Abstract
Objective:To discuss the clinical application of laparoscopic anatomical adrenalectomy via the renal cortex surface in the operation of adrenal masses.Methods:A retrospective analysis was performed on 231 patients with adrenal masses who were received and cured in the urology department of the Affiliated Hospital of Hebei University from July 2016 to January 2019. All patients received retroperitoneal adrenalectomy by means of laparoscopic anatomical adrenalectomy via the renal cortex surface. Operation duration, bleeding volume, postoperative complications, retention time of the drainage tube were measured and analyzed, and postoperative follow-up surveys were administered.Results:All cases were successfully operated. Two cases were converted to open surgery due to the presence of large adrenal tumors, and the patients suffered no significant complications. The mean operation duration, bleeding volume and retention time of the drainage tube were 31 minutes, 20 mL and 1.2±0.6 d, respectively. In terms of the postoperative pathology of adrenal tumors, 183 cases were shown to have adenomas, 34 had pheochromocytomas, nine had schwannomas, 3 had metastases from lung cancer, and two had sarcomas. A total of 174 patients were followed up for three to 18 months. Only one case with sarcoma that relapsed within half a year of the operation.Conclusion:In the treatment of adrenal masses, laparoscopic anatomical adrenalectomy via the renal cortex surface has many advantages including the large operation space, clear view of anatomical markers, little bleeding, small trauma, few postoperative complications, simple operational procedures and short learning curves. This technique needs clinical promotion.
Highlights
Adrenal tumors are common diseases in urology
Laparoscopic adrenalectomy is the best choice for surgical patients
Inclusion criteria: (1) Surgical cases suitable for adrenal space-occupying diseases were selected according to the Chinese Practice Guideline of Urological Diseases; (2) laparoscopic adrenalectomy via the renal cortex surface was applied
Summary
Adrenal tumors are common diseases in urology. In the case of an adrenal mass, it is necessary to determine whether the lesion is benign or malignant and whether hormone secretion is active to determine the proper therapy or follow-up visits. Surgeons can, according to preoperative imaging, calculate and measure the distance from the skin to Gerota’s fascia, the upper boundary of the adrenal gland and kidney, the distance from the adrenal gland to the 12th rib, the distance from the 12th rib to the ilium, and the fat thickness and decide on an operation method.[3,4,5] Buxton[6] treated 56 patients with HAL to assess the curative effect of this method on adrenal tumors larger than 5 cm He noted that HAL was a safe and repeatable adrenal gland surgery method and an effective combination of a minimally invasive surgery with tactile sense. It provides a short learning curve for surgeons.[7,8] In China, retroperitoneal and transperitoneal microsurgeries are widely applied
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