Baba S, Miyajima A, Uchida A, Asanuma H, Miyakawa A, Murai M
Department of Urology, Keio University, School of Medicine, Tokyo, Japan.
Urology. 1997 Jul;50(1):19-24. doi: 10.1016/S0090-4295(97)00119-2.
To compare the efficacy of retroperitoneoscopic adrenalectomy by a posterior lumbar approach (RPA) with that obtained by a transperitoneal anterior approach (TAA) or retroperitoneal lateral flank approach (RLA).
Fifty-one patients underwent endoscopic adrenalectomy by three approaches, including laparoscopic adrenalectomy by TAA in 33, retroperitoneoscopic adrenalectomy by RLA in 5, and retroperitoneoscopic adrenalectomy by RPA in 13.
The average adrenal tumor size was 27 mm (range 8 to 65). The average number of trocars required for RPA was 3.2 which was significantly less than that for TAA and for RLA (4.2 and 4.1, respectively). The conversion rate to open surgery was 9.1% by TAA, 0% by RLA, and 7.7% by RPA. The average operating time for TAA was 252 minutes, which was significantly shortened to 194 minutes by RLA and 142 minutes by RPA (P < 0.02). The average blood loss was 101 mL for TAA and was negligible by RLA and RPA (22 and 32 mL. respectively).
RPA allowed direct access to the main adrenal vascular supply before the gland was greatly manipulated. Endoscopic adrenalectomy by TAA or even by RLA required extra ports for retraction of liver, spleen, vena cava, or adrenal gland, with higher chance of vein avulsion. RPA was technically feasible and most effective for retroperitoneoscopic adrenalectomy in regard to the simplicity of vascular control. The operating time, perioperative morbidity, and cost were reduced with this approach.
比较经后腰部入路腹膜后腹腔镜肾上腺切除术（RPA）与经腹腔前入路（TAA）或腹膜后外侧入路（RLA）的疗效。
51例患者接受了三种入路的内镜肾上腺切除术，其中33例行TAA腹腔镜肾上腺切除术，5例行RLA腹膜后腹腔镜肾上腺切除术，13例行RPA腹膜后腹腔镜肾上腺切除术。
肾上腺肿瘤平均大小为27mm（范围8至65mm）。RPA所需的平均套管针数量为3.2个，显著少于TAA和RLA（分别为4.2个和4.1个）。TAA的开放手术转换率为9.1%，RLA为0%，RPA为7.7%。TAA的平均手术时间为252分钟，RLA显著缩短至194分钟，RPA缩短至142分钟（P<0.02）。TAA的平均失血量为101mL，RLA和RPA可忽略不计（分别为22mL和32mL）。
RPA可在腺体受到较大操作之前直接进入肾上腺主要血管供应处。TAA甚至RLA的内镜肾上腺切除术需要额外的端口来牵拉肝脏、脾脏、腔静脉或肾上腺，静脉撕裂的几率更高。就血管控制的简便性而言，RPA在腹膜后腹腔镜肾上腺切除术中技术上可行且最为有效。采用这种方法可缩短手术时间、降低围手术期发病率并降低成本。
