a 3 mm port was added to elevate the liver/spleen. Mean parameters of LESS AE vs. SLAE (Wilcoxon test): maximal tumour diameter 43.7 mm vs. 36.1 mm (p = 0.28), time of surgery 63.3 min vs. 55.3 min (p = 0.22), blood loss 38.0 ml vs. 38.0 ml (p = 0.38), BMI 26.9 kg/m(2) vs. 28.5 kg/m(2) (p = 0.13), discharge from hospital 5.4 days vs. 3.9 days (p = 0.038). There were no complications in either group.
The LESS AE is feasible in selected cases, especially small left-sided tumours in thin patients with no history of previous abdominal operations, but requires an additional port in half of the cases.
自2011年起，在我们机构，腹腔镜单部位手术（LESS）已成为腹腔镜肾切除术的一项技术，自2012年起也用于部分选择性肾上腺切除术（AE）。
比较LESS肾上腺切除术与标准腹腔镜肾上腺切除术（SLAE）。
在2012年3月至2014年7月期间，共进行了35例肾上腺切除术。其中18例（51.4%）采用了LESS手术方式。手术指征严格限定为无复杂情况的病例（体重指数（BMI）<34 kg/m²，肿瘤≤7 cm，非恶性病因，无既往手术史）。所有LESS手术均由一名外科医生完成。标准设备包括一个10毫米刚性0°摄像头、Triport+、一个预弯抓钳和一个密封器械。除1例（一名瘦男子采用经脐入路）外，所有病例均采用直肠旁入路。3例LESS手术患者被排除（2例仅为部分肾上腺切除术，1例肾上腺癌患者先转为SLAE，后转为开放手术）。将这15例LESS肾上腺切除术与2008年1月至2012年2月期间进行的54例SLAE中选取的15例具有相似特征的手术进行比较。
在8例（53.3%）LESS肾上腺切除术中，额外增加了一个3毫米的端口以抬高肝脏/脾脏。LESS肾上腺切除术与SLAE的平均参数比较（Wilcoxon检验）：最大肿瘤直径43.7毫米对36.1毫米（p = 0.28），手术时间63.3分钟对55.3分钟（p = 0.22），失血量38.0毫升对38.0毫升（p = 0.38），BMI 26.9 kg/m²对28.5 kg/m²（p = 0.13），住院天数5.4天对3.9天（p = 0.038）。两组均无并发症发生。
LESS肾上腺切除术在部分选择性病例中是可行的，特别是对于无腹部手术史的瘦患者左侧的小肿瘤，但半数病例需要额外增加一个端口。
