腹腔镜单孔后腹腔镜肾上腺切除术：双侧分步技术。

Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique.

作者信息

Machado Marcos-Tobias, Nunes-Silva Igor, da Costa Eduardo Fernandes, Hidaka Alexandre Kyoshi, Faria Eliney Ferreira, Zampolli Hamilton, Bezerra Carlos Alberto

机构信息

Urology Division, ABC Medical School, Santo André, SP, Brazil.

Urology Division, Arnaldo Vieira de Carvalho Cancer Institute- IAVC, São Paulo, SP, Brazil.

出版信息

Surg Endosc. 2017 Aug;31(8):3351-3352. doi: 10.1007/s00464-016-5400-1. Epub 2017 Feb 23.

DOI:10.1007/s00464-016-5400-1

PMID:28233094

Abstract

BACKGROUND

Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2-4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5-8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA).

METHODS

A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient's demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale.

RESULTS

Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary.

CONCLUSION

LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.

摘要

背景

腹腔镜肾上腺切除术是治疗小型良性肾上腺肿瘤的金标准手术方法[1]。为克服位于上腹膜后间隙的肾上腺难以暴露的问题，人们开发了多种手术方法[2-4]。经脐单孔后腹腔镜肾上腺切除术（LESS-PRA）是一种新兴技术，它减少了与多个套管针相关的创伤，改善了美容效果，同时将术后发病率降至最低[5-8]。本研究的目的是描述我们的LESS-PRA分步技术，并将我们的围手术期结果与传统三孔侧腹腔镜肾上腺切除术（LRA）进行比较。

方法

对2008年2月至2016年1月期间100例肾上腺肿瘤小于4 cm的患者进行回顾性研究。研究排除标准定义为肿瘤大小大于4 cm、年龄大于80岁以及体重指数（BMI）大于40。共有20例患者接受了LESS-PRA，80例患者接受了三孔侧腹腔镜肾上腺切除术。比较并统计分析患者的人口统计学数据和围手术期结果。采用视觉模拟量表评估美容满意度。

结果

LRA的估计失血量更高（100 vs. 50 ml；p = 0.35）。LESS-PRA的手术时间比LRA长（100.0 vs. 60分钟；p < 0.001）。LRA所需的镇痛时间比LESS-PRA长（40 vs. 24小时；p < 0.001）。LESS-PRA的美容满意度评分更高（9.5 vs. 8.6；p = 0.03）。围手术期并发症和住院时间无显著差异。无需转为传统腹腔镜手术或开放手术。