Institute of Urology, University of Southern California, Los Angeles, CA, USA.
Division of Urology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
BMC Urol. 2020 Oct 7;20(1):155. doi: 10.1186/s12894-020-00727-x.
Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations.
We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2-13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244-265 min); median blood loss was estimated at 100 ml (range, 15-175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1-6 days). All patients remain disease-free at median follow-up of 19 months (range, 12-30 months).
Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.
腹腔镜切除术是最常用于肾上腺切除术的微创方法。与开放手术相比，它可以改善美容效果，加快恢复速度，缩短住院时间，但器械的活动度限制会影响儿科患者的手术灵活性。机器人辅助可以极大地提高手术视野的可视化程度和器械控制能力，目前正在学术中心的儿科人群中开始采用。
我们介绍了一个单机构的小儿肾上腺切除术病例系列。在我们中心，使用达芬奇 Xi 手术系统对连续 3 例患者（年龄 2-13 岁）进行了肾上腺切除术。最终的病理结果显示神经节母细胞瘤（n=2）和嗜铬细胞瘤（n=1）。中位手术时间为 244 分钟（范围，244-265 分钟）；中位估计出血量为 100 毫升（范围，15-175 毫升）。标本完整送达，所有切缘均为阴性。中位术后住院时间为 2 天（范围，1-6 天）。所有患者在中位随访 19 个月（范围，12-30 个月）时均无疾病复发。
我们的经验在不断发展，表明机器人手术对于精心选择的小儿患者的肾上腺肿块切除是安全、可行且具有肿瘤学疗效的。
