犬双孔腹腔镜肾上腺切除术

肾上腺肿块是肾上腺切除术的主要指征。 腹腔镜肾上腺切除术是一种微创手术技术，可最大程度地减少疼痛并改善患者康复。 传统技术涉及使用单个或多个端口（三个或四个）。 该研究的目的是评估双端口腹腔镜肾上腺切除术切除直径小于 4 厘米的肾上腺肿块的可行性和并发症发生率。 总共有 16 只患有肾上腺肿块的狗参加了这项研究，并从病历中收集了临床病理学数据。 狗被放置在胸骨卧位，垫子位于胸骨和耻骨下方，以模拟四足站立并置换腹部内脏。 在所有情况下，这些程序对于两个端口都是可行的。 5例发生包膜破裂，均为肾上腺癌。

功能性肿瘤的金标准治疗是肾上腺切除术，手术可以是开腹手术，也可以是腹腔镜手术。 腹腔镜肾上腺切除术 (LA) 是一种微创技术，专用于无血管侵犯的中小型肾上腺肿瘤。 LA 通常使用三个或四个端口进行，患者处于胸骨或侧卧位。 该研究的目的是评估具有两个端口的 LA 的可行性，以减少侵入性和改善患者康复。 总共有 16 只患有肾上腺肿瘤的狗被纳入研究，并进行了双端口技术。 肾上腺切除术是根据 13 例患者皮质醇增多症的存在进行的，而在 3 例患者中，肾上腺切除术是在没有皮质醇产生证据的情况下进行的。 13例为癌，3例为肾上腺腺瘤； 还有十二个在左边，四个在右边。 5例发生包膜破裂。 在所有情况下执行该技术后，没有发生额外的端口或剖腹手术转换。 根据作者的经验，腹腔镜肾上腺切除术可以通过两个端口进行。

犬双孔腹腔镜肾上腺切除术

图 1
T1 和 T2 的位置如图所示。 T1 在最后一根肋骨后面，T2 在腰椎旁窝。

犬双孔腹腔镜肾上腺切除术

图 2
仪器和狗的位置在图中表示。 外科医生位置在肾上腺肿瘤侧。

犬双孔腹腔镜肾上腺切除术

图 3
使用 5 mm 密封装置实现肾上腺的圆周解剖。

犬双孔腹腔镜肾上腺切除术

图 4
使用密封装置识别并密封膈腹 (PA) 静脉和动脉。

犬双孔腹腔镜肾上腺切除术

图 5
完整解剖肾上腺。

参考资料：
1. Lunn K.F., Boston S.E. Withrow and MacEwen’s Small Animal Clinical Oncology. Elsevier; Amsterdam, The Netherlands: 2020. Tumors of the Endocrine System; pp. 565–596.
2. Mayhew P.D. Advanced Laparoscopic Procedures (Hepatobiliary, Endocrine) in Dogs and Cats. Vet. Clin. N. Am. Small Anim. Pract. 2009;39:925–939. doi: 10.1016/j.cvsm.2009.05.004.   
3. Taylor C.J., Monnet E. A Comparison of Outcomes between Laparoscopic and Open Adrenalectomies in Dogs. Vet. Surg. 2021;50:O99–O107. doi: 10.1111/vsu.13565.   
4. Cook A.K., Spaulding K.A., Edwards J.F. Clinical Findings in Dogs with Incidental Adrenal Gland Lesions Determined by Ultrasonography: 151 Cases (2007–2010) J. Am. Vet. Med. Assoc. 2014;244:1181–1185. doi: 10.2460/javma.244.10.1181.   
5. Behrend E.N., Kooistra H.S., Nelson R., Reusch C.E., Scott-Moncrieff J.C. Diagnosis of Spontaneous Canine Hyperadrenocorticism: 2012 ACVIM Consensus Statement (Small Animal) J. Vet. Intern. Med. 2013;27:1292–1304. doi: 10.1111/jvim.12192.   
6. Balsa I., Culp W. Use of Minimally Invasive Surgery in the Diagnosis and Treatment of Cancer in Dogs and Cats. Vet. Sci. 2019;6:33. doi: 10.3390/vetsci6010033.   
7. Mayhew P.D., Boston S.E., Zwingenberger A.L., Giuffrida M.A., Runge J.J., Holt D.E., Raleigh J.S., Singh A., Culp W.T.N., Case J.B., et al. Perioperative Morbidity and Mortality in Dogs with Invasive Adrenal Neoplasms Treated by Adrenalectomy and Cavotomy. Vet. Surg. 2019;48:742–750. doi: 10.1111/vsu.13221.   
8. Kyles A.E., Feldman E.C., Cock H.E.V.D., Kass P.H., Mathews K.G., Hardie E.M., Nelson R.W., Ilkiw J.E., Gregory C.R. Surgical Management of Adrenal Gland Tumors with and without Associated Tumor Thrombi in Dogs: 40 Cases (1994–2001) J. Am. Vet. Med. Assoc. 2003;223:654–662. doi: 10.2460/javma.2003.223.654.   
9. Mayhew P.D., Culp W.T.N., Hunt G.B., Steffey M.A., Mayhew K.N., Fuller M., Della-Maggiore A., Nelson R.W. Comparison of Perioperative Morbidity and Mortality Rates in Dogs with Noninvasive Adrenocortical Masses Undergoing Laparoscopic versus Open Adrenalectomy. J. Am. Vet. Med. Assoc. 2014;245:1028–1035. doi: 10.2460/javma.245.9.1028.   
10. Jiménez Peláez M., Bouvy B.M., Dupré G.P. Laparoscopic Adrenalectomy for Treatment of Unilateral Adrenocortical Carcinomas: Technique, Complications, and Results in Seven Dogs. Vet. Surg. 2008;37:444–453. doi: 10.1111/j.1532-950X.2008.00410.x.   
11. Naan E.C., Kirpensteijn J., Dupré G.P., Galac S., Radlinsky M.G. Innovative Approach to Laparoscopic Adrenalectomy for Treatment of Unilateral Adrenal Gland Tumors in Dogs. Vet. Surg. 2013;42:710–715. doi: 10.1111/j.1532-950X.2013.12029.x.   
12. Ko J., Jeong J., Lee S., Son H., Kweon O.-K., Kim W.H. Feasibility of Single-Port Retroperitoneoscopic Adrenalectomy in Dogs. Vet. Surg. 2018;47:O75–O83. doi: 10.1111/vsu.12789.   
13. Mayhew P.D., Araya F.J.L., Kirpensteijn J. Laparoscopic Adrenalectomy. In: Fransson B.A., Mayhew P.D., editors. Small Animal Laparoscopy and Thoracoscopy. Wiley; Hoboken, NJ, USA: 2022. pp. 199–213.
14. Sasaki A., Nitta H., Otsuka K., Nishizuka S., Baba S., Umemura A., Koeda K., Mizuno M., Wakabayashi G. Laparoendoscopic Single Site Adrenalectomy: Initial Results of Cosmetic Satisfaction and the Potential for Postoperative Pain Reduction. BMC Urol. 2013;13:21. doi: 10.1186/1471-2490-13-21.   
15. Tamburro R., Brunetti B., Muscatello L.V., Mantovani C., De Lorenzi D. Short-Term Surgical Outcomes and Histomorphological Evaluation of Thermal Injury Following Palatoplasty Performed with Diode Laser or Air Plasma Device in Dogs with Brachycephalic Airway Obstructive Syndrome. Vet. J. 2019;253:105391. doi: 10.1016/j.tvjl.2019.105391.   
16. Labelle P., Kyles A.E., Farver T.B., de Cock H.E.V. Indicators of Malignancy of Canine Adrenocortical Tumors: Histopathology and Proliferation Index. Vet. Pathol. 2004;41:490–497. doi: 10.1354/vp.41-5-490.   
17. Case J.B., Marvel S.J., Boscan P., Monnet E.L. Surgical Time and Severity of Postoperative Pain in Dogs Undergoing Laparoscopic Ovariectomy with One, Two, or Three Instrument Cannulas. J. Am. Vet. Med. Assoc. 2011;239:203–208. doi: 10.2460/javma.239.2.203.   
18. Culp W.T.N., Mayhew P.D., Brown D.C. The Effect of Laparoscopic versus Open Ovariectomy on Postsurgical Activity in Small Dogs. Vet. Surg. 2009;38:811–817. doi: 10.1111/j.1532-950X.2009.00572.x.   
19. Devitt C.M., Cox R.E., Hailey J.J. Duration, Complications, Stress, and Pain of Open Ovariohysterectomy versus a Simple Method of Laparoscopic-Assisted Ovariohysterectomy in Dogs. J. Am. Vet. Med. Assoc. 2005;227:921–927. doi: 10.2460/javma.2005.227.921.   
20. Mayhew P.D. Complications of Minimally Invasive Surgery in Companion Animals. Vet. Clin. N. Am. Small Anim. Pract. 2011;41:1007–1021. doi: 10.1016/j.cvsm.2011.05.008.   
21. Barrera J.S., Bernard F., Ehrhart E.J., Withrow S.J., Monnet E. Evaluation of Risk Factors for Outcome Associated with Adrenal Gland Tumors with or without Invasion of the Caudal Vena Cava and Treated via Adrenalectomy in Dogs: 86 Cases (1993–2009) J. Am. Vet. Med. Assoc. 2013;242:1715–1721. doi: 10.2460/javma.242.12.1715.   
22. Yoshida O., Kutara K., Seki M., Ishigaki K., Teshima K., Ishikawa C., Iida G., Edamura K., Kagawa Y., Asano K. Preoperative Differential Diagnosis of Canine Adrenal Tumors Using Triple-Phase Helical Computed Tomography: Preoperative CT of Canine Adrenal Tumors. Vet. Surg. 2016;45:427–435. doi: 10.1111/vsu.12462.   
23. Zini E., Nolli S., Ferri F., Massari F., Gerardi G., Nicoli S., Romanelli G., Montinaro V., Trez D., Cavicchioli L., et al. Pheochromocytoma in Dogs Undergoing Adrenalectomy. Vet. Pathol. 2019;56:358–368. doi: 10.1177/0300985818819174.   
24. Bianchi A., Collivignarelli F., Vignoli M., Scaletta L., Cuomo A., Falerno I., Paolini A., Tamburro R. A Comparison of Times Taken for the Placement of the First Portal and Complication Rates between the Veress Needle Technique and the Modified Hasson Technique in Canine Ovariectomy Laparoscopic Surgery. Animals. 2021;11:2936. doi: 10.3390/ani11102936.   
25. Anderson C., Birchard S., Powers B., Belandria G., Kuntz C., Withrow S. Surgical Treatment of Adrenocortical Tumors: 21 Cases (1990–1996) J. Am. Anim. Hosp. Assoc. 2001;37:93–97. doi: 10.5326/15473317-37-1-93.   
26. Schwartz P., Kovak J.R., Koprowski A., Ludwig L.L., Monette S., Bergman P.J. Evaluation of Prognostic Factors in the Surgical Treatment of Adrenal Gland Tumors in Dogs: 41 Cases (1999–2005) J. Am. Vet. Med. Assoc. 2008;232:77–84. doi: 10.2460/javma.232.1.77.   
27. Van Sluijs F.J., Sjollema B.E., Voorhout G., van den Ingh T.S.G.A.M., Rijnberk A. Results of Adrenalectomy in 36 Dogs with Hyperadrenocorticism Caused by Adrenocortical Tumour. Vet. Q. 1995;17:113–116. doi: 10.1080/01652176.1995.9694547.   
28. Massari F., Nicoli S., Romanelli G., Buracco P., Zini E. Adrenalectomy in Dogs with Adrenal Gland Tumors: 52 Cases (2002–2008) J. Am. Vet. Med. Assoc. 2011;239:216–221. doi: 10.2460/javma.239.2.216.   
29. Cavalcanti J.V.J., Skinner O.T., Mayhew P.D., Colee J.C., Boston S.E. Outcome in Dogs Undergoing Adrenalectomy for Small Adrenal Gland Tumours without Vascular Invasion. Vet. Comp. Oncol. 2020;18:599–606. doi: 10.1111/vco.12587.   
30. Lacitignola L., Trisciuzzi R., Imperante A., Fracassi L., Crovace A.M., Staffieri F. Comparison of Laparoscopic Steerable Instruments Performed by Expert Surgeons and Novices. Vet. Sci. 2020;7:135. doi: 10.3390/vetsci7030135.   
31. Gonzalez-Gasch E., Monnet E. Comparison of Single Port Access Versus Multiple Port Access Systems in Elective Laparoscopy: 98 Dogs (2005–2014) Vet. Surg. 2015;44:895–899. doi: 10.1111/vsu.12373.   
32. Wright T., Singh A., Mayhew P.D., Runge J.J., Brisson B.A., Oblak M.L., Case J.B. Laparoscopic-Assisted Splenectomy in Dogs: 18 Cases (2012–2014) J. Am. Vet. Med. Assoc. 2016;248:916–922. doi: 10.2460/javma.248.8.916.   
33. Runge J.J., Mayhew P.D., Case J.B., Singh A., Mayhew K.N., Culp W.T.N. Single-Port Laparoscopic Cryptorchidectomy in Dogs and Cats: 25 Cases (2009–2014) J. Am. Vet. Med. Assoc. 2014;245:1258–1265. doi: 10.2460/javma.245.11.1258.   
34. Lacitignola L., Guadalupi M., Massari F. Single Incision Laparoscopic Surgery (SILS) in Small Animals: A Systematic Review and Meta-Analysis of Current Veterinary Literature. Vet. Sci. 2021;8:144. doi: 10.3390/vetsci8080144.   
35. Walz M.K., Groeben H., Alesina P.F. Single-Access Retroperitoneoscopic Adrenalectomy (SARA) Versus Conventional Retroperitoneoscopic Adrenalectomy (CORA): A Case–Control Study. World J. Surg. 2010;34:1386–1390. doi: 10.1007/s00268-010-0494-4.   
36. Beiša V., Kildušis E., Strupas K. Single Access Retroperitoneoscopic Adrenalectomy: Initial Experience. Wideochir. Inne Tech. Maloinwazyjne. 2012;7:45–49. doi: 10.5114/wiitm.2011.25640.   
37. Jeong J., Ko J., Lim H., Kweon O., Kim W.H. Retroperitoneal Laparoscopy in Dogs: Access Technique, Working Space, and Surgical Anatomy. Vet. Surg. 2016;45:O102–O110. doi: 10.1111/vsu.12571.   
38.Published online 2022 Oct 25. doi: 10.3390/ani12212917