手助腹腔镜肾上腺切除术

目的：探讨手助腹腔镜肾上腺手术的方法和临床价值。方法：采用手助腹腔镜肾上腺切除术治疗肾上腺肿瘤4例。肿瘤最大直径6～11cm。结果：4例手助腹腔镜手术均获成功，无术中和术后并发症发生。手术时间190～220min，平均205min；术中出血50～100m1．平均73ml；术后住院时间8～9d。结论：手助腹腔镜肾上腺切除术治疗巨大肾上腺肿瘤是一种可选择的新的手术方式，与开放手术相比，具有损伤小、出血少、术后恢复快等优点。     

简易手助腹腔镜下肾及肾上腺切除术(附37例报告)

目的　介绍简易手助腹腔镜下肾及肾上腺肿瘤切除术的方法和特点。　方法　 1999年 6月至 2 0 0 4年 4月采用简易手助装置实施手助腹腔镜下肾及肾上腺肿瘤切除术 ,共 37例。男 2 2例 ,女 15例 ,平均年龄 5 2岁。肾切除组 2 9例 ,其中肾癌 13例 ,肾盂癌 2例 ,肿瘤分期均为T1N0 M0 ,肿瘤大小平均 3cm× 3cm× 2cm ,巨大肾积水 (肾无功能 ) 8例 ,肾结核肾自截 2例 ,肾性高血压肾萎缩 4例 ;肾上腺肿瘤切除组 8例 ,肿瘤大小平均 4cm× 5cm× 6cm。　结果　除 1例肾癌患者改行开放手术外 ,36例患者手术成功 ,无损伤肠管及其他腹内重要脏器等并发症。肾切除术平均手术时间 14 5min ,平均出血量 115ml;肾上腺肿瘤切除术平均 12 5min ,平均出血量 10 5ml。术后恢复好 ,7～ 8d出院。术后随访 3个月～ 5年 ,健康存活 35例 ;死亡 2例 ,均为肾癌患者 ,其中 1例术后 2年死于脑血管意外 ,1例术后 3年死于肺及脑部转移。　结论　简易手助腹腔镜下肾及肾上腺肿瘤切除术具有简便易行、节省费用、手术时间短、术后恢复快等优点 ,值得推广。     

肾上腺肿物切除术后再行腹腔镜肾上腺手术

目的：总结既往有肾上腺手术史者再行腹腔镜肾上腺手术的经验。方法：2005年5月～2007年3月采用腹腔镜经腹腔途径对3例肾上腺肿物切除术后患者再行腹腔镜肾上腺肿物切除术。3例原发性醛固酮增多症患者均为女性,平均48岁（35～56岁）,左侧1例,右侧2例,肿瘤平均直径1．4cm（1．2～2．0cm）,2例曾行腹腔镜经后腹腔肾上腺肿物切除,1例曾行经腰切口开放’肾上腺肿物切除。观察手术时间、术中出血量、住院天数、并发症及手术效果。结果：3例手术均顺利完成。平均手术时间90min（75～110min）,术中平均出血量20ml（10-30ml）。平均住院时间5天（4～6天）,术中术后无并发症发生。随访8～25个月肿瘤无复发。结论：对于有肾上腺手术史者再行腹腔镜肾上腺手术难度增加,但腹腔镜再次手术是可行有效的。     

腹腔镜肾上腺巨大肿瘤切除术临床分析

目的:探讨腹腔镜肾上腺巨大肿瘤切除术的临床可行性及意义。方法:应用经腹腔途径为45例肾上腺肿瘤患者行腹腔镜肾上腺肿瘤切除术。术前均经B超、CT或MRI等相关影像学检查初步确诊。45例患者分为2组,32例肾上腺肿瘤直径5cm(A组),13例肿瘤直径5cm(B组)。观察2组患者手术时间、术中出血量、住院时间、中转开放率及围手术期并发症等情况。术后常规随访,定期行B超及胸片检查。结果:45例均顺利完成腹腔镜手术,平均手术时间(A组58.6min,B组86.7min)、术中平均出血(A组31.6ml,B组84.3ml)两组差异均有统计学意义(P0.01);中转开放手术A组3例(9%),B组1例(8%),两组差异无统计学意义(P0.05)。B组术中1例需输血;术后平均住院A组5.2d,B组5.7d,两组差异无统计学意义(P0.05)。术后患者均顺利康复。结论:与腹腔镜较小肾上腺肿瘤(5cm)切除术相比,腹腔镜巨大肾上腺肿瘤(5cm)切除术手术时间长,术中出血多,但住院时间及围手术期并发症无显著差异。只要术者具备娴熟的腹腔镜操作技巧及充分的临床经验,腹腔镜较大肾上腺肿瘤切除术切实可行。     

腹腔镜下巨大肾上腺肿瘤切除术7例报告

目的：探讨腹腔镜下肾上腺巨大肿瘤（直径≥6 cm）切除术的技术方法和应用价值.方法：7例肾上腺肿瘤患者均行腹腔镜下肾上腺肿瘤切除术,在瘤体表面相对无血管区处切开包膜,沿包膜与瘤体之间迅速分离,切除肿瘤,填塞纱布止血.结果：5例腹腔镜下肾上腺肿瘤切除术顺利完成,1例手助腹腔镜下完成,1例粘连明显转开放手术.平均手术时间120 min;平均术中出血量200 ml.术后1～4天肠功能恢复,3～5天拔除引流管;无明显外科并发症,术后住院平均10天.术后病理诊断嗜铬细胞瘤4例,肾上腺囊肿1例,神经节细胞瘤1例,畸胎瘤1例.术后随访6（3～18）个月,临床症状消失,复查彩超及SCT未见肿瘤复发及恶性变.结论：腹腔镜下肾上腺肿瘤切除术创伤小、恢复快、效果满意,是治疗巨大肾上腺肿瘤的一种理想术式.     

腹腔镜肾上腺切除术

目的：探讨腹腔镜肾上腺切除术的适应证和临床价值。方法：2005年1月～2008年3月对125例患者行腹腔镜下肾上腺切除术,其中经后腹腔途径110例（肿瘤直径〈5cm）,经腹途径15例（肿瘤直径5～8cm）。结果：124例手术成功,1例因术中出血中转开放。手术时间35～150min,平均50min,术中出血20～800ml,平均50ml,住院时间3～10天,平均5天。患者术前症状约于术后3个月内缓解,均无复发。结论：腹腔镜肾上腺手术具有创伤小、出血少、并发症少、恢复快、患者住院时间短的优点,是肾上腺肿瘤手术治疗的首选方法。     

后腹腔镜手术切除肾上腺节细胞神经瘤疗效观察

目的 :探讨后腹腔镜微创手术治疗肾上腺节细胞神经瘤的适应证和可行性。方法 :采用后腹腔镜手术治疗肾上腺节细胞神经瘤患者 5例 ,其中左侧肾上腺节细胞神经瘤 2例 ,右侧 3例。结果 :5例后腹腔镜手术全部获得成功 ,4例肾上腺肿瘤为单发 ,1例为多发 (4个肿瘤 ) ;肿瘤最大直径 2 .5～ 8.0 (4 .2± 1.8)cm ;手术时间35～ 10 5 (5 9± 2 7)min ,估计出血量 10～ 30 (19± 7)ml,术后镇痛剂吗啡用量 0～ 2 0 (8± 8)mg ,2例未用镇痛剂 ;排气、恢复进食时间 1～ 3(1.4± 0 .5 )d ;术后住院时间 4～ 7(5 .4± 1.5 )d。无围手术期并发症发生。结论 :后腹腔镜手术切除肾上腺节细胞神经瘤是安全可行的 ,能充分体现腹腔镜手术创伤小、恢复快的优点。肾上腺节细胞神经瘤是腹腔镜手术很好的适应证。     

腹腔镜手术切除巨大肾上腺肿瘤的临床探讨

目的：探讨腹腔镜手术切除巨大（直径≥8cm）肾上腺肿瘤的可行性。方法：采用经腹途径腹腔镜切除术治疗巨大肾上腺肿瘤患者6例,左侧4例,右侧2例,肿瘤最大径8．5～12cm。结果：6例腹腔镜手术均获得成功,无中转开放手术。手术时间平均120min（90～185min）,术中出血量平均150ml（50～400m1）。术后胃肠功能恢复时间1～2天,术后2～3天拔除引流管,术后住院6～lO天。随访4～24个月,未发现异常。病理检查报告肾上腺嗜铬细胞瘤2例,神经节细胞瘤1例,神经鞘瘤1例,髓性脂肪瘤2例。结论：肿瘤大小并不是选择腹腔镜手术的决定性因素。在技术娴熟的条件下,腹腔镜治疗巨大肾上腺肿瘤是安全、可行的。     

腹腔镜在肾上腺手术中的应用

目的探讨腹腔镜技术在肾上腺手术中的临床应用价值。方法2000年12月-2006年5月,对86例肾上腺占位性病变行腹腔镜肾上腺切除术,其中经腹腔途径1例,经腹膜后途径81例,经腹手助腹腔镜4例。结果86例手术全部成功,无中转开放手术,无严重并发症发生。手术时间50-175 min,平均72 min。术中出血量15-120 ml,平均54 ml。术后住院时间5-8 d,平均6.3 d。86例术后随访2-65个月,平均26.5月,影像学检查未见肿瘤复发或转移,功能性肿瘤病人的症状减轻或消失。结论腹腔镜肾上腺切除术创伤小,术中出血少,术后恢复快,是治疗大多数肾上腺占位性病变的首选术式。     

后腹腔镜手术治疗肾上腺髓质脂肪瘤的疗效观察(附12例报告)

目的:探讨后腹腔镜手术治疗肾上腺髓质脂肪瘤的疗效及临床意义。方法:回顾性分析12例肾上腺髓质脂肪瘤行后腹腔镜手术患者的临床资料。患者年龄33～72岁,平均53岁;左侧3例,右侧9例;偶发10例,因阵发性高血压、腰疼检查发现各1例。术前均诊断为肾上腺髓质脂肪瘤,肿瘤直径2～8 cm,平均4.9 cm;其中8例直径大于3.5 cm,4例小于3.5 cm。12例患者均在全麻下行后腹腔镜肾上腺肿物切除术。结果:12例患者手术均获成功,手术时间60～270 min,平均130 min。出血量10～660 ml,平均116 ml。术中无并发症。术后住院4～10天,平均5.6天。随访时间6个月～5年,平均2年,未出现肿瘤复发。结论:采用后腹腔镜手术治疗肾上腺髓质脂肪瘤安全有效,具有创伤小、出血少、住院时间短等优点,可以作为肾上腺髓质脂肪瘤的主要手术方法。     

Laparoscopic adrenalectomy

Background Soon after its introduction, laparoscopic adrenalectomy (LA) became the procedure of choice in the surgical management of most adrenal tumors. The aim of this study was to assess the outcome and learning curve of the first 100 cases operated by the same surgical team.Methods Retrospective analysis of prospectively collected data of 100 consecutive LAs was performed. The parameters studied were indication for surgery, side and length of operation, intra- and postoperative complications, size of tumor, conversion to open surgery, final diagnosis, and length of stay.Results Between 1996 and 2002, 100 LAs were performed in 90 patients. The procedures included 45 left, 35 right, and 10 bilateral resections for pheochromocytoma (29), Cushings syndrome (27), Conns syndrome (16), nonfunctioning adenoma (13), and others (5). Mean tumor size was 4.16 cm (range, 0.3–11). Overall major morbidity occurred in eight patients (9%); there was one mortality due to cerebrovascular accident in an elderly patient. Five cases (5%) were converted to open surgery. The mean length of stay for the whole group was 4.7 days (range, 2–25). In order to assess the learning curve, procedures were divided into three, equal consecutive groups (n = 33, 33, and 34). Intraoperative complications in the intermediate and late groups were significantly less compared to those in the early group (2/33, 2/34, and 7/33, respectively; (p < 0.05). Similarly, the mean operating time was significantly reduced between the early (169 min) and both intermediate (116 min) and late (127 min) groups (p < 0.005). The conversion rate was reduced between the three groups (3/33, 2/33, and 0/34), but this was not significant (p = 0.06).Conclusions As expected, the outcome of LA is associated with a steep learning curve. According to this study, it seems that performance of approximately 30 cases by an experienced laparoscopic surgeon is required to master the procedure.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, CA, USA, 12–15 March 2003An erratum to this article can be found at .     

Laparoscopic adrenalectomy

Adrenalectomy is usually performed via transabdominal or posterior approaches. Unfortunately, both approaches are associated with painful postoperative syndromes. Recently, laparoscopic surgery was applied to organ removal.During a period of 12 months, we performed a series of successful laparoscopic adrenalectomies (10 of the right and 11 of the left gland). The pathologies were medullary cyst (1), angiomyolipoma (1), DHEAS hyperplasia (1), primary aldosteronism (2), Cushing's adenoma (3), pheochromocytoma (4), Cushing's syndrome (4), and nonfunctional adenoma (5). A flank approach was taken with four 11-mm trocars. Electrocautery and blunt forceps were used for dissection. The vessels were secured with medium—large titanium clips, and the adrenal was removed in a sterile plastic bag. The average operating time was 2.3 h, and median postoperative stay was 4 days. Two patients required blood transfusion of 2 units postoperatively.We believe this technique is adequate for the surgical removal of adrenal tissue, resulting in less postoperative pain and in rapid recovery. It may also change the surgical management of asymptomatic adrenal lesions.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Phoenix, Arizona, USA, 3 April 1993     

Laparoscopic adrenalectomy

BACKGROUND: Laparoscopic adrenalectomy is a good option for removal of the adrenal gland that is becoming preferred over the conventional open technique. METHODS: We reviewed the initial 30 laparoscopic adrenalectomies (in 27 patients) that were performed at our institution from 1995 to 1998. We used the lateral decubitus transperitoneal approach in 26 cases and the retroperitoneal approach in only one case. The indications for adrenalectomy were Conn's adenoma in eight patients, pheochromocytoma in six, Cushing's syndrome in five, nonfunctional adenomas in seven, and metastasis in one case. RESULTS: Only two patients (7%) were converted to laparotomy. Operating time ranged from 75 to 240 min. Average adrenal gland size was 6.1 cm (range, 4-9 cm). There was no mortality, and morbidity occurred in only two patients (8%)-one case of self-limited gastrointestinal bleeding and one case of hypercapnia and subcutaneous emphysema (in the only patient operated by the retroperitonal approach). Mean hospital stay was 3 days (range, 1-6). CONCLUSIONS: Laparoscopic adrenalectomy is a safe and useful procedure for nearly all adrenal pathologies. Lateral decubitus transperitoneal approach is the procedure of choice in most cases.     

Laparoscopic adrenalectomy

Laparoscopic adrenalectomy has become an accepted method for removing benign lesions of the adrenal gland. There are few contraindications to the laparoscopic approach, and the transperitoneal and retroperitoneal techniques yield excellent results. Virtually all benign lesions and select malignant lesions can be removed laparoscopically. Laparoscopic adrenalectomy has been shown to be a safe and effective approach to many forms of adrenal pathologic conditions. It should be considered the standard of care in the management of benign lesions of the adrenal gland that require surgical removal.     

Laparoscopic adrenalectomy

Laparoscopic extirpation of the suprarenal gland is considered the 'gold standard' of surgery for benign conditions, but its indication in suprarenal cancer is still controversial. In this article, we review the pros and cons of the laparoscopic approach in the different disorders that affect the adrenal gland, pheochromocytoma, cancer, partial and bilateral adrenalectomy, etc.     

Robotic adrenalectomy

The use of robotics in surgery is an emerging field. Robot-assisted laparoscopic adrenalectomy has been performed in small numbers worldwide. Advantages of robotic assistance over conventional laparoscopy are not acknowledged. Improvement in robotic technology, including addition of tactile feedback, miniaturization of end-effectors, reduced cost, and advances in remote surgery telecommunication technology are awaited.     

Robot-assisted adrenalectomy

Currently laparoscopic adrenalectomy (LA) is regarded as the preferred surgical approach for the management of most adrenal surgical disorders. Despite the benefits of LA, the procedure has shortcomings that are shared by other laparoscopic techniques. Commonly noted problems include the absence of 3-dimensional perception, reduced dexterity, and poor ergonomics for the surgeon. Recently, robotic technology has been introduced into laparoscopic clinical practice. The requirement for precise surgery in adrenalectomy is important, and the introduction of robotically assisted LA offers new possibilities. This review summarizes current available data regarding robotic adrenalectomy, including its indications, advantages, limitations, and comparison with conventional laparoscopic adrenalectomy. See the videos, Supplemental Digital Content 1, http://links.lww.com/SLE/A33, Supplemental Digital Content 2, http://links.lww.com/SLE/A34 and Supplemental Digital Content 3, http://links.lww.com/SLE/A35.     

Laparoscopic adrenalectomy

Advances in minimally invasive surgery have made it possible to remove solid organs such as the adrenal gland laparoscopically. Several studies have shown that when applied to appropriate operative candidates, laparoscopic adrenalectomy is a safe alternative to conventional open surgery with real advantages in terms of decreasing postoperative pain and length of hospital stay and allowing earlier return to normal activity. The indications for laparoscopic adrenalectomy are essentially the same as those described for open adrenalectomy. We do not recommend laparoscopic adrenalectomy for known primary or metastatic malignant tumors of the adrenal glands, because of the risk of tumor implantation that might compromise the patient's chance for cure, nor do we recommend it for lesions larger than 6 to 8 cm where the chance of malignancy is high. The preoperative preparation, laparoscopic instruments, operative techniques, and potential complications and their treatments are described in this review. Laparoscopic adrenalectomy is becoming the preferred method of surgically treating many adrenal problems. Although conventional surgical approaches will undoubtedly be required to treat certain adrenal lesions, surgeons with an interest in treating patients with adrenal disorders must become proficient in the technique of laparoscopic adrenalectomy. This will allow them to select the most appropriate operative approach for their patients' individual problems.