Isiktas Gizem, Avci Seyma Nazli, Erten Ozgun, Ergun Onuralp, Krishnamurthy Vikram, Shin Joyce, Siperstein Allan, Berber Eren
Department of Endocrine Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave/F20, Cleveland, OH, 44195, USA.
Surg Endosc. 2023 Feb;37(2):1107-1113. doi: 10.1007/s00464-022-09594-z. Epub 2022 Sep 19.
Over the last 20 years, the prevalence of severe obesity (body mass index ≥ 35 kg/m) has almost doubled. This condition increases the challenge of laparoscopic adrenalectomy (LA) by creating problems with instrument reach, adequate exposure, and visualization. The aim was to compare perioperative outcomes of laparoscopic versus robotic adrenalectomy (RA) in severely obese patients.
This was an institutional review board-approved retrospective study. Prospectively collected clinical parameters of patients who underwent LA versus RA between 2000 and 2021 at a single center were compared using Mann-Whitney U, ANOVA, Chi-square, and multivariate regression analysis. Continuous data are expressed as median (interquartile range).
For lateral transabdominal (LT) adrenalectomies, skin-to-skin operative time (OT) [164.5 (71.0) vs 198.8 (117.0) minutes, p = 0.006] and estimated blood loss [26.2 (15.0) vs 72.6 (50.0) ml, p = 0.010] were less in RA versus LA group, respectively. Positive margin rate, hospital stay and 90-day morbidity were similar between the groups (p = NS). For posterior retroperitoneal (PR) approach, operative time and perioperative outcomes were similar between LA and RA groups. Multivariate analysis demonstrated robotic versus laparoscopic technique (p = 0.006) to be an independent predictor of a shorter OT.
There was a benefit of robotic over the laparoscopic LT adrenalectomy regarding OT and estimated blood loss. Although limited by the small sample size, there was no difference regarding perioperative outcomes between RA and LA performed through a PR approach.
在过去20年中，重度肥胖（体重指数≥35kg/m²）的患病率几乎翻了一番。这种情况增加了腹腔镜肾上腺切除术（LA）的难度，因为它会导致器械操作范围、充分暴露和视野方面的问题。本研究旨在比较重度肥胖患者腹腔镜肾上腺切除术（LA）与机器人辅助肾上腺切除术（RA）的围手术期结果。
这是一项经机构审查委员会批准的回顾性研究。使用Mann-Whitney U检验、方差分析、卡方检验和多因素回归分析，比较了2000年至2021年在单一中心接受LA与RA的患者前瞻性收集的临床参数。连续数据以中位数（四分位间距）表示。
对于经腹外侧（LT）肾上腺切除术，RA组与LA组相比，皮肤到皮肤的手术时间（OT）[164.5（71.0）对198.8（117.0）分钟，p = 0.006]和估计失血量[26.2（15.0）对72.6（50.0）ml，p = 0.010]分别更少。两组的切缘阳性率、住院时间和90天发病率相似（p =无统计学意义）。对于后腹腔镜（PR）入路，LA组和RA组的手术时间和围手术期结果相似。多因素分析表明，机器人技术与腹腔镜技术相比（p = 0.006）是手术时间较短的独立预测因素。
在手术时间和估计失血量方面，机器人辅助LT肾上腺切除术优于腹腔镜LT肾上腺切除术。尽管受样本量小的限制，但通过PR入路进行的RA和LA之间的围手术期结果没有差异。
