針對腎上腺腫瘤使用雷射輔助腹腔鏡部分腎上腺切除手術治療經驗
蔡禮賢、邱鴻傑、黃志平
中國醫藥大學附設醫院泌尿部
Preliminary outcomes of laparoscopic partial thulium laser adrenalectomy in patient with small adrenal tumor
Li Hsien. Tsai, Hung Chieh Chiu, Chi Pin. Huang
China Medical University Hospital, Dept. of Urology, Taichung, Taiwan
Purpose:
Adrenal tumors were not uncommon in diagnosis and minimal invasive adrenalectomy was the gold standard treatment for adrenal lesions nowadays. Adrenal sparing surgery had been described in recent reports for preserving unaffected adrenal tissue. Furthermore, the utility of thulium laser could achieve precise tumor excision and better hemostasis. This is the first study to report patients underwent laparoscopic partial thulium laser adrenalectomy (PTLA) and comparison with laparoscopic total adrenalectomy (TA).
Materials and Methods:
During the period between Jan. 2011 and Dec. 2018, total 61 patients were diagnosed as adrenal tumors and they were divided into two groups based on tumor size and tumor character. Group I: Laparoscopic partial thulium laser adrenalectomy (with a wavelength of 2013 nm in the infrared spectrum, laser fiber 272 μm, 10 W thulium laser) for tumor size<2cm and benign tumor character, Group II: laparoscopic total adrenalectomy for tumor size≥2 cm or possible malignant tumor character, metastasis .Two groups patients underwent surgical intervention in single institution by single urologist. We compared perioperative, postoperative and pathologic outcomes between two groups.
Results:
Total 61 patients (19 patients in PTLA group and 42 patients in TA group) were enrolled in our study. The patient’s age, sex, BMI, ASA scores and follow-up period were similar between two groups. Larger tumor size .longer operative time and hospital stay were noted in TA group (P<0.001). Minimal blood loss and no blood transfusion were noted in both groups. There was no margin positive specimen in PTLA group, however, two margin positive specimen were observed in TA group. No major complication nor steroid supplement were reported in follow-up period in both groups
Conclusion:
Laparoscopic partial thulium laser adrenalectomy is an effective and safe modality for small adrenal tumor treatment. It could preserve unaffected adrenal tissue and offer precise excision and hemostasis ,furthermore, excellent perioperative, postoperative outcomes and negative tumor margin were achieved in our study.