Laparoscopic Adrenalectomy:Comparison Of Three Surgical Approaches And Individualized Treatment Case Selection

Objective:Through laparoscopic adrenalectomy(TLA),posterior approach laparoscopic adrenalectomy(PRA),and lateral approach laparoscopic adrenalectomy(LRA),three types of laparoscopic adrenal surgery were compared and analyzed.Laparoscopic adrenalectomy for these three different surgical approaches differed in terms of tumor size and location,operative time,postoperative indwelling catheter time,postoperative indwelling drainage time,postoperative bedtime,and hospitalization costs.It aims to provide some reference for the development of individualized treatment plans for patients.Methods:From January 2013 to October 2016,546 patients undergoing laparoscopic adrenalectomy were performed in our center,including 43 patients with TLA,39 patients with PRA,and 464 patients with LRA;a total of 218 men were enrolled.A total of 328 cases were women.Preoperative examination of related hormones and adrenal CT examination were clearly adrenal lesions.We compared the three groups of patients in terms of age,tumor size and location,operation time,intraoperative blood loss,postoperative indwelling catheter time,postoperative indwelling drainage time,postoperative bedtime,and hospitalization costs.Results:All 546 patients completed the operation without conversion to open surgery.After a comparative analysis,there was no significant difference in age between the three groups,and the difference was not statistically significant(P>0.05);the size of the tumors from large to small was TLA group(5.96±2.72),PRA group(3.13±1.48),LRA In the group(2.10±1.05),the difference between the three groups was statistically significant(P<0.05).In terms of operation time,the operation time of the TLA group was higher(99.79±42.27)than that of the PRA group(69.62±28.98).The differences between the LRA group and the LRA group(62.59±26.88)were statistically significant(P<0.05).However,the difference in operation time between the PRA group and the LRA group was not statistically significant(P>0.05).Catheterization time,indwelling drainage time,postoperative bedtime and hospitalization cost were higher in the TLA group than in the PRA group and the LRA group,but there was no significant difference in the PRA group and the LRA group in these aspects(P> 0.05).From the intraoperative blood loss,TLA group had more blood loss than PRA group and LRA group,but LRA group and PRA group could not calculate intraoperative blood loss,so it was difficult to compare accurately.From the point of view of tumor location,the tumor location of TLA group was mostly clumpy and closely related to the surrounding tissues,organs,and blood vessels;PRA group and LRA group were able to treat the medial,lateral,and isthmus tumors of the adrenal gland,but to the rear of the vena cava.For tumors,PRA can be used.Conclusion:The three laparoscopic approaches are safe and effective in the treatment of adrenal tumors.In the clinical application process,the best surgical approach should be selected for the patient according to the size and location of the tumor and the different characteristics of the patient.