Laparoscopic adrenalectomy: comparison between pneumoperitoneum and the use of a laparoscopic lift device in dog cadavers

ABSTRACT: This study evaluated the feasibility of abdominal liftfor laparoscopic adrenalectomy and compared it with the conventional laparoscopic technique using pneumoperitoneum with medicinal CO2 in dog cadavers. The total surgical time (TST), adrenalectomy time (AT), and gland integrity after removal were evaluated. Thirty-eight adrenalectomies were performed in 19 cadavers. Regardless of the antimere, the TST was significantly lower in the CO2 procedures than in the lift laparoscopy procedures (P=0.001). When comparing the techniques between antimeres, the TST was significantly higher on the left side with lift laparoscopy than with CO2 (P=0.015) and similar between the techniques on the right side of the animals (P=0.086). In the comparison of AT, regardless of the execution side, no differences were observed between the techniques (P=0.05). The same was observed when AT was evaluated separately using antimeres (P=0.902). Of the 38 adrenals evaluated, 92.1% were removed in a single block, and 32.29% had a superficial lesion in the capsule. There was no difference between the groups in the removal capacity in a single block (P=0.340) and capsule integrity (P=0.287). Abdominal lift for laparoscopic adrenalectomy is a feasible technique in dog cadavers; however, it requires a longer surgical time than the conventional technique. The traction force used to elevate the abdominal wall must be evaluated.

摘要：本研究评估了腹部悬吊法（abdominal lift）应用于腹腔镜肾上腺切除术（laparoscopic adrenalectomy）的可行性，并以使用医用二氧化碳（medicinal CO₂）气腹术（pneumoperitoneum）的常规腹腔镜技术为对照，在犬尸体中开展对比实验。研究评估指标包括总手术时长（total surgical time, TST）、肾上腺切除时长（adrenalectomy time, AT）以及摘除后腺体完整性。实验共在19具犬尸体上完成38例肾上腺切除术。无论术侧为何侧，采用医用二氧化碳气腹术的总手术时长均显著短于腹部悬吊腹腔镜术式（P=0.001）。按术侧分别对比两种术式时，左侧术式中腹部悬吊法的总手术时长显著长于二氧化碳气腹术（P=0.015）；而右侧术式中两种术式的总手术时长无显著差异（P=0.086）。针对肾上腺切除时长的对比中，无论术侧为何侧，两种术式均未观察到显著差异（P=0.05）。按术侧分别评估肾上腺切除时长时，亦得到相同结果（P=0.902）。在评估的38个肾上腺中，92.1%实现了整块摘除，32.29%的肾上腺被膜存在浅表损伤。两组在整块摘除成功率（P=0.340）及被膜完整性（P=0.287）方面均无显著差异。应用于腹腔镜肾上腺切除术的腹部悬吊法在犬尸体中具备可行性，但相较于常规术式，其手术时长更长。后续需对提拉腹壁所用的牵引力展开进一步评估。