Laparoendoscopic single site,laparoscopic or open surgery for adrenal tumors:Selecting the optimal approach
Laparoendoscopic single site, laparoscopic or open surgery for adrenal tumors: Selecting the optimal approach作者机构：Michigan State University College of Human MedicineGrand RapidsMI 49503United States Urology DivisionSpectrum Health Hospital SystemGrand RapidsMI 49503United States
出 版 物：《World Journal of Clinical Urology》 (世界临床泌尿杂志)
年 卷 期：2014年第3卷第2期
页 面：54-65页
学科分类：10[医学]
主 题：Adrenal masses Surgical approach Indications Open adrenalectomy Laparoscopic adrenalectomy Laparoendoscopic single-site adrenalectomy
摘 要：Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy(OS-A), minimally-invasive adrenalectomy(MI-A), and laparoendoscopic single-site adrenalectomy(LESS-A) remain unclear. A comprehensive Englishlanguage literature review was performed using MEDLINE/Pub MED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors( 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors( 4-5 cm), including pheochromocytoma and isolated adrenal metastases.
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