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Han JH, Lee BC, Park YM, Jung HJ, Kim DI, Choi JB. Initial experience with laparoscopic posterior retroperitoneal adrenalectomy in single tertiary center. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2021; 17:90-95. [PMID: 36945664 PMCID: PMC9942749 DOI: 10.14216/kjco.21014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
Purpose Laparoscopic posterior retroperitoneal adrenalectomy (LPRA) is a surgical method that accesses the adrenal gland through the back. The aim of this study was to report initial experience of LPRA and evaluate possibilities for surgical application. Methods From March 2018 to December 2019, a total of 30 consecutive patients diagnosed with adrenal tumor underwent surgical treatment at Pusan National University Hospital were enrolled. Clinicopathologic features and various peri- and postoperative parameters were analyzed by retrospective medical record review. The mean age of the patients was 48.20±13.66 years. Results The mean body mass index (BMI) was 25.50±4.30 kg/m2. Primary hyperaldosteronism was the most frequently preoperative diagnosed disease (n=13, 43.4%), followed by adrenal incidentaloma (n=8, 26.6%), Cushing syndrome (n=5, 16.6%) and pheochromocytoma (n=4, 13.3%). The mean size of postoperative adrenal tumor was 2.72±1.76 cm. The mean operating time was 162±58.14 minutes. Among the 30 patients, 28 patients underwent total adrenalectomy (93.3%) and two patients underwent cortical sparing adrenalectomy (6.7%). When LPRA was performed for patients with BMI >23.16 kg/m2, the operating time was longer than the average (P=0.016). Conclusion LPRA was suitable and safe for patients with benign adrenal tumors. BMI, retroperitoneal fat density and postoperative adrenal weight may be related to the operating time, so they should be considered when deciding on a surgical method for adrenalectomy.
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Affiliation(s)
- Jeong Hee Han
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Byoung Chul Lee
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Young Mok Park
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Hyuk Jae Jung
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Dong-il Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Bum Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
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New predictive factors for prolonged operation time of laparoscopic posterior retroperitoneal adrenalectomy; retrospective cohort study. Int J Surg 2021; 94:106113. [PMID: 34534705 DOI: 10.1016/j.ijsu.2021.106113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/29/2021] [Accepted: 09/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy is a standard surgical procedure for benign adrenal diseases. Laparoscopic posterior retroperitoneal adrenalectomy (LPRA) has many benefits. However, it is associated with factors such as prolong operation time. The aim of the study was to determine the predictive factors associated with prolonged operation time in LPRA. MATERIALS AND METHODS This study retrospectively analyzed data from 284 patients who underwent LPRA between 2014 and 2019 at Asan Medical Center. Then, we analyzed the predictive factors prolonging operation time using multivariate logistic regression analysis and classified the differences according to the learning curve using cumulative sum analysis. RESULTS In multivariate logistic regression analysis, the following were determined as factors associated with prolonged operation time: male sex (OR, 2.540; 95% CI, 1.225-5.266), pheochromocytoma (OR, 3.669; 95% CI, 1.548-8.694), right site (OR, 2.499; 95% CI, 1.086-5.748), surgeon A (OR, 3.293; 95% CI, 1.522-7.122), depth of descended adrenal tumor location to kidney (OR, 3.793; 95% CI, 1.660-8.667), large periadrenal fat volume (OR, 2.366; 95% CI, 1.120-4.996), and posterior adiposity index (PAI) (OR, 2.171; 95% CI, 1.090-4.324) (all p < 0.05). However, in the period after the learning curve, periadrenal fat volume was not a significant predictor of surgery time prolongation. CONCLUSION This study demonstrates that depth of descended adrenal tumor location to kidney is a new and important independent predictive factor for prolonged operation time in LPRA. In addition, periadrenal fat volume is a predictor of surgery time prolongation for beginner surgeons before the learning curve.
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Kostiainen I, Hakaste L, Kejo P, Parviainen H, Laine T, Löyttyniemi E, Pennanen M, Arola J, Haglund C, Heiskanen I, Schalin-Jäntti C. Adrenocortical carcinoma: presentation and outcome of a contemporary patient series. Endocrine 2019; 65:166-174. [PMID: 30980285 PMCID: PMC6606857 DOI: 10.1007/s12020-019-01918-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/28/2019] [Indexed: 12/08/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare endocrine carcinoma with poor 5-year survival rates of < 40%. According to the literature, ACC is rarely an incidental imaging finding. However, presentation, treatment and outcome may differ in modern series. DESIGN AND METHODS We studied all patients (n = 47, four children) from a single centre during years 2002-2018. We re-evaluated radiologic and histopathological findings and assessed treatments and outcome. We searched for possible TP53 gene defects and assessed nationwide incidence of ACC. RESULTS In adults, incidental radiologic finding led to diagnosis in 79% at median age of 61 years. ENSAT stage I, II, III and IV was 19%, 40%, 19% and 21%, respectively. Nonenhanced CT demonstrated > 20 Hounsfield Units (HU) for all tumours (median 34 (21-45)), median size 92 mm (20-196), Ki67 17% (1-40%), Weiss score 7 (4-9) and Helsinki score 24 (4-48). ACC was more often found in the left than the right adrenal (p < 0.05). One child had Beckwith-Wiedemann and one a TP53 mutation. In adults, the primary tumour was resected in 88 and 79% received adjuvant mitotane therapy. Median hospital stay was significantly shorter in the laparoscopic vs. open surgery group (4 (3-7) vs. 8 (5-38) days, respectively; p < 0.001). In 3/4 patients, prolonged remission of > 5 to > 10 years was achieved after repeated surgery of metastases. Overall 5-year survival was 67%, and 96% vs. 26% for ENSAT stage I-II vs. III-IV (p < 0.0001). ENSAT stage and Ki67 predicted survival, type of surgery did not. Mitotane associated with better survival. CONCLUSIONS Contemporary ACC predominantly presents as an incidental imaging finding, characterised by HU > 20 on nonenhanced CT but variable tumour size (20-196 mm). Malignancy cannot be ruled out by small tumour size only. The 5-year survival of 96% in ENSAT stage I-III compares favourably to previous studies.
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Affiliation(s)
- Iiro Kostiainen
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Liisa Hakaste
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pekka Kejo
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Helka Parviainen
- HUS Medical Imaging Centre, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tiina Laine
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eliisa Löyttyniemi
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Mirkka Pennanen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Johanna Arola
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Caj Haglund
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ilkka Heiskanen
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Fassnacht M, Dekkers O, Else T, Baudin E, Berruti A, de Krijger R, Haak H, Mihai R, Assie G, Terzolo M. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol 2018; 179:G1-G46. [PMID: 30299884 DOI: 10.1530/eje-18-0608] [Citation(s) in RCA: 562] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare and in most cases steroid hormone-producing tumor with variable prognosis. The purpose of these guidelines is to provide clinicians with best possible evidence-based recommendations for clinical management of patients with ACC based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. We predefined four main clinical questions, which we judged as particularly important for the management of ACC patients and performed systematic literature searches: (A) What is needed to diagnose an ACC by histopathology? (B) Which are the best prognostic markers in ACC? (C) Is adjuvant therapy able to prevent recurrent disease or reduce mortality after radical resection? (D) What is the best treatment option for macroscopically incompletely resected, recurrent or metastatic disease? Other relevant questions were discussed within the group. Selected Recommendations: (i) We recommend that all patients with suspected and proven ACC are discussed in a multidisciplinary expert team meeting. (ii) We recommend that every patient with (suspected) ACC should undergo careful clinical assessment, detailed endocrine work-up to identify autonomous hormone excess and adrenal-focused imaging. (iii) We recommend that adrenal surgery for (suspected) ACC should be performed only by surgeons experienced in adrenal and oncological surgery aiming at a complete en bloc resection (including resection of oligo-metastatic disease). (iv) We suggest that all suspected ACC should be reviewed by an expert adrenal pathologist using the Weiss score and providing Ki67 index. (v) We suggest adjuvant mitotane treatment in patients after radical surgery that have a perceived high risk of recurrence (ENSAT stage III, or R1 resection, or Ki67 >10%). (vi) For advanced ACC not amenable to complete surgical resection, local therapeutic measures (e.g. radiation therapy, radiofrequency ablation, chemoembolization) are of particular value. However, we suggest against the routine use of adrenal surgery in case of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies. Furthermore, we offer detailed recommendations about the management of mitotane treatment and other supportive therapies. Finally, we suggest directions for future research.
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Affiliation(s)
- Martin Fassnacht
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Olaf Dekkers
- Department of Clinical Epidemiology
- Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tobias Else
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Baudin
- Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France
- INSERM UMR 1185, Faculté de Médecine, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Ronald de Krijger
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Harm Haak
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands
- Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands
- Division of General Internal Medicine, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Guillaume Assie
- Department of Endocrinology, Reference Center for Rare Adrenal Diseases, Reference Center dor Rare Adrenal Cancers, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique UMR8104, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Massimo Terzolo
- Department of Clinical and Biological Sciences, Internal Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
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Vrielink OM, Engelsman AF, Hemmer PHJ, de Vries J, Vorselaars WMCM, Vriens MR, Karakatsanis A, Hellman P, Sywak MS, van Leeuwen BL, El Moumni M, Kruijff S. Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. Br J Surg 2018; 105:544-551. [PMID: 29493779 DOI: 10.1002/bjs.10740] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/20/2017] [Accepted: 09/30/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy has gained international popularity in the past decade. Despite major advantages, including shorter duration of operation, minimal blood loss and decreased postoperative pain, many surgeons still prefer laparoscopic transperitoneal adrenalectomy. It is likely that the unfamiliar anatomical environment, smaller working space and long learning curve impede implementation. The present study assessed the number of procedures required to fulfil the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. METHODS The first consecutive posterior retroperitoneoscopic adrenalectomies performed by four surgical teams from university centres in three different countries were analysed. The primary outcome measure was duration of operation. Secondary outcomes were conversion to an open or laparoscopic transperitoneal approach, complications and recovery time. The learning curve cumulative sum (LC-CUSUM) was used to assess the learning curves for each surgical team. RESULTS A total of 181 surgical procedures performed by four surgical teams were analysed. The median age of the patients was 57 (range 15-84) years and 61·3 per cent were female. Median tumour size was 25 (range 4-85) mm. There were no significant differences in patient characteristics and tumour size between the teams. The median duration of operation was 89 (range 29-265) min. There were 35 perioperative and postoperative complications among the 181 patients (18·8 per cent); 17 of 27 postoperative complications were grade 1. A total of nine conversions to open procedures (5·0 per cent) were observed. The LC-CUSUM analysis showed that competency was achieved after a range of 24-42 procedures. CONCLUSION In specialized endocrine surgical centres between 24 and 42 procedures are required to fulfil the entire surgical learning curve for the posterior retroperitoneoscopic adrenalectomy.
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Affiliation(s)
- O M Vrielink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A F Engelsman
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - P H J Hemmer
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - J de Vries
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - W M C M Vorselaars
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M R Vriens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Karakatsanis
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - P Hellman
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - M S Sywak
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - B L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M El Moumni
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Kruijff
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Comparative outcomes of lateral transperitoneal adrenalectomy versus posterior retroperitoneoscopic adrenalectomy in consecutive patients: A single surgeon's experience. Asian J Surg 2017; 39:74-80. [PMID: 26117204 DOI: 10.1016/j.asjsur.2015.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 03/30/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Among several minimally invasive adrenalectomy techniques, lateral transperitoneal adrenalectomy (LTA) is the procedure of choice for benign adrenal tumors; however, posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative that is increasing in popularity. This study compared the outcomes of these two approaches. METHODS Since a single surgeon started adrenalectomy, LTA had been performed exclusively until PRA was adopted and became the standard treatment. Therefore, the consecutive patients were allocated into two groups according to the date of surgery: the first group received LTA and the second group received PRA. RESULTS LTA was performed in 29 patients and PRA in 19 patients. There was no difference in sex, age, body mass index, clinical diagnosis, and tumor size between the LTA and the PRA group. The PRA group showed less blood loss (117.0 mL vs. 58.5 mL, p = 0.035) and tended to have a shorter operating time (92.2 minutes vs. 78.1 minutes, p = 0.054) and less pain score on postoperative Day 1 (3.8 vs. 3.0, p = 0.095) and Day 2 (3.2 vs. 2.5, p = 0.051). The mean operation time was significantly shorter for patients in the PRA group undergoing right adrenalectomy (109.2 minutes vs. 80.5 minutes, p = 0.009), but those undergoing left adrenalectomy had a similar operating time to the LTA group (83.2 minutes vs. 74.8 minutes, p = 0.380). CONCLUSION PRA is a good alternative operative technique for an endocrine surgeon who is experienced in the transperitoneal approach.
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7
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Vrielink OM, Wevers KP, Kist JW, Borel Rinkes IHM, Hemmer PHJ, Vriens MR, de Vries J, Kruijff S. Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard? Langenbecks Arch Surg 2016; 402:767-773. [PMID: 27888343 PMCID: PMC5506107 DOI: 10.1007/s00423-016-1533-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Abstract
Purpose There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the “classic” laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size. Methods A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches. Results Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0–200) vs. 50 (0–1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches. Conclusions Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.
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Affiliation(s)
- O M Vrielink
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - K P Wevers
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - J W Kist
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - I H M Borel Rinkes
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P H J Hemmer
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - M R Vriens
- Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J de Vries
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - S Kruijff
- Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
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Conzo G, Tartaglia E, Gambardella C, Esposito D, Sciascia V, Mauriello C, Nunziata A, Siciliano G, Izzo G, Cavallo F, Thomas G, Musella M, Santini L. Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg 2016; 28 Suppl 1:S118-S123. [PMID: 26708860 DOI: 10.1016/j.ijsu.2015.12.042] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 04/18/2015] [Accepted: 05/10/2015] [Indexed: 02/06/2023]
Abstract
In the last decades, minimally invasive transperitoneal laparoscopic adrenalectomy has become the standard of care for surgical resection of the adrenal gland tumors. Recently, however, adrenalectomy by a mininvasive retroperitoneal approach has reached increasingly popularity as alternative technique. Short hospitalization, lower postoperative pain and decrease of complications and a better cosmetic resolution are the main advantages of these innovative techniques. In order to determine the better surgical management of adrenal neoplasms, the Authors analyzed and compared the feasibility and the postoperative complications of minimally invasive adrenalectomy approaches. A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, comparing laparoscopic transperitoneal adrenalectomy versus retroperitoneoscopic adrenalectomy. Many studies support that posterior retroperitoneal adrenalectomy is superior or at least comparable to laparoscopic transperitoneal adrenalectomy in operation time, pain score, blood loss, hospitalization, complications rates and return to normal activity. However, laparoscopic transperitoneal adrenalectomy is up to now a safe and standardized procedure with a shorter learning curve and a similar low morbidity rate, even for tumors larger than 6 cm. Nevertheless, further studies are needed to objectively evaluate these techniques, excluding selection bias and bias related to differences in surgeons' experiences with this approaches.
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Affiliation(s)
- G Conzo
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - E Tartaglia
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - C Gambardella
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - D Esposito
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - V Sciascia
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - C Mauriello
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - A Nunziata
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - G Siciliano
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - G Izzo
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - F Cavallo
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - G Thomas
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
| | - M Musella
- Advanced Biomedical Sciences Department, AOU "Federico II", Naples, Italy.
| | - L Santini
- Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy.
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Abstract
BACKGROUND The aim of this study was to evaluate the suitability of posterior retroperitoneoscopic adrenalectomy for patients with morbid obesity. METHODS This retrospective clinical cohort study included patients who underwent elective posterior retroperitoneoscopic adrenalectomy. Intraoperative (operative time, blood loss, intraoperative complications, conversion rate) and postoperative (hospital stay, morbidity, mortality) parameters were compared between the two study subgroups: obese (body mass index [BMI] ≥30 kg/m(2)) and non-obese patients (BMI <30 kg/m(2)). RESULTS A total of 137 subsequent patients were enrolled in the study (41 obese and 96 non-obese patients). Mean tumour size was 5.2 ± 2.2 cm; aldosteronism and incidentaloma were the most frequent indications. Operative time was significantly longer (87 vs. 65 min; P = 0.0006) in obese patients. There was no difference in operative blood loss. One conversion was necessary. Overall, the 30-day postoperative morbidity was significantly higher in obese patients (26.8 vs. 11.5 %; P = 0.025). The hospital stay was significantly longer in obese patients (3.1 vs. 2.5 days; P = 0.003). CONCLUSIONS Dorsal retroperitoneoscopic adrenalectomy can be safely performed in morbidly obese patients, maintaining the advantages of minimally invasive surgery. Avoiding an abdominal approach is beneficial for patients. There is a more favourable postoperative course, shorter hospital stay, better cosmetic outcome and quicker recovery with dorsal retroperitoneoscopic adrenalectomy. The prolonged operative time, longer hospital stay and higher risk of postoperative complications that occurred in obese patients were acceptable in light of the generally higher risk associated with surgeries performed in obese patients.
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10
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Abstract
Over the last decade minimally invasive adrenalectomy has become the gold standard in adrenal surgery. Laparoscopic adrenalectomy with the patient in the lateral decubitus position and posterior retroperitoneoscopic adrenalectomy have gained worldwide acceptance. In this overview the complications of minimally invasive adrenalectomy are analyzed based on the published data. Die incidence of intraoperative and postoperative complications ranges from 0 % to 15 % for unilateral adrenalectomy and rises up to 23 % for bilateral surgery. No significant differences were found between laparoscopic and retroperitoneoscopic operations. Nevertheless, splenic injuries and intra-abdominal abscesses are reported only after laparoscopic procedures, while relaxation and/or hypoesthesia of the abdominal wall are typical for posterior retroperitoneoscopic surgery. Conversion to open surgery significantly influences the rate of perioperative and postoperative complications (odds ratio 6.2); therefore, high surgeon and center case volume could improve the results of adrenal surgery.
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Affiliation(s)
- P F Alesina
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland,
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11
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de Fourmestraux A, Salomon L, Abbou CC, Grise P. Ten year experience of retroperitoneal laparoscopic resection for pheochromocytomas: A dual-centre study of 72 cases. World J Urol 2014; 33:1103-7. [PMID: 25208805 DOI: 10.1007/s00345-014-1397-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/29/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of retroperitoneal laparoscopic resection in patients with pheochromocytoma in a retrospective study. METHODS Clinical data of patients with adrenal and extra-adrenal pheochromocytomas, operated on between September 1998 and September 2008 at two institutions, including information on patient demographics, surgical procedure, complications and hospital stay were retrieved. RESULTS Seventy-two retroperitoneal laparoscopic resections were performed (68 patients, 30 males/38 females). Mean age was 51.4 years (15-87 years). Four patients had a bilateral pheochromocytoma. Median BMI was 27 kg/m(2) (interquartile range 23-29). Mean tumour diameter was 4.6 cm (1.3-9). Thirteen patients had a tumour >6 cm. Mean operation time was 110 min (40-210), and median blood loss during surgery was 160 ml (0-1200 ml). Duration of surgery significantly increased with BMI (p = 0.004) and tumour size (p = 0.004). Four patients required conversion to open surgery (two bleeding, one severe adhesion to inferior vena cava and one renal artery aneurysm). Five patients required a blood transfusion with minor postoperative complications in three patients. Major perioperative haemodynamic variations (systolic blood pressure > 180 mmHg, diastolic blood pressure < 70 mmHg) were observed in 54 % of patients, 30 % required postoperative adrenergic drug treatment. The only predictive factor of a perioperative haemodynamic complication was the high level of normetanephrine in the preoperative blood samples. The median postoperative hospital stay was 4.5 days. Blood loss, postoperative complication and postoperative hospital stay did not increase in patients with tumours >6 cm. CONCLUSION Retroperitoneal laparoscopic surgery for pheochromocytoma is reproducible, safe and effective.
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Affiliation(s)
- Aude de Fourmestraux
- Service d'Urologie, Groupe Hospitalier du Havre, Hôpital Jacques Monod, BP 24, 76083, Le Havre, France,
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Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutan Tech 2013; 23:121-7. [PMID: 23579504 DOI: 10.1097/sle.0b013e3182827b57] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The study aims to provide a pooled meta-analysis of existing studies that compare the outcomes of retroperitoneal laparoscopic adrenalectomy with transperitoneal approach for adrenal tumor. METHODS A systematic search of electronic databases was performed and studies were selected based on specific inclusion and exclusion criteria. Data of interest were subjected to meta-analysis using randomized or fixed-effect model to calculate weight mean difference (WMD) or odds ratio (OR). The sensitivity analysis and publication bias test also be conducted. RESULTS Nine observational studies with 632 patients were identified (339 retroperitoneal vs. 293 transperitoneal). Retroperitoneal approach was associated with shorter operative time [WMD=-13.10; 95% confidence interval (CI), -23.83 to -2.36; P=0.02], less intraoperative blood loss (WMD=-40.60; 95% CI, -79.73 to -1.47; P=0.04), shorter duration of hospital stay (WMD=-1.25; 95% CI, -2.36 to -0.14; P=0.03), or time to first ambulation (WMD=-0.38; 95% CI, -0.47 to -0.28; P<0.001). Although the difference between number of convert to open management, time to first oral intake, and major postoperative complication rate was not significant (OR=0.53; 95% CI, 0.17 to 1.60; P=0.26; WMD=-0.31; 95% CI, -1.14 to 0.52; P=0.47; OR=0.41; 95% CI, 0.06 to 1.06; P=0.07). CONCLUSIONS The present evidence demonstrates that retroperitoneal adrenalectomy is better than transperitoneal approach for patients with adrenal tumor in short-term outcomes. However, extended follow-ups and further randomized controlled trials should be required to analysis.
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Huyghe E, Crenn G, Duly-Bouhanick B, Vezzosi D, Bennet A, Atallah F, Mazerolles M, Salloum A, Thoulouzan M, Delaunay B, Grunenwald S, Amar J, Plante P, Chamontin B, Caron P, Soulié M. Retroperitoneoscopic adrenalectomy: comparison of retrograde and antegrade approach among a series of 279 cases. Urology 2013; 81:85-91. [PMID: 23273074 DOI: 10.1016/j.urology.2012.08.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 07/09/2012] [Accepted: 08/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the results of retroperitoneal laparoscopic adrenalectomy using the antegrade and retrograde approach. MATERIALS AND METHODS We performed an analysis of a single-center series of 279 retroperitoneal laparoscopic adrenalectomies from 1996 to 2010. We compared 172 cases performed with an antegrade approach and 107 with a retrograde approach without dissection of the renal hilum and initial control of the adrenal vein in comparable populations. RESULTS The operative time was shorter in the group treated with the retrograde technique, 101±51 vs 140±40 minutes, respectively (Student's t test, P<.001). Blood loss was similar in both groups, 85±224 vs 80±126 mL, respectively (P=NS). Hemodynamic instability was defined as the maximal systolic blood pressure minus the minimal systolic blood pressure divided the maximal systolic blood pressure. It was lower in the group who underwent the retrograde technique (32.7 vs 37.6 mL; Student's t test, P=.005) with a lower perioperative consumption of ephedrine (2.2 vs 5.1 mg, P=.004) and atropine (0.09 vs 0.22 mg, P=.026). No difference was found between the 2 groups in the frequency of perioperative complications or postoperative mortality (1 death in each group of causes unrelated to the surgery). CONCLUSION Retroperitoneal laparoscopic adrenalectomy using a retrograde approach is a safe and reproducible technique. It makes it possible to perform adrenalectomy without dissection of the renal hilum, with a reduction in the operative time. The good hemodynamic stability observed with this technique makes it very attractive for the treatment of pheochromocytoma.
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Affiliation(s)
- Eric Huyghe
- Department of Urology, Toulouse Rangueil University Hospital, Toulouse, France.
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Constantinides VA, Christakis I, Touska P, Palazzo FF. Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg 2012; 99:1639-48. [PMID: 23023976 DOI: 10.1002/bjs.8921] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) has replaced open adrenalectomy as the standard operation for non-malignant adrenal tumours. Retroperitoneoscopic adrenalectomy (RA) is an increasingly popular alternative minimally invasive approach. Advocates of each technique claim its superiority, but the issue has yet to be resolved and conclusions are complicated by the existence of a lateral (LRA) and true posterior (PRA) RA. METHODS A literature search was performed for all comparative studies of RA versus LA. Meta-analysis was performed according to PRISMA guidelines. Odds ratios and standardized mean differences (SMD) were used to compare dichotomous and continuous outcomes respectively. RESULTS Twenty-two studies were included, reporting on 1257 LAs, 471 LRAs and 238 PRAs. Both PRA and LRA were associated with a reduced length of hospital stay: SMD - 1·45 (95 per cent confidence interval - 2·76 to - 0·14) and - 0·54 (-1·04 to - 0·03) days respectively compared with LA. Interstudy heterogeneity was present throughout the comparisons of hospital stay. When considering only the two randomized clinical trials (RCTs) there was no statistically significant difference in this outcome. One RCT, however, found a reduction in the median time to convalescence of 2·4 weeks in the LRA group. There were no differences in duration of operation, blood loss, time to ambulation and oral intake, or complication rates between techniques. CONCLUSION RA overall has equivalent outcomes to LA but may be associated with a shorter hospital stay.
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Affiliation(s)
- V A Constantinides
- Department of Thyroid and Endocrine Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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Miller JA, Kwon DS, Dkeidek A, Yew M, Hisham Abdullah A, Walz MK, Perrier ND. Safe introduction of a new surgical technique: remote telementoring for posterior retroperitoneoscopic adrenalectomy. ANZ J Surg 2012; 82:813-6. [PMID: 23013552 DOI: 10.1111/j.1445-2197.2012.06188.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy (PRA) is a safe and effective approach to adrenalectomy, offering less pain and faster recovery than open or laparoscopic surgery. Although the popularity of PRA is increasing, few surgical centres have extensive experience with the procedure. The ideal approach to achieve proficiency with any new technique involves on-site observation of an experienced surgeon-mentor, followed by mentored hands-on experience of the surgeon-learner. However, it is not always feasible for a surgeon-mentor to offer on-site supervision to the surgeon-learner in his or her home institution. Advances in Internet applications have made remote telementoring a viable alternative to on-site mentoring in selected situations. METHODS We describe our experience in safely introducing PRA to Melbourne, Australia, where no highly experienced surgeon-mentors were available. A surgeon with experience of 12 PRA procedures attended from interstate, along with live telementoring via Skype video link by an overseas surgeon who had performed more than 200 PRA procedures, to mentor the surgeon-learner performing her first three cases. RESULTS The operating surgeon's first three PRA procedures proceeded uneventfully, with no complications, relatively short operative times and one-night hospital stays for all three patients. Twenty-two more have been performed since, without complications. CONCLUSION Remote telementoring is a safe and feasible way to assist surgeons in safely introducing new techniques. This strategy is particularly applicable in centres where no surgeon-mentor is locally available. It is important that the surgeon-learner has the skills and experience to complete the procedure using alternative techniques in the case of complications or technical failure.
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Affiliation(s)
- Julie A Miller
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
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Unilateral subtotal adrenalectomy for pheochromocytoma in multiple endocrine neoplasia type 2 patients: a feasible surgical strategy. Ann Surg 2012; 254:1022-7. [PMID: 22107743 DOI: 10.1097/sla.0b013e318237480c] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the best surgical strategy for pheochromocytoma in multiple endocrine neoplasia type 2 (MEN2) patients. BACKGROUND Pheochromocytomas occur in 50% to 60% of MEN2 patients, approximately half of them eventually develop bilateral disease. Unilateral subtotal adrenalectomy as primary surgery for pheochromocytoma in these patients may avoid or postpone the need for corticosteroid replacement therapy and the risk of Addisonian crisis, but is not yet widely accepted. METHODS We conducted a retrospective cohort study including 61 MEN2 patients with pheochromocytoma who were treated at the University Medical Center Utrecht between 1959 and 2010. Surgery was classified into 4 adrenalectomy groups: bilateral total, unilateral total, bilateral subtotal, and unilateral subtotal. RESULTS Primary surgery involved 22 bilateral total, 30 unilateral total, 2 bilateral subtotal, and 7 unilateral subtotal adrenalectomies. Twenty-one patients developed ipsilateral or contralateral recurrence after a median follow-up of 13.4 ± 10.8 years (range: 0.1-41.8). Unilateral total and unilateral subtotal adrenalectomy had similar rates of recurrence (P = 0.232) and survival time (5.5 versus 8.8 years; P = 0.170). Steroid replacement after bilateral total adrenalectomy led to complications in 8 patients. Reoperations for recurrence included unilateral total adrenalectomy in 12 patients, after which 10 needed steroid replacement (with complications in 3) and unilateral subtotal adrenalectomy in 5 patients, after which none needed replacement therapy. Ipsilateral recurrence after reoperation was similar between these groups. CONCLUSIONS Unilateral subtotal adrenalectomy is a feasible surgical strategy for pheochromocytoma in MEN2 patients. It has comparable recurrence rates and eventually less complications of steroid replacement compared to unilateral total adrenalectomy.
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Abstract
Since the first laparoscopic adrenalectomy, the technique has evolved and it has become the standard of care for many adrenal diseases, including pheochromocytoma. Two laparoscopic accesses to the adrenal have been developed: transperitoneal and retroperitoneal. Retroperitoneoscopic adrenalectomy may be recommended for the treatment of pheochromocytoma with the same peri-operative outcomes of the transperitoneal approach because it allows direct access to the adrenal glands without increasing the operative risks. Although technically more demanding than the transperitoneal approach, retroperitoneoscopy can shorten the mean operative time, which is critical for cases with pheochromocytoma where minimizing the potential for intra-operative hemodynamic changes is essential. Blood loss and the convalescence time can be also shortened by this approach. There is no absolute indication for either the transperitoneal or retroperitoneal approach; however, the latter procedure may be the best option for patients who have undergone previous abdominal surgery and obese patients. Also, retroperitoneoscopic adrenalectomy is a good alternative for treating cases with inherited pheochromocytomas, such as multiple endocrine neoplasia type 2A, in which the pheochromocytoma is highly prevalent and frequently occurs bilaterally.
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Affiliation(s)
- Marcelo Hisano
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Dickson PV, Alex GC, Grubbs EG, Ayala-Ramirez M, Jimenez C, Evans DB, Lee JE, Perrier ND. Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery 2011; 150:452-8. [PMID: 21878230 DOI: 10.1016/j.surg.2011.07.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 07/06/2011] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Laparoscopic adrenalectomy (LA) is a safe minimally invasive approach for treatment of pheochromocytoma (PHEO). Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative minimally invasive technique; however, there is a lack of data regarding the appropriateness of this approach in patients with PHEO. METHODS Our endocrine surgery database was queried to identify patients who underwent LA or PRA for PHEO. Patient and tumor characteristics, as well as operative details and postoperative course were compared between the 2 groups. RESULTS LA or PRA was attempted in 46 patients with PHEO (23 LA, 23 PRA). There were no differences in age, BMI, or tumor size between these groups. PRA was associated with significantly reduced operative times (99 min vs 145 min, P < .001), estimated blood loss (8.4 cc vs 123.8 cc, P = .02), and postoperative length of stay (1.9 nights vs 3.1 nights, P < .01). There was no significant difference in rates of conversion to an open procedure or perioperative complications between these groups. CONCLUSION LA and PRA are both safe and effective approaches in patients with PHEO. In our experience, PRA results in decreased operative times, blood loss, and postoperative length of stay compared with LA. PRA has become our preferred approach for patients with PHEO.
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Affiliation(s)
- Paxton V Dickson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
PURPOSE OF REVIEW To summarize the recent developments in minimally invasive adrenal surgery. RECENT FINDINGS Modern adrenal surgery continues to evolve with new techniques. Both the laparoscopic transabdominal and retroperitoneoscopic approaches are now the standard of care for the removal of nonmalignant adrenal tumors. Other recent developments include robotic retroperitoneal adrenalectomy, single-incision laparoendoscopic surgery, and ambulatory adrenalectomy. SUMMARY Here, we review the literature of minimally invasive adrenal surgery over the last year to highlight new developments and technical refinements.
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Affiliation(s)
- Matthew A Nehs
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2011; 18:231-4. [PMID: 21844704 DOI: 10.1097/med.0b013e3283473d73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dickson PV, Jimenez C, Chisholm GB, Kennamer DL, Ng C, Grubbs EG, Evans DB, Lee JE, Perrier ND. Posterior retroperitoneoscopic adrenalectomy: a contemporary American experience. J Am Coll Surg 2011; 212:659-65; discussion 665-7. [PMID: 21463807 DOI: 10.1016/j.jamcollsurg.2010.12.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Posterior retroperitoneoscopic adrenalectomy (PRA) is an excellent surgical option for adrenal gland removal. The operation requires that surgeons learn a new approach with few similarities to anterior adrenalectomy. This study reports a large series of PRAs incorporated into surgical care using a team-model approach. STUDY DESIGN The prospective endocrine surgery database was queried to identify patients who underwent PRA during a recent 4-year period. Demographic, operative, and pathologic data were recorded. The authors' initial experiences with PRA (group 1) are compared with our contemporary experience (group 2). RESULTS One hundred and eighteen PRAs were successfully performed (100 unilateral and 9 bilateral). Indications were pheochromocytoma in 21 patients, Cushing's syndrome or Cushing's disease in 22 patients, aldosteronoma in 22 patients, virilizing tumor in 3 patients, isolated metastasis in 28 patients, and nonfunctional mass in 19 patients. Forty-eight percent of patients had undergone earlier abdominal surgery. Forty-eight percent were obese (body mass index [calculated as kg/m(2)] ≥30). No significant differences were found in operative time (110 versus 118 minutes, p = 0.30), tumor size (2.59 versus 2.85 cm, p = 0.44), or body mass index (29.63 versus 29.93, p = 0.82) between groups 1 and 2. Both complications (15.9% versus 7.7%, p = 0.29) and conversion rates (9.5% versus 1.9%, p = 0.19) were lower in group 2, although this was not statistically significant. CONCLUSIONS PRA is a technique safely performed for a variety of adrenal lesions, is ideal for patients who have undergone earlier abdominal surgery, and is feasible in obese patients. Proficiency can be obtained during a short period, leading to low conversion and complication rates. This technique should be incorporated into the armamentarium of the endocrine surgeon. A team approach to learning new surgical techniques is effective.
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Affiliation(s)
- Paxton V Dickson
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
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Saffin AP, Thomas JM. Anaesthetic management of laparoscopic assisted bilateral adrenalectomy in a five-year-old child with Cushing's disease. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2011. [DOI: 10.1080/22201173.2011.10872813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - JM Thomas
- Red Cross War Memorial Children's Hospital, University of Cape Town
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