Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome

The laparoscopic approach to the adrenal gland has evolved to be the gold standard for most cases of adrenal conditions requiring surgical treatment. There is general consent about the safety, efficacy, and reproducibility of laparoscopic adrenal surgery. Compared to the open surgery, significant advantages with regard to shorter hospitalization time, decreased postoperative morbidity, improved cosmetics, and quicker convalescence are evident. The anatomic location of the adrenal gland led to the development of various approaches, including lateral transperitoneal, anterior transperitoneal, lateral retroperitoneal, posterior retroperitoneal, and even transthoracic approaches. The lateral transperitoneal approach is the technique most frequently used for laparoscopic adrenalectomy. A large operative field provides good orientation and visualization of familiar landmarks known from open surgery. In particular in the early learning curve this represents an advantage of the transperitoneal laparoscopic approach. This article describes in detail the indications, contraindications, preoperative evaluation, surgical technique, management of intraoperative complications, and outcome after lateral transperitoneal adrenalectomy.     

Anterior,lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy

BACKGROUND: Three approaches are currently used for endoscopic adrenalectomy-the lateral (transperitoneal), the posterior (retroperitoneal), and the anterior (transperitoneal). Both the lateral and posterior approaches are performed with the patient placed in the flank decubitus position; in the anterior approach the patient is supine. This study was designed to compare these three types of access in a relatively large series of patients undergoing adrenalectomy at three different institutions. METHODS: Laparoscopic adrenalectomy was performed in 216 patients with a variety of adrenal disorders, including 66 patients with Conn's syndrome, 55 with incidentaloma, 58 with Cushing's syndrome, 33 with pheochromocytoma, two with virilizing adrenogenital syndrome, and two with other lesions. Seventy-two adrenalectomies were performed using the lateral access, 67 via the posterior approach, and 77 via the transperitoneal anterior approach. There were 111 right and 105 left lesions. RESULTS: One patient in the lateral access group and three patients in the posterior group required conversion to open surgery. No conversions were needed in the anterior group. The learning curve was statistically significant only in the anterior access group. In both of the transperitoneal approaches (lateral and anterior), a statistically significant correlation was found between the operative time and the patient's body mass index (BMI). The postoperative hospital stay and time needed to return to normal activities were similar for the three groups. One patient who underwent retroperitoneal adrenalectomy for Cushing' disease died in the postoperative period of Candida sepsis and peritonitis. CONCLUSIONS: The anterior access route requires that the surgeon be skilled in advanced laparoscopic surgery. Both of the transperitoneal approaches (anterior and lateral) are suitable to remove larger adrenal masses. The posterior access may represent a better option in obese patients or in cases with small lesions.     

Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma

Background: Laparoscopic adrenalectomy has been shown to be safe and effective in the treatment of patients with primary hyperaldosteronism due to aldosterone-producing adenoma. Most laparoscopic adrenalectomies for aldosterone-producing adenomas involve total removal of the adrenal gland, and there have been few reports of laparoscopic adrenal-sparing surgery or partial adrenalectomies. Methods: A prospective review is performed on eight patients with primary hyperaldosteronism due to aldosterone-producing adenoma who underwent laparoscopic transperitoneal adrenal-sparing surgery in our institution over a 2-year period. Results: There were 1 male and 7 females with a mean age of 43.1 years. The mean diameter of the adenoma was 2 cm; there were six right-sided lesions and two left-sided lesions. The adenoma was located in the anterior margin of the adrenal gland in seven cases and was removed by laparoscopic enucleation. One patient had a partial adrenalectomy using the vascular stapler for an adenoma that was located posteriorly in the adrenal gland. Hemostasis was excellent in all cases. All patients were able to tolerate liquid orally on the day of operation and were on diet on the second postoperative day. Postoperative analgesic requirement was minimal. The mean hospital stay was 3.8 days. At a mean follow-up of 25 months, seven patients were cured of their hypertension and one patient had her antihypertensive medications significantly reduced. Conclusion: Laparoscopic transperitoneal adrenal-sparing surgery is safe and effective in the treatment of patients with primary hyperaldosteronism due to aldosterone-producing adenoma.     

经腹腔及腹膜后入路机器人辅助腹腔镜治疗肾上腺腺瘤临床对比研究

目的探讨经腹腔及经腹膜后两种途径的机器人手术治疗肾上腺腺瘤的安全性及临床疗效。 方法回顾性分析2017年1月至2018年12月首都医科大学附属北京安贞医院泌尿外科收治的经腹腔途径和经腹膜后途径机器人手术治疗肾上腺腺瘤的39例患者临床资料,其中经腹腔途径16例、经后腹腔途径23例,比较两组患者建立气腹时间、手术时间、术中出血量、术后并发症、平均住院时间及术后住院时间等临床资料,并应用独立样本t检验比较两组的指标差异。 结果两组的手术时间分别为(142±28)min和(107±26)min,经后腹腔组明显短于经腹腔组(P<0.01);建立气腹时间分别为(25±6)min和(19±3)min,经后腹腔组明显短于经腹腔组(P<0.01);术后住院时间分别为(8±2)d和(7±1)d,经后腹腔组明显短于经腹腔组(P＝0.009);两组的术中出血量、平均住院时间比较,差异无统计学意义(P>0.05)。 结论对于机器人辅助腹腔镜肾上腺腺瘤切除术,经后腹腔入路较经腹腔入路具有手术时间短、创伤小、术后恢复快等优势。     

Transabdominal laparoscopic adrenalectomy

Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland at many centers worldwide. Functional adrenal tumors such as aldosteronoma, glucocorticoid, androgen/estrogenproducing adenomas, and small-to-moderate sized solitary pheochromocytomas are amenable to removal via a laparoscopic approach. The advantages of laparoscopic adrenalectomy over open adrenalectomy are well documented and include a shorter hospital stay, a decrease in postoperative pain, shorter interval between surgery and return to preoperative activity level, and improved cosmesis. Various laparoscopic approaches to the adrenal gland have been described. Among these are the lateral transabdominal, anterior transabdominal, lateral retroperitoneal, and posterior retroperitoneal approaches. Each of these methods has specific advantages and disadvantages. This article reviews the transperitoneal approach to laparoscopic adrenalectomy, and discusses indications, operative technique, and a survey of the available literature.     

Lessons learned from 274 laparoscopic adrenalectomies

AIMS: To define the role of minimally invasive video-assisted surgery in the surgical management of adrenal disease and discuss the respective indications of the trans and retroperitoneal video assisted approaches. MATERIALS AND METHODS: During the last 8 years (1994-2001), 330 adrenalectomies were performed in 305 patients: 274 (83%) laparoscopic approaches and 56 (17%) open approach. Open surgery was reserved for patients presenting with large or malignant tumours (29 cases), multiple and/or extraadrenal phaeochromocytomas (13 cases), previous intraabdominal intestinal surgery (10 cases), and in those requiring concomitant intraabdominal surgery (4 cases). Laparoscopic adrenalectomy was performed using the lateral transperitoneal approach for 89 Conn's syndrome, 67 Cushing's syndrome, 2 virilizing tumours, 51 phaeochromocytomas and 65 non secretory tumours greater than 4 cm in diameter. Nineteen patients underwent bilateral adrenalectomy. RESULTS: There were no deaths. Twenty patients (7.3%) had a complication. Eleven cases required open conversion (4%) because of difficulties with dissection (8 cases), preoperative suspicion of malignancy (2 cases), and one pneumothorax. The average size of tumours was 34 mm (7-110 mm). There were 18 malignant tumours (6.5%): 8 adrenocortical carcinomas, 1 leiomyosarcoma, and 9 metastases. All patients with hormonally secreting tumours were cured of their endocrinopathy. There was 1 death secondary to hepatic metastases in a patient with an adrenocortical carcinoma. CONCLUSION: Most adrenal tumours are suitable for video assisted excision. The only absolute contraindication is an invasive carcinoma requiring an extended excision. The lateral, transperitoneal approach is the most suitable for tumours greater than 5-6 cm in diameter. Both the transperitoneal or retroperitoneal approaches are suitable for smaller tumours depending on operator choice and experience. However in the presence of a large right lobe of liver or previous intraabdominal surgery the retroperitoneal approach may be preferable.     

Trans- and retroperitoneal endoscopic adrenalectomy: experience in 26 consecutive adrenalectomies

OBJECTIVE: To assess our current concept and results of transperitoneal laparoscopic adrenalectomy (TPLA) and retroperitoneal endoscopic adrenalectomy (ERA) for a variety of benign disorders of the adrenal glands. BACKGROUND DATA: According to the literature, minimal invasive adrenalectomy has shown to be a safe and effective surgical alternative to open adrenalectomy. Both, transperitoneal and retroperitoneal endoscopic minimal invasive access are currently used for surgical removal of benign adrenal tumors. There is still some debate about the indications and the access used for a minimal invasive approach. PATIENTS AND METHODS: Treatment and clinical outcome of all patients who underwent either transperitoneal laparoscopic or endoscopic retroperitoneal adrenalectomies for benign diseases from February 1997 to August 2002 were analyzed retrospectively. RESULTS: Twenty-six minimal invasive adrenalectomies were performed in 23 patients with a mean age of 57 years. Whereas 11 patients underwent unilateral right- sided ERA, unilateral TPLA was performed in 9 patients on the left side. Three patients had bilateral TPLA. The mean operating time for unilateral ERA and TPLA was 114 and 79 min, respectively. Bilateral TPLA was prolonged to 223 min operating time. There were only two minor postoperative complications. The mean hospital stay for unilateral TPLA, ERA and bilateral TPLA was 4.7, 5 and 6 days, respectively. There was no mortality. CONCLUSION: Both, ERA and TPLA are safe and clinically effective treatment modalities for benign disorders of the adrenal glands. We currently favor a transperitoneal laparoscopic approach for bilateral and left-sided adrenal tumors, whereas right-sided tumors <8 cm are removed by a retroperitoneal approach. Large right-sided tumors >8 cm are better removed by transperitoneal access.     

Endoscopic treatment of bilateral pheochromocytoma in MEN 2A syndrome: case report and review of the literature

The benefits of laparoscopic adrenalectomy for single adrenal lesion have been well documented in literature; less experience though has been reported with simultaneous bilateral laparoscopic adrenalectomy. This operation is indicated in case of primary hypercortisolism caused by bilateral adrenocortical hyperfunction, Cushing's disease after failure of pituitary surgery, ectopic adrenocorticotropic hormone (ACTH) production by a tumour inaccessible for surgical intervention, and pheochromocytoma when it occurs bilaterally in case of multiple endocrine neoplasia type 2A and 2B. Different laparoscopic approaches have been described to perform this operation, such as the "anterior" approach (transperitoneal), the "lateral" approach (transperitoneal and retroperitoneal), and the "posterior" approach (retroperitoneal). We report a case of bilateral laparoscopic adrenalectomy in a 33 years old female affected with bilateral pheochromocytoma due to multiple endocrine neoplasia type 2A treated with a bilateral transperitoneal laparoscopic adrenalectomy and disease free after 18 months follow-up.     

COMPARISON OF 3 SURGICAL APPROACHES TO LAPAROSCOPIC ADRENALECTOMY: A NONRANDOMIZED, BACKGROUND MATCHED ANALYSIS

PURPOSE: To clarify the characteristics of surgical approaches to laparoscopic adrenalectomy we performed background matched analysis of clinical outcomes of the 3 approaches. MATERIALS AND METHODS: From February 1992 to July 2000 we performed 118 laparoscopic adrenalectomies in 115 patients with adrenal tumors. For these operations we used the anterior transperitoneal approach in 46 patients, the lateral transperitoneal approach in 32 and the lateral retroperitoneal approach in 40. RESULTS: To exclude the learning curve effect we eliminated our initial 20 patients treated with the anterior transperitoneal approach. To allow background matching of the 3 groups we also excluded 14 patients with tumors more than 5 cm., 6 who underwent conversion to open surgery and 1 patient who required 5 days of bed rest for retroperitoneal hematoma caused by bleeding from a trocar port. The final analysis included 16, 25 and 36 cases managed via the anterior transperitoneal, lateral transperitoneal and lateral retroperitoneal approach, respectively. Average operative time was significantly shorter for the lateral transperitoneal approach. Postoperative recovery was not significantly different in the lateral transperitoneal and lateral retroperitoneal groups. Postoperative complications included mild paralytic ileus in 2 patients and shoulder tip pain, probably peritoneal irritation due to carbon dioxide insufflation and bowel preparation, in 4 in the transperitoneal groups. Our results imply that the easiest procedure is the lateral transperitoneal approach but the lateral retroperitoneal approach is slightly less invasive. CONCLUSIONS: Although it is important to remember that this study was not a prospective randomized trial and, thus, had from certain biases, we believe that if a tumor is more than 5 cm. and/or the surgeon is not yet skilled in laparoscopic adrenalectomy, the lateral transperitoneal approach is the most suitable method. If the surgeon has performed at least 20 operations, the adrenal tumor is unilateral and the lesion is less than 5 cm., the lateral retroperitoneal approach seems to be more suitable because of its minimally invasive nature. The lateral retroperitoneal approach is also preferred in patients with a history of upper abdominal surgery. With improvements in technique and new instruments the time required for the lateral retroperitoneal approach has been significantly decreased.     

经腹膜后与经腹腔入路腹腔镜下侧位肾上腺手术的比较

目的 比较经腹膜后入路和腹腔入路腹腔镜下肾上腺手术的方法、优缺点，总结腹腔镜下肾上腺手术的适应证、禁忌证以及2种入路手术的选择。方法 回顾分析1996年7月-2005年12月105例腹腔镜肾上腺手术经验，其中经腹腔入路50例，经腹膜后入路55例。比较2组患者的手术时间、手术优缺点、中转开放手术率、手术并发症等指标。结果 经腹腔入路者5例（10％）中转开放手术，其中1例因为肝损伤，2例因发生肾上腺血管难以控制的出血，2例因粘连严重镜下难以分离；经腹膜后入路者2例（4％）中转开放手术，其中1例肾损伤，另1例暴露困难。余98例手术均成功。经腹腔入路手术时间50～180min，平均82min；出血量15～180ml，平均65ml；36h即下床活动；术后住院5～14d。经腹膜后途径者手术时间45～130min，平均60min；出血量15～100ml，平均30ml；24h后下床活动；术后住院3～7d。术中并发症：经腹腔途径者1例发生肝损伤，2例嗜铬细胞瘤患者发生难以控制的肾上腺出血；经腹膜后入路者中1例发生肾损伤。结论 腹腔镜下肾上腺手术应根据病变性质、肿瘤大小、位置及患者的具体情况选择手术入路，对体积较大、位于肾蒂前内方的肿瘤或血运丰富的嗜铬细胞瘤应采用经腹腔入路。     

International Consultation on Urological Diseases and European Association of Urology International Consultation on Minimally Invasive Surgery in Urology: laparoscopic and robotic adrenalectomy

The aim of this study was to provide an evidence‐based systematic review of the use of laparoscopic and robotic adrenalectomy in the treatment of adrenal disease as part of the International Consultation on Urological Diseases and European Association of Urology consultation on Minimally Invasive Surgery in Urology. A systematic literature search (January 2004 to January 2014) was conducted to identify comparative studies assessing the safety and efficacy of minimally invasive adrenal surgery. Subtopics including the role of minimally invasive surgery for pheochromocytoma, adrenocortical carcinoma (ACC) and large adrenal tumours were examined. Additionally, the role of transperitoneal and retroperitoneal approaches, as well as laparoendoscopic single‐site (LESS) and robotic adrenalectomy were reviewed. The major findings are presented in an evidence‐based fashion. Large retrospective and prospective data were analysed and a set of recommendations provided by the committee was produced. Laparoscopic surgery should be considered the first‐line therapy for benign adrenal masses requiring surgical resection and for patients with pheochromocytoma. While a laparoscopic approach may be feasible for selected cases of ACC without adjacent organ involvement, an open surgical approach remains the ‘gold standard’. Large adrenal tumours without preoperative or intra‐operative suspicion of ACC may be safely resected via a laparoscopic approach. Both transperitoneal and retroperitoneal approaches to laparoscopic adrenalectomy are safe. The approach should be chosen based on surgeon training and experience. LESS and robotic adrenalectomy should be considered as alternatives to laparoscopic adrenalectomy but require further study.     

Laparoscopic retroperitoneal renal and adrenal surgery in children

OBJECTIVE: To retrospectively assess the use of a retroperitoneal laparoscopic approach for simple nephrectomy and adrenalectomy in children. PATIENTS AND METHODS: All retroperitoneal laparoscopic renal and adrenal procedures carried out in children and completed between 1993 and March 2000 were reviewed retrospectively. Analgesic requirements, hospital stay, complications and blood loss were reviewed. The technique is described in detail. RESULTS: Forty-eight retroperitoneal laparoscopic procedures were completed in 48 patients (mean age 5.5 years, range 0.5-16). The procedures included nephrectomy (22), nephroureterectomy (15), renal biopsy (six), cyst ablation (two) and simple adrenalectomy (three). In all, 11 procedures were undertaken in children aged < 2 years. Forty-one (91%) of the children undergoing renal procedures were discharged in < 24 h. Two patients underwent three adrenalectomies. Two children required conversion to open surgery, one undergoing a right-sided adrenalectomy and one a nephrectomy. The mean operative duration for nephrectomy and nephroureterectomy was 75 min, and for adrenalectomy was 115 min. CONCLUSION: Renal and adrenal surgery in children is a safe and rapid procedure with retroperitoneal laparoscopy. The operative duration for nephrectomy and nephroureterectomy are frequently < 1 h. In addition, laparoscopic surgery offers significant advantages in terms of cosmesis and a quicker recovery.     

Technique and results of laparoscopic adrenalectomy

The aim of this report is to evaluate the benefits of laparoscopic adrenalectomy in terms of perioperative morbidity, complications and patients recuperation. We reviewed our experience with laparoscopic adrenalectomy in 47 consecutive patients who underwent adrenalectomy over a 4-year period. We used the lateral transperitoneal approach in all cases. The indications for adrenalectomy were Conn's adenoma in 24 patients, pheochromocytoma in 11, Cushing's syndrome in 3 and incidental adrenal tumour in 9. The average duration of surgery was 130 min (range, 60-300 min) and average adrenal gland size was 3.4 cm (range, 1.2-8 cm). Conversion from laparoscopy to laparotomy was necessary in three patients (6.4%), and postoperative complications occurred in two patients. There was no mortality. Laparoscopic adrenalectomy can be considered the method of choice for managing almost all adrenal masses, because of its low morbidity and short postoperative recovery. The main difficulty is to identify the adrenal gland, so several technical procedures are suggested.     

经腹、经后腹腔途径腹腔镜肾上腺肿瘤切除术(附56例报告)

目的 总结经腹腔、经后腹腔途径腹腔镜肾上腺肿瘤切除术的临床经验. 方法 2001年12月～2004年12月,我院施行腹腔镜肾上腺切除术56例.采用经腹腔途径肾上腺肿瘤切除术10例,腹部取3个trocar 穿刺入路,切开侧腹膜和肾周筋膜,在肾上极内上方分离肾上腺或瘤体,结扎速结合超声刀将肿瘤切除.经后腹腔途径切除肾上腺肿瘤46例,腰部取3个trocar 穿刺入路,用自制的气囊扩张后腹腔,切开肾周筋膜,在肾上极内上方分离肾上腺或瘤体,结扎速结合超声刀将肿瘤切除. 结果 10例经腹腔途径中3例因腹腔广泛粘连中转开放手术,46例经后腹腔途径中1例因下腔静脉损伤大出血中转开放手术.余52例术中出血量20～200 ml,平均70 ml,均未输血.手术时间40～200 min,平均110 min.术后住院3～8 d,平均5.4 d.52例随访6～36个月,平均8个月,未见肿瘤复发和转移. 结论 腹腔镜肾上腺切除术效果确切,损伤小,术后恢复快,住院时间短,是肾上腺手术的首选术式.     

RETROPERITONEOSCOPIC SURGERY IS NOT ASSOCIATED WITH INCREASED CARBON DIOXIDE ABSORPTION

PURPOSE: Previous studies have suggested that retroperitoneal laparoscopy is associated with greater carbon dioxide absorption and related postoperative morbidity, such as subcutaneous emphysema and pneumothorax. We prospectively compared the effects of carbon dioxide absorption during transperitoneal and retroperitoneal laparoscopic renal and adrenal surgery at our institution. MATERIALS AND METHODS: Data were collected prospectively on 51 patients who underwent laparoscopic renal (26) or adrenal (25) surgery via the transperitoneal (18) or retroperitoneal (33) approach from September 1997 to February 1998. RESULTS: There was no significant difference in carbon dioxide elimination in patients who underwent transperitoneal laparoscopy compared to retroperitoneoscopy at any interval. Subcutaneous emphysema occurred in 12.5% of the transperitoneal and 45% of the retroperitoneal group (p = 0.09). Patients with subcutaneous emphysema had greater carbon dioxide elimination during the first 2.5 hours of insufflation compared to those without subcutaneous emphysema and, thereafter, carbon dioxide elimination decreased to baseline. CONCLUSIONS: In contrast to previous reports our prospective nonrandomized study suggests that retroperitoneoscopy is not associated with greater carbon dioxide absorption compared to transperitoneal laparoscopy. Patients with subcutaneous emphysema exhibited only transient increases in carbon dioxide absorption above control levels.     

Laparoscopic adrenalectomy: Comparison of lateral transperitoneal and lateral retroperitoneal approaches

Laparoscopic adrenalectomy has become the method of choice of removal of most of adrenal lesions. This study investigated and compared the results of 2 different approaches of laparoscopic adrenalectomy, through retrospective review of 40 patients. Within this study period between 1995 and 2004, there were 20 lateral retroperitoneal and 20 lateral transperitoneal laparoscopic adrenalectomies performed. There was no significant difference in demographic variables between the 2 groups. Operative time, days to diet and ambulation, hospital stay, rate of conversion and complication did not differ significantly between the 2 approaches. No recurrence was detected upon mean follow-up period of 15.9 months. Learning curves showed gradual decrease in operation time in both approaches, reflecting maturation of techniques. In conclusion, both lateral transperitoneal and lateral retroperitoneal laparoscopic adrenalectomy are safe and effective. There is no difference in outcome between 2 approaches.     

后腹腔镜手术切除肾上腺肿瘤(附80例报告)

目的:探讨应用后腹腔镜术切除肾上腺肿瘤的疗效和安全性.方法:应用后腹腔镜手术切除肾上腺肿瘤80例:功能性肾上腺肿瘤56例,非功能性肾上腺肿瘤24例.用自制的气囊扩张后腹腔,腰部3个Trocar穿刺入路,超声刀将肿瘤切除,用自制的标本袋取出肿瘤.结果:80例中73例完全由腹腔镜手术完成,7例因术中粘连、出血等改开放手术.术中出血量10～500 ml,平均70 ml.患者均未输血.76例随访3～48个月,平均8个月,未见肿瘤复发和转移,血电解质、儿茶酚胺、醛固酮、皮质醇等肾上腺内分泌检查均恢复正常;但12例仍有高血压.结论:应用后腹腔镜术切除肾上腺肿瘤安全、创伤小、恢复快,对肾上腺恶性肿瘤主张行开放手术.     

Is right-sided laparoscopic adrenalectomy truly more challenging than left-sided? The 10-year experience of a single institute

BackgroundThere are few data regarding the difference of the right-sided and left-sided laparoscopic adrenalectomy. The aim of this study was to determine if there are differences between right-sided and left-sided laparoscopic adrenalectomy with a transperitoneal (TLA) or retroperitoneal approach (RLA).MethodsOur surgery database was reviewed to identify patients who had undergone laparoscopic adrenalectomy by either retroperitoneal or transperitoneal approaches since 2000. A total of 127 patients were enrolled (55 right-sided, 72 left-sided; 82 RLA, 45 TLA). Patient characteristics as well as operative and perioperative data were compared between the two groups.ResultsThere was a statistically significant difference in operation time between right-sided RLA and left-sided RLA. There was no statistically significant difference of estimated blood loss and duration of hospitalization between right-sided RLA and left-sided RLA, nor was there any statistically significant difference of operative time, blood loss, and duration of hospitalization between right-sided TLA and left-sided TLA.ConclusionRight-sided laparoscopic adrenalectomy is somewhat more difficult and time consuming with a retroperitoneal approach. There was no difference in laterality with a transperitoneal approach.     

经肾周脂肪囊内入路后腹腔镜肾上腺手术初步探讨

目的探讨经肾周脂肪囊内入路后腹腔镜肾上腺手术的安全性和可行性。 方法2015年1月1日至2018年12月30日,临沂市人民医院共收治252例肾上腺肿瘤患者。其中行经腹腔入路腹腔镜肾上腺手术115例(经腹腔组),行经肾周脂肪囊内入路后腹腔镜肾上腺手术137例(经脂肪囊内组)。经肾周脂肪囊内入路后腹腔镜肾上腺手术方法：手术常规建立腹膜后空间,打开肾筋膜后直接经肾脏中上极与肾周脂肪囊之间的无血管层面分离、解剖肾上腺,行肾上腺全切术或部分切除术。分析、比较两组患者的手术时间、术中出血量、术后住院时间等临床资料。 结果经腹腔入路腹腔镜肾上腺手术115例及经肾周脂肪囊内入路后腹腔镜肾上腺手术137例均顺利完成,无一例中转开放手术。经腹腔入路腹腔镜肾上腺手术平均手术时间(52.7±19.7)min,平均术中出血量(33.1±23.2)ml,平均术后住院时间(3.5±0.9)d。经肾周脂肪囊内入路后腹腔镜肾上腺手术平均手术时间(54.4±22.7)min,平均术中出血量(31.8±21.4)ml,平均术后住院时间(2.8±0.4)d。两组比较,手术时间、术中出血量无统计学差异,经肾周脂肪囊内入路后腹腔镜肾上腺手术组术后住院时间缩短,差异有统计学意义。 结论经肾周脂肪囊内入路后腹腔镜肾上腺手术解剖肾上腺操作简便,患者术后康复较快,是安全可行的手术方式。     

经腹膜后腔和经腹腔途径行腹腔镜肾上腺切除术的比较

目的比较经腹腔和经腹膜后腔两种途径的腹腔镜下肾上腺肿瘤切除术的安全性及疗效的差别。 方法回顾性分析2012年3月至2017年12月我院间收治的经腹腔途径（35例）及经腹膜后腔途径（31例）的单侧肾上腺切除手术患者的临床资料,比较两组的曲卡置入时间、手术时间、术中出血量、术后禁食时间、术后引流管留置时间及术后住院天数等临床资料。 结果所有66例手术均于腹腔镜下完成切除,无一例中转开放手术。两组在肾上腺切除手术时间、术后禁食时间等方面差异无统计学意义。但经腹腔组与经腹膜后腔组相比,置曲卡时间、总体手术时间、出血量、术后引流管留置天数及术后住院天数均明显降低。分层分析显示,在肿瘤直径>6 cm时,除了术后引流管留置时间及术后住院天数外,肿瘤切除的手术时间也是经腹腔组短于经腹膜后腔组。 结论两种手术入路的腹腔镜肾上腺切除术皆安全、有效,经腹腔途径建立操作通道时间及总体手术时间更短,对于>6 cm的肿瘤,经腹腔途径在手术时间及安全性方面的优势更明显。