Our experience with retroperitoneal and transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction obstruction

OBJECTIVE: Laparoscopic dismembered pyeloplasty has been quoted to have equivalent success rates to the traditional open procedure in the treatment of pelvi-ureteric junction obstruction (PUJO). The aim of this study was to report our experience with laparoscopic pyeloplasty. PATIENTS AND METHODS: All patients with PUJO are entered into a database to record patient, operative and post-operative details. Over an eleven-year period, 176 procedures were performed. Eighty-three procedures were dismembered laparoscopic pyeloplasties, of which two retroperitoneal procedures were converted to open. The first 17 procedures were performed via the retroperitoneal approach and the following 66 via the transperitoneal route. Thirty-one procedures were open pyeloplasty. RESULTS: The retroperitoneal group had a mean follow up of 35 (16-66) months. Five patients (33%) developed recurrent symptoms with evidence of obstruction seen on the renogram within 4 months and required further surgery. The transperitoneal group had a mean follow up of 15 (3-38) months. Five patients were classified as failures (mean time to failure 4.6 months) resulting in a success rate of 92% for the transperitoneal route. Both groups had a mean post-operative hospital stay of 3.6 days. Open pyeloplasty at our institution has a success rate of 88% at a mean follow up of 85 months (range 3-260 months) and a mean length of post-operative stay of 6 days. CONCLUSION: Overall our success rate following laparoscopic pyeloplasty is 88%. However, our preferred approach is transperitoneal, which is associated with a success rate of 92%. This is equivalent, if not better than that seen following open pyeloplasty with the additional benefits of reduced hospital stay and time to recovery. There are many possible explanations for this difference in success rates between approaches, however equivalent results are reported in the literature and therefore the learning curve is likely to be the major factor in this series.     

经后腹腔镜肾癌根治术的体会

目的探讨经后腹腔镜肾癌根治术的临床经验。方法收集行后腹腔镜肾癌根治术80例患者资料,回顾分析总结。结果手术时间为90～240 min,平均150 min。80例手术均获成功,无中转开放手术者。术中出血量50～200 mL,平均100 mL,术后随访8～24个月,无肿瘤复发及转移。结论后腹腔镜肾癌根治术具有微创、解剖清晰、出血少、术后恢复快等优点,是一种安全可靠的手术治疗方法。     

经腹腔和经后腹膜腔途径腹腔镜手术治疗肾上腺肿瘤的对比研究

目的比较经腹腔途径和经后腹膜腔途径两种腹腔镜手术在肾上腺肿瘤治疗中的应用及对机体应激的影响。方法 2001年12月至2009年2月我们应用腹腔镜手术治疗肾上腺肿瘤110例,其中34例采用经腹腔途径,76例采用后腹膜腔途径,两组患者年龄、性别构成、体重指数、肿瘤大小等指标无明显差别;采用化学发光法检测术前24h、术中切除瘤体时及术后24h血清肿瘤坏死因子-α(TNF-α)、白介素6(IL-6)、C反应蛋白(CRP)和血清淀粉样蛋白A(SAA)水平。结果 110例手术全部成功,手术时间30～250min,其中经腹腔途径160±30min(80～250min),经后腹腔途径60±14min(30～180min),两组差别具有统计学意义(t=2.33,P=0.006);术中出血10～150ml,其中经腹腔途径组80±24m(l40～150ml),后腹膜腔途径组20±7ml(10～90ml),两组差别具有统计学意义(t=3.19,P=0.02),所有患者均未输血。110例患者术后平均住院3～14d,其中经腹腔途径组7±2d,后腹膜腔途径组5±1d,差别无统计学意义(t=1.06,P=0.17)。两组患者术前24h、术中切除瘤体时及术后24h血清TNF-α,IL-6,CRP和SAA水平差别均无统计学意义(P>0.05)。结论腹腔镜手术治疗肾上腺肿瘤,具有创伤小,康复快,安全可靠的优点。后腹膜腔途径相对腹腔途径术中出血更少,手术时间更短。     

后腹腔镜下肾部分切除术治疗肾肿瘤的疗效评价

目的 探讨后腹腔镜下肾部分切除术治疗肾肿瘤的手术方式和临床效果. 方法 2002年6月至2009年12月对113例肾癌患者行后腹腔镜下肾部分切除术.患者平均年龄52(26～73)岁.肿瘤位于左肾51例,右肾62例.肿瘤直径平均3.7(1.2～6.3)cm.临床分期T1a 98例,T1b15例.腔镜下阻断肾动脉,以冷刀切开肾实质完整切除肿瘤.行肾楔形切除84例,肾极切除22例,半肾切除7例.腔镜下重建肾盂肾盏,2-0可吸收线间断或连续缝合关闭肾实质.开放肾动脉后取出标本.术后卧床10～14 d. 结果 113例手术均顺利完成,无中转开放及腹腔脏器损伤病例.平均手术时间85(60～125)min,平均热缺血时间24(19～43)min,术中平均出血150(50～350)ml,无术中输血患者.术后病理确诊肾透明细胞癌87例、乳头状肾细胞癌9例、嫌色细胞癌7例、肾血管周细胞瘤6例、嗜酸细胞瘤4例,肿瘤切缘均阴性.术后未出现尿漏,发生肉眼血尿2例,其中行肾切除术1例、血尿自行消失1例.随访3～41个月,未见肿瘤局部复发.结论 后腹腔镜下肾部分切除术治疗肾肿瘤安全有效,手术创伤小,有可能替代开放手术.     

后腹腔镜肾部分切除术与肾癌根治术治疗复杂性T1b期肾肿瘤的比较 #br#

目的对比分析后腹腔镜肾部分切除术（RLPN）与后腹腔镜肾癌根治术（RLRN）治疗复杂性T_1b期肾肿瘤的疗效。 方法回顾性纳入2014年11月至2015年11月西安市人民医院收治的68例复杂性T_1b期肾脏肿瘤患者的临床资料,根据手术方法将患者分为RLPN组和RLRN组,每组34例。RLPN组行后腹腔镜肾部分切除术,RLRN组行后腹腔镜肾癌根治术。比较两组患者的围术期相关指标、肾功能情况及生存情况。 结果两组患者手术时间、术中出血量、引流管留置时间、术后住院时间及术后并发症情况比较,差异均无统计学意义（P>0.05）;时间与方法在肾小球滤过率估算值上不存在交互作用（P>0.05）,时间与方法在eGFR上主效应均显著（P<0.05）;RLPN组患者术后6个月时eGFR水平高于RLRN组;随访期间,Kaplan-Meier分析显示,RLRN组患者5年总生存率为88.2%,无病生存率为85.3%;RLPN组患者5年总生存率为91.2%,无病生存率为82.4%,两组患者总生存率与无病生存率比较差异无统计学意义（χ²=0.188、0.082,P=0.664、0.774）。 结论RLPN安全有效,可以最大限度地保留正常肾组织,保护肾功能,提高了术后生活质量,且具有与RLRN相当的远期疗效,值得临床推广应用。     

Feasibility of laparoscopic tumour nephrectomy in children

Aims

The laparoscopic approach to tumour nephrectomy in children is controversial. We therefore reviewed our institution's cases of tumour nephrectomy (laparoscopic, open, and converted) to better understand which is suitable for this approach, what factors prevent it, and whether one can excise tumours greater than the CCLG recommendation of 300 ml.

后腹腔镜下肾癌根治术65例临床疗效分析

目的 评价后腹腔镜肾癌根治手术临床疗效,总结手术经验.方法 回顾性分析2006年6月至2010年12月65例后腹腔镜肾癌根治性切除术患者的临床资料.结果 65例手术均获成功,手术平均时间90.2±34.6 min,平均出血量80.1±28.5 ml,术后住院时间平均7.0±2.3 d;11例腹膜破裂,1例误伤下腔静脉,术中钛夹夹闭止血,夹闭下腔静脉腔1/3,术后无并发症发生.随访6~48个月,未见肿瘤复发及转移.结论 后腹腔镜肾癌根治术具有创伤小、出血少、恢复快的优点,是一种安全、有效的治疗方法,具有良好的临床应用前景.     

The impact of introducing laparoscopic donor nephrectomy to an established renal transplant program

Background Although the advent of hand-assisted laparoscopic donor nephrectomy (HLDN) has had a positive impact on the donor pool, there is still some concern about its safety. The aim of this study was to assess the impact of a change in surgical access to live-donor nephrectomy on donor-related complication rates, the renal function of the donor, and the graft function of the recipient.Methods At our hospital, HLDN was introduced in 1998. Thereafter, we compared 49 consecutive donors undergoing open donor nephrectomy (ODN) between 1987 and 2002 with 57 consecutive donors undergoing HLDN between 1998 and 2002. Donor renal and recipient graft functions were assessed by measuring creatinine levels and urine output, with the addition of warm and cold ischemia time and dialysis requirements in the latter group. Data are presented as means (±SD) and analyzed with the Student t-test or Fishers exact test.Results The ODN and HLDN donors were comparable for age, gender, body mass index, renovascular anatomy, and preoperative creatinine. Estimated blood loss (370 ± 280 vs 168 ± 160 ml, p < 0.0001), time to resumption of oral intake (1.7 ± 0.5 vs 1.3 ± 0.7 days, p = 0.01), duration of intravenous narcotic requirements (23 ± 0.7 vs 1.7 ± 1.0 days, p < 0.0001), and hospital stay (4.2 ± 1.4 vs 2.9 ± 1.3 days, p < 0.0001) were significantly decreased after HLDN. There were no significant differences between ODN and HLDN in operating time (204 ± 46 vs 202 ± 49 min), donor-related complication rates (12.2% vs 14%), or donor renal and recipient graft functions.Conclusion The introduction of HLDN to an established renal transplant program led to an improved short-term outcome without any increase in donor-related complication rates or delay in recipient graft function.     

后腔镜三套管自制套索控制肾血管下肾脏肿瘤切除术

目的：探讨后腔镜下肾脏肿瘤切除术中使用三套管自制套索控制肾血管临床应用的可行性。方法：后腔镜三套管自制套索控制肾血管下行肾脏肿瘤切除术5例。5例患者术前无或仅有轻微腰痛,无肉眼血尿及腰部包块,经肾脏B超、CT、MRI检查明确肾脏肿块。结果：本组5例手术均获得成功。手术时间130～180min,平均145min。术中出血量50～150m1,平均85ml。术后住院时间7～9天,平均为8天。肾周引流管留置5天,无并发症。随访4～12个月,B超、CT检查未见肿瘤复发。结论：后腔镜肾肿瘤切除术具有患者创伤小,出血少,康复快,并发症少等优点,而采用三套管自制套索控制肾血管具有操作简单,干扰少,经济等优点。     

Robotic partial nephrectomy versus laparoscopic cryoablation for the small renal mass

Background

Open partial nephrectomy (OPN) remains the gold standard for treatment of small renal masses (SRMs). Laparoscopic cryoablation (LCA) has provided encouraging outcomes. Robotic partial nephrectomy (RPN) represents a new promising option but is still under evaluation.

Objective

Compare the outcomes of RPN and LCA in the treatment of patients with SRMs.

Design, setting, and participants

We retrospectively analyzed the medical charts of patients with SRMs (≤4 cm) who underwent minimally invasive nephron-sparing surgery (RPN or LCA) in our institution from January 1998 to December 2010.

Intervention

RPN and LCA.

Measurements

Perioperative complications and functional and oncologic outcomes were analyzed.

Results and limitations

A total of 446 SRMs were identified in 436 patients (RPN, n = 210; LCA, n = 226). Patients undergoing RPN were younger (p < 0.0001), had a lower American Society of Anesthesiologists score (p < 0.001), and higher baseline preoperative estimated glomerular filtration rate (eGFR) (p < 0.0001). Mean tumor size was smaller in the LCA group (2.2 vs 2.4 cm; p = 0.004). RPN was associated with longer operative time (180 vs 165 min; p = 0.01), increased estimated blood loss (200 vs 75 ml; p < 0.0001), longer hospital stay (72 vs 48 h; p < 0.0001), and higher morbidity rate (20% vs 12%, p = 0.015). Mean follow-ups for RPN and LCA were 4.8 mo and 44.5 mo, respectively (p < 0.0001). Local recurrence rates for RPN and LCA were 0% and 11%, respectively (p < 0.0001). Mean eGFR decrease after RPN and LCA was insignificant at 1 mo, at 6 mo after surgery, and during last follow-up. Limitations include retrospective study design, length of follow-up, and selection bias.

Conclusions

Both techniques remain viable treatment options in the management of SRMs. A higher incidence of perioperative complications was found in patients undergoing RPN. However, the technique was not predictive of the occurrence of postoperative complications. Early oncologic outcomes are promising for RPN, which also seems to be associated with better preservation of renal function. Long-term follow-up and well-designed prospective comparative studies are awaited to corroborate these findings.     

A comparison of traditional open,minimal-incision donor nephrectomy and laparoscopic donor nephrectomy

Laparoscopic donor nephrectomy (LDN) and minimal-incision donor nephrectomy (MILD) are less invasive procedures than the traditional open donor nephrectomy approach (ODN). This study compares donor and recipient outcome following those three different procedures. Sixty consecutive donor nephrectomies were studied (n=20 in each group). Intra-operative variables, analgesic requirements, donor recovery, donor/recipient complications and allograft function were recorded prospectively. Operating and first warm ischaemia times were longer for LDN than for ODN and MILD (232±35 vs 121±24 vs 147±27 min, P<0.001; 4±1 vs 2±2 vs 2±1 min, P<0.01). Postoperative morphine requirements were significantly higher after ODN than after MILD and LDN (182±113 vs 86±48 vs 71±45 mg; P<0.0001). There was no episode of delayed graft function in this study. Donors returned to work quicker after LDN than after ODN and MILD (6±2 vs 11±5 vs 10±7; P=0.055). Donor and recipient complication rates and recipient allograft function were comparable. We concluded that MILD and LDN reduce postoperative pain and allow a faster recovery without compromising recipient outcome.     

机器人辅助腹腔镜下肾部分切除术两种入路的对比研究

目的:比较经腹膜后和经腹腔两种手术入路机器人辅助腹腔镜下肾部分切除术的临床疗效。方法:回顾性分析2018年6月-2021年1月于甘肃省人民医院行肾部分切除术患者67例的临床资料,根据手术入路不同将患者分为经腹腔组和经腹膜后组。经腹腔入路组患者共26例(男11例,女15例),平均年龄为(53.5±9.7)岁;经腹膜后入路组患者共41例(男20例,女21例),平均年龄为(55.2±12.5)岁。比较两组患者的手术疗效、病理结果和围手术期情况。结果:67例患者的机器人辅助腹腔镜下肾部分切除术均顺利完成,无中转开腹手术。经腹腔入路和经腹膜后入路组术中出血量、热缺血时间、手术时间、术后并发症发生率比较,差异均无统计学意义(P>0.05)。而经腹膜后入路组患者的术后肠道功能较经腹腔入路组恢复快(P<0.05)。结论:采用经腹膜后入路在机器人辅助腹腔镜下肾部分切除术中可以取得和经腹腔入路同样的手术效果,而且其在术后肠道功能恢复方面具有优势。     

A prospective comparison of transperitoneal and retroperitoneal laparoscopic nephrectomy in the extremely obese patient

OBJECTIVE: To prospectively compare the outcomes of transperitoneal laparoscopic nephrectomy (TLN) and retroperitoneal LN (RLN) in extremely obese patients, as LN in such patients (body mass index, BMI >/= 40 kg/m(2)) is an accepted but technically challenging undertaking, and either approach to the kidney can be used. PATIENTS AND METHODS: Between July 1998 and August 2005, 51 consecutive patients with extreme obesity had 53 LNs at our institution (13 TLN and 40 RLN). Peri-operative data were collected prospectively in a database approved by the Institutional Review Board. RESULTS: There were no statistically significant differences between the two approaches for several variables, including baseline BMI (44 vs 45; P = 0.23), muscle-splitting extraction incision length (7.0 vs 7.7 cm; P = 0.53), and intraoperative complications (none vs 5%; P = 0.99). RLN tended to cause less estimated blood loss (EBL, 150 vs 100 mL; P = 0.31), a shorter operation (190 vs 180 min; P = 0.11), larger specimen weight (682 vs 938 g; P = 0.078), lower intraoperative open conversion rate (15% vs 0%; P = 0.06), and a shorter hospital stay (53.6 vs 37.5 h; P = 0.33), although none of these variables was statistically significant at P < 0.05. CONCLUSIONS: In the extremely obese patient, RLN tended to have advantages in EBL, operative duration, specimen weight, open conversion rate, and duration of hospital stay. RLN provides direct access to the renal hilum, and avoids the pannus and voluminous intra-abdominal fat encountered during TLN. These data and our experience support RLN as the technique of choice for LN in the extremely obese patient.     

后腹腔镜肾癌根治术对于T2期肾癌的临床治疗价值探讨

目的：探讨后腹腔镜肾癌根治术对于T2期肾癌的临床治疗价值。方法选取2010年1月～2011年1月期间在我院接受治疗的60例T2期肾癌患者,随机分为实验组与对照组。实验组以后腹腔镜肾癌根治术进行治疗;对照组以开放式肾癌根治术进行治疗。判定后腹腔镜肾癌根治术对于T2期肾癌的临床治疗价值。结果60例患者手术均得以顺利实施,其中,实验组患者的手术平均时长约为（130.2±20.5）min;术中平均失血量为（130.5±10.0）mL;术后平均住院时长为（6.5±3.5）d。术后1年随访,仅1例患者发生疾病复发情况,其他患者均恢复良好;对照组患者手术平均时长为（165.8±30.2）min;术中平均失血量为（175.5±12.2）ml;术后平均住院时长为（15.5±4.2）d。术后1年随访,6例患者发生疾病复发情况。两组数据差异显著,结果具有统计意义（P＜0.05）。结论后腹腔镜肾癌根治术具有较高的临床治疗价值,其手术耗时短、患者术中出血量少、术后住院时间短、复发率低,该手术法值得在临床上广泛推广,帮助更多的肾癌患者受益。     

da Vinci robotic partial nephrectomy for renal cell carcinoma: an atlas of the four-arm technique

da Vinci robotic surgery is becoming a standard alternative to open and laparoscopic surgical techniques. Robotic partial nephrectomy has been described in limited numbers. In this article, a surgical atlas of the transperitoneal four-arm approach to robotic partial nephrectomy is outlined. Surgical pearls, pitfalls, and limitations are reviewed.     

Hem-o-lok结扎夹在腹腔镜肾切除肾蒂处理中的应用

目的:探讨腹腔镜肾切除术中用Hem-o-lok结扎夹处理肾蒂的方法、优势及其应用价值.方法:2004年1月～2006年9月行腹腔镜肾切除术56例,其中38例术中应用Hem-o-lok夹处理肾蒂血管,包括腹腔镜单纯肾切除9例,腹腔镜.肾癌根治术18例,腹腔镜肾输尿管全长切除术11例.观察手术时间、术中出血量、是否中转开放、术后胃肠功能恢复时间、术后住院时间以及术后并发症等情况.结果:应用Hem-o-lok夹处理肾蒂的38例腹腔镜肾切除手术均获成功,无一例转为开放手术,术中术后无肾血管出血及其他严重并发症.手术时间35～270 min,平均165 min;术中出血量50～600 ml,平均187 ml;术后胃肠道功能恢复时间18～72 h,平均32h;术后住院时间7～16天,平均11天.结论:在腹腔镜.肾切除术中,Hem-o-lok结扎夹可以安全快速可靠的处理肾蒂血管,是一种新型有效的血管控制系统,具有广阔的应用前景.     

Early experience of laparoscopic radical nephrectomy for T3b renal cell carcinoma

We report our experience with laparoscopic radical nephrectomy for a 79-year-old man who had renal cell carcinoma (RCC) with a renal vein thrombus. For the transaction of the renal vein with the thrombus, we used an endoscopic gastrointestinal anastomosis stapler. The operating time was 4 h and blood loss was 400 mL. The patient could walk and drink on the first postoperative day. He recovered normal activity 30 days postoperatively. There were no intraoperative and postoperative complications. The present report demonstrates the feasibility of laparoscopic radical nephrectomy in patients with T3b RCC who suffer from tumor thrombus in the renal vein.     

腹股沟斜切口在后腹腔镜活体供肾切取术中的临床应用分析

研究腹股沟斜切口在后腹腔镜活体供肾切取术中应用的安全性和有效性。方法回顾性分析2008年5月至2012年3月在烟台毓璜顶医院泌尿外科行后腹腔镜活体供肾切取术的76例供者临床资料,根据供肾取出切口的不同将其分为两组,腹股沟切口组40例供者和腰部切口组36例供者分别采用腹股沟斜切口和腰部切口取出供肾。比较两组供者手术时间、术中出血量、供肾血管长度、住院时间、术后切口并发症发生情况和切口美容满意度。结果腹股沟切口组40例供者手术均成功;腰部切口组33例供者手术成功,3例因肾粘连和肾周脂肪组织较多改开放手术;两组均未发生死亡和严重并发症。两组手术时间和术中出血量差异均无统计学意义（P均＞0.01）。腹股沟切口组供肾热缺血时间为（1．6±1．2）min,短于腰部切口组,差异有统计学意义（t＝5．18,P＜0．01）。腹股沟切口组左、右侧供肾动脉血管长度分别为（2．6±0.4）cm和（3．7±0．3） cm,均长于腰部切口组;腹股沟切口组左、右侧供肾静脉血管长度分别为（3．50±0．40）cm和（1．70±0．23）cm,均长于腰部切口组,差异均有统计学意义（t＝4．75,7．32,76．3,6．45,P均＜0.01）。腹股沟切口组术后需接受镇痛治疗和腰腹部外观不对称的供者比例均低于腰部切口组,切口美容满意度高于腰部切口组,差异有统计学意义（χ2＝12．52,7．41,32.53,P均＜0．01）;腹股沟切口组无供者发生切口膨出,腰部切口组有6例供者发生切口膨出,两组比较差异有统计学意义（P＝0．009）。腹股沟切口组住院时间明显短于腰部切口组（t＝3.42,P＜0．01）。结论采用腹股沟斜切口的后腹腔镜活体供肾切取术能够提高手术安全性,保证最佳供肾血管长度,明显缩短供肾热缺血时间,减少切口并发症,提高供者切口美容满意度,值得临床推广。     

A prospective comparison of laparoscopic and robotic radical nephrectomy for T1-2N0M0 renal cell carcinoma

Objectives  We prospectively evaluated the safety, feasibility, and efficiency of robotic radical nephrectomy (RRN) for localized renal tumors (T1-2N0M0) and compared this with laparoscopic radical nephrectomy (LRN). Materials and methods  Between October 2006 to August 2007, a prospective data analysis of 15 cases of renal cell carcinoma (RCC) stage T1-2N0M0, undergoing RRN was done. These patients were compared with a contemporary cohort of 15 patients of RCC with clinical stage T1-2N0M0, undergoing LRN. To keep comparison robust, all cases were performed by a single surgeon. Demographic, intra-operative, post-operative outcomes, pathological characteristics and follow-up data of the two groups were recorded and analyzed statistically. Results  Patients in group A (RRN) experienced significantly (P = 0.001) long operating time than group B (LRN). However, mean estimated blood loss, intra-operative and post-operative complications, blood transfusion rate, analgesic requirement, hospital stay and convalescence were comparable in two groups (P < 0.05). There was one conversion to open surgery in group A, and none in group B. The mean follow-up was comparable in two groups (8.3 and 9.1 months, respectively, in group A and B, P = 0.09). There were no local, port-site or distal recurrences in either group. Conclusions  Robotic radical nephrectomy is a safe, feasible and effective for performing radical nephrectomy for localized RCC. Both groups (RRN and LRN) had comparable intra-operative, peri-operative, post-operative and oncological outcomes except for longer operating time with increased cost for RRN. In this comparative study, there were no outstanding benefits of RRN observed over LRN for localized RCC.     

腹膜后腹腔镜嗜铬细胞瘤切除术107例

目的 探讨腹膜后腹腔镜嗜铬细胞瘤切除术的安伞性及疗效.方法 回顾性分析107例嗜铬细胞瘤,肾上腺内102例,肾上腺外5例.采用腹膜后腹腔镜手术治疗,根据技术掌握程度分为3个时期:技术探索期、经验积累期及相对成熟期.结果 技术探索期完成10例:肿瘤平均直径4.2 cm,手术平均时间105 min,术中平均出血量620 ml.经验积累期完成66例,包括4例复发性嗜铬细胞瘤:肿瘤平均汽径5.7 cm,手术平均时间95 min,术中平均出血量350 ml.相对成熟期完成31例,包括5例肾上腺外嗜铬细胞瘤:肿瘤平均直径6.5 cm,手术平均时间75 min,术中平均出血量180rnl.各期均无围手术期死亡病例.结论 腹膜后腹腔镜嗜铬细胞瘤切除术安全可靠.肿瘤大小、是否复发及肿瘤部位不是决定能否采取腹腔镜手术的绝对因素.