Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique

被引：6

作者：

Machado, Marcos-Tobias ^{[1
]}

Nunes-Silva, Igor ^{[2
]}

da Costa, Eduardo Fernandes ^{[3
]}

Hidaka, Alexandre Kyoshi ^{[4
]}

Faria, Eliney Ferreira ^{[5
]}

Zampolli, Hamilton ^{[2
]}

Bezerra, Carlos Alberto ^{[1
]}

机构：

[1] ABC Med Sch, Urol Div, Santo Andre, SP, Brazil

[2] Arnaldo Vieira de Carvalho Canc Inst IAVC, Urol Div, Sao Paulo, SP, Brazil

[3] ABC Med Sch, Inst Urol, Santo Andre, Brazil

[4] ABC Med Sch, Santo Andre, Brazil

[5] Hosp Canc Barretos, Urol Div, Barretos, SP, Brazil

来源：

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2017年 / 31卷 / 08期

关键词：

Adrenalectomy; Laparoscopy; Laparoendoscopic; Single-site surgery; Single-port surgery; LESS; LAPAROSCOPIC ADRENALECTOMY; SURGERY; PORT;

D O I：

10.1007/s00464-016-5400-1

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2-4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5-8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA). Methods A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient's demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale. Results Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary. Conclusion LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.

引用

页码：3351 / 3352

页数：2