无夹闭、免缝合腹腔镜肾上腺切除术的可行性和安全性：单中心 7 年经验。

Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Department of Urology, Firoozgar hospital, Iran University of Medical Sciences, Tehran, Iran.

Urol J. 2020 Mar 16;17(2):143-145. doi: 10.22037/uj.v0i0.5493.

PURPOSE

Laparoscopic adrenalectomy (LAD) is considered the gold standard surgical method for resecting adrenal tumors. To date, only few small studies have investigated the safety of clipless laparoscopic adrenalectomy in which the adrenal vessels were controlled by the LigaSure system or bipolar coagulation. The aim of the present study was to evaluate the safety and feasibility of sutureless and clipless laparoscopic adrenalectomy operations performed in our center.

MATERIALS AND METHODS

All patients with functional adrenal tumors, nonfunctional adrenal tumors larger than 5 cm and secondary adrenal metastases from the kidneys, lungs or breasts who had underwent an LAD procedure between 2012 to 2019 were included in our study. In all of the cases, complete coagulation of adrenal veins was achieved through bipolar cautery and no vascular staplers, clips or other energy sources were used for controlling the adrenal vessels whatsoever. Outcomes of interest included operation time, length of hospital stay, changes of serum hemoglobin level, and occurrence of major complications.

RESULTS

Of a total 251 patients, unilateral right and left-side adrenalectomy was performed in 168 and 67 cases, respectively, and 16 cases had underwent bilateral adrenal resection. The mean age (SD) of patients was 40.7 (13.6) years old at the time of operation and the mean size (SD) of the adrenal lesions was 5.2 (3.1) cm as measured by the greatest diameter. Histological examination showed that the most common pathology of the resected adrenal glands was pheochromocytoma (n=78). None of the laparoscopic operations required a conversion to open surgery. Also, major bleeding or other serious complications did not occur in any of the cases either intraoperatively or postoperatively.

CONCLUSION

Clipless and sutureless laparoscopic adrenalectomy seems to be feasible and safe for removing adrenal tumors. Moreover, bipolar cautery is associated with an acceptable outcome for vessel closure.

目的

腹腔镜肾上腺切除术（LAD）被认为是切除肾上腺肿瘤的金标准手术方法。迄今为止，只有少数小型研究调查了无夹闭腹腔镜肾上腺切除术的安全性，其中肾上腺血管由 LigaSure 系统或双极电凝控制。本研究旨在评估我们中心无夹闭和无缝线腹腔镜肾上腺切除术的安全性和可行性。

材料和方法

所有在 2012 年至 2019 年间接受 LAD 手术的功能性肾上腺肿瘤、大于 5 厘米的非功能性肾上腺肿瘤和来自肾脏、肺部或乳房的继发性肾上腺转移患者均纳入本研究。在所有病例中，均通过双极电灼实现肾上腺静脉的完全凝固，并且完全不使用血管吻合器、夹子或其他能源来控制肾上腺血管。主要观察指标包括手术时间、住院时间、血清血红蛋白水平变化和主要并发症的发生。

结果

在总共 251 例患者中，单侧右侧和左侧肾上腺切除术分别进行了 168 例和 67 例，16 例患者进行了双侧肾上腺切除术。手术时患者的平均年龄（SD）为 40.7（13.6）岁，最大直径测量的肾上腺病变的平均大小（SD）为 5.2（3.1）cm。组织学检查显示，切除的肾上腺最常见的病理是嗜铬细胞瘤（n=78）。无腹腔镜手术需要转为开放手术。此外，术中或术后均无大出血或其他严重并发症发生。