Hansen P, Bax T, Swanstrom L
Legacy Portland Hospitals, Oregon, USA.
Endoscopy. 1997 May;29(4):309-14. doi: 10.1055/s-2007-1004195.
Refinements in the field of laparoscopic general surgery have not only made the performance of laparoscopic adrenalectomy technically feasible, but have even made it the preferred method of treatment for benign adrenal pathology. The advantage of the laparoscopic approach lies in the fact that it allows precise, hemostatic dissection of the gland in a minimally invasive fashion. We present here the results of published reports of laparoscopic adrenalectomy as well as our own experience, and compare these data with reports from open procedures. The indications for the surgical removal of the adrenal gland have not changed, and include: endocrine active tumors, suspected malignancies, adrenal masses larger than 6 cm, and masses that have been followed and observed to be growing. Laparoscopic adrenalectomy can be accomplished with one of three approaches: anterior, lateral and posterior. Each approach has advantages and limitations, and our preferences are discussed. The general techniques are briefly described. The findings from many studies show that the blood loss, operative complications, hospital stay and recovery period are significantly reduced with the laparoscopic approach. Based on our experience with 19 laparoscopic adrenalectomies and a review of the current literature, laparoscopic adrenalectomy can be fairly described as the current "gold standard" treatment for benign adrenal disease. Patients benefit from short hospital stays, lower morbidity, and a more rapid recovery. The only question that remains is the appropriateness of laparoscopic adrenalectomy in the treatment of adrenal malignancy, and the answer to this will depend on the results of long-term outcome studies.
腹腔镜普通外科领域的技术改进不仅使腹腔镜肾上腺切除术在技术上可行，甚至使其成为治疗良性肾上腺疾病的首选方法。腹腔镜手术方法的优势在于它能够以微创方式对肾上腺进行精确、止血的解剖。我们在此展示已发表的腹腔镜肾上腺切除术报告结果以及我们自己的经验，并将这些数据与开放手术的报告进行比较。肾上腺手术切除的适应症没有改变，包括：内分泌活性肿瘤、疑似恶性肿瘤、直径大于6厘米的肾上腺肿块以及经随访观察有增大的肿块。腹腔镜肾上腺切除术可通过三种方法之一完成：前路、侧路和后路。每种方法都有其优缺点，我们也会讨论我们的偏好。一般技术将简要描述。许多研究结果表明，腹腔镜手术方法可显著减少失血量、手术并发症、住院时间和恢复期。基于我们19例腹腔镜肾上腺切除术的经验以及对当前文献的回顾，腹腔镜肾上腺切除术可以被恰当地描述为目前治疗良性肾上腺疾病的“金标准”。患者受益于较短的住院时间、较低的发病率和更快的康复。唯一剩下的问题是腹腔镜肾上腺切除术在治疗肾上腺恶性肿瘤方面是否合适，而这一问题的答案将取决于长期结果研究的结果。
