Pavan Nicola, Autorino Riccardo, Lee Hak, Porpiglia Francesco, Sun Yinghao, Greco Francesco, Jeff Chueh S, Han Deok Hyun, Cindolo Luca, Ferro Matteo, Chen Xiang, Branco Anibal, Fornara Paolo, Liao Chun-Hou, Miyajima Akira, Kyriazis Iason, Puglisi Marco, Fiori Cristian, Yang Bo, Fei Guo, Altieri Vincenzo, Jeong Byong Chang, Berardinelli Francesco, Schips Luigi, De Cobelli Ottavio, Chen Zhi, Haber Georges-Pascal, He Yao, Oya Mototsugu, Liatsikos Evangelos, Brandao Luis, Challacombe Benjamin, Kaouk Jihad, Darweesh Ithaar
University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA.
Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy.
World J Urol. 2016 Oct;34(10):1473-9. doi: 10.1007/s00345-016-1791-9. Epub 2016 Feb 29.
To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide.
A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities.
Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p < 0.001). European centers mostly adopted CL and ML techniques, whereas those from Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis.
Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.
评估微创肾上腺切除术实施的当代国际趋势，并评估全球泌尿外科中心采用不同微创技术的当代疗效。
对2008年至2013年期间在全球14家泌尿外科机构接受微创肾上腺切除术的患者进行一项回顾性多国多中心研究，并纳入分析。病例根据微创肾上腺切除术技术进行分类：传统腹腔镜手术（CL）、机器人辅助腹腔镜手术（RAL）、经自然腔道内镜手术（LESS）和迷你腹腔镜手术（ML）。根据手术年份确定四种治疗方式的比例，并对所有手术方式的趋势进行回归分析。
总体而言，参与研究的机构共进行了737例肾上腺切除术并纳入本分析：337例CL（占病例的46%）、57例ML（8%）、263例LESS（36%）和80例RAL（11%）。总体而言，204例（28%）手术采用腹膜后入路。2008年至2013年肾上腺切除术的总数有所增加（p = 0.05）。除ML组外，所有组均首选经腹腔入路（p < 0.001）。欧洲中心大多采用CL和ML技术，而亚洲和南美洲的中心报告LESS手术的比例最高，美国则更大程度地采用RAL。LESS的使用率增长最快，为每年6%。RAL手术的增长率较慢（每年2.2%），与ML相似（每年1.7%）。本研究的局限性在于回顾性设计以及缺乏成本分析。
全球泌尿外科机构成功实施了几种用于治疗肾上腺肿块的微创外科技术。CL和LESS似乎是最常用的技术，而ML和RAL的增长速度较慢。所有微创技术均可安全有效地用于治疗各种肾上腺疾病。
