Application Of Laparoscopy Combined With Computer-assisted Surgery System (Hisense CAS) In Pediatric Adrenal Tumors Precise Surgery

Objective:To investigate the application value and clinical significance of laparoscopy combined with computer-assisted surgery(Hisense CAS)in accurate resection of adrenal tumors in children.Methods:The clinical data of 35 children who underwent laparoscopic adrenalectomy via abdominal approach in Pediatric Surgery,Affiliated Hospital of Qingdao University from January 2015 to October 2020 were analyzed retrospectively.All the children underwent abdominal mass ultrasound and abdominal enhanced CT before operation.Among them,19 children who underwent three-dimensional reconstruction of Hisense CAS on the basis of abdominal enhanced CT were the reconstruction group,and 16 children who did not undergo three-dimensional reconstruction of Hisense CAS were the non-reconstruction group.All children underwent laparoscopic adrenalectomy via abdominal approach.The general clinical data,operation duration,intraoperative blood loss,the number of cases with abdominal drainage tube,postoperative hospital stay,postoperative metastasis and recurrence,pathological diagnosis results and other related data of 35 children were collected for comparative analysis between reconstruction group and non-reconstruction group.Results:1.Laparoscopic adrenalectomy was performed in 35 children.Intraoperative exploration and postoperative pathology confirmed that it was adrenal tumor.2.According to whether three-dimensional reconstruction of Hisense CAS was performed or not,the patients were divided into two groups.The reconstruction group had19 children,non-reconstruction group included 16 children.There were 23 male children and 12 female children,with an average age of(53.00±44.11)months.There was no significant difference between the two groups in general data such as sex,age,height,weight,tumor side,and clinical symptoms.3.The reconstruction group’s CAS three-dimensional reconstruction images accurately provide the location and adjacent relationship of adrenal tumors and central veins,which is consistent with the intraoperative exploration.The average operation time of the experimental group and the control group was(130.84±23.78)min and(151.19±34.81)min respectively.The median blood loss during operation was 15.0(10.0～20.0)m L and20.0(16.3～28.8)m L,respectively,with statistical significance(P= 0.049,0.004).The median postoperative hospital stay between the reconstructed group and the non-reconstructed group was 7.0(6.0～7.0)d and 7.0(6.0～7.8)d,respectively,with no significant difference(P = 0.404).There were 13 cases with indwelling abdominal drainage tube and 12 cases with no statistical difference(P= 0.723).There was no significant difference between the two groups(P = 0.515).4.All the children were followed up regularly(6 ～ 36)months after operation.There was 1 case of metastasis in the reconstruction group and 2 cases of recurrence and metastasis in the non-reconstruction group,with no significant difference(P = 0.582).Conclusion:The operation planning,preoperative and intraoperative real-time navigation of adrenal tumors are carried out by three-dimensional reconstruction of Hisense CAS,which can achieve accurate resection of adrenal tumors under laparoscopy and improve the accuracy and safety of surgery.