腹腔鏡下副腎摘除術 : 術式導入期5例の経験

Abstract

From January 1993 to May 1994, 5 patients with unilateral adrenal tumor underwent laparoscopic adrenalectomy at the Department of Urology, Nara Medical University. The preoperative diagnoses were primary aldosteronism in 3 cases and nonfun- ctioning tumor in 2. Three were on the right side and 2 on the left side. The adrenal gland was removed laparoscopically in 4 patients ; one case underwent open hemostasis and extirpation because of intraoperative massive arterial bleeding caused by the slipping out of a hemoclip. In the 4 cases in which laparoscopic adrenalectomy was completed, the mean operative time was 401 minutes, ranging from 330 to 490 minutes, and estimated bleeding volume ranged from 25 to 288 ml (mean 131 ml). Operative complications were localized pulmonary embolism in one patient, localized renal infarction in one and subcutaneous emphysema in 2, which could be treated conservatively. Laparoscopic adrenalectomy requires practice and skill. However, it is less invasive, compared to open adrenalectomy. It is considered that laparoscopic surgery would be highly useful in the field of adrenal surgery.