Modified three-level techniques of retroperitoneal laparoscopic procedures to treat adrenal lesions for patients with BMI ≥ 25 Kg/m2

The modified retroperitoneal laparoscopic adrenalectomy overcomes adhesive periadrenal fat and achieves superior outcomes than classical approach: a retrospective study

OBJECTIVES

Mayo adhesive probability (MAP) score affects the outcomes of adrenaletomy. Aimed to determine whether the modified retroperitoneal laparoscopic adrenalectomy (MRLA) overcomes periadrenal fat adhesion compared to Classical retroperitoneal laparoscopic adrenalectomy (CRLA) to achieve better surgical outcomes.

PATIENTS AND METHODS

Patients admitted from January 2016 to December 2022 were retrospectively analyzed and systematically categorized into two distinct cohorts: the MRLA group and the CRLA group, based on specific criteria.The main surgical techniques modified of MRLA is third separation level: between the edge of adrenal gland and the peripheral renal fat. The baseline characteristics and perioperative data, e.g., age, gender, BMI, tumor position, tumor size (cm), MAP score, P distance (cm), perinephric stranding, and periadrenal stranding, estimated blood loss, Operating time, were analyzed, with statistical significance defined as p < 0.05. We analyzed the differences between groups using the t test. For measurement data that didn't follow normal distribution, we described the concentration and dispersion trended using M (Q25, Q75) and analyzed the differences between groups using the M-U test. For data that met certain conditions like being linear, normal and independent, we used linear regression analysis. For binary classification of dependent variables, we used binary logistic regression analysis.

RESULTS

A total of 731 patients underwent adrenaletomy, and 651 patients had adequate data, were available for MAP score assessment. Of these patients, 247 were in the MRLA group, whereas 404 were in the CRLA group, baseline characteristics weren't found to be different between the two groups (p > 0.05). The MRLA group exhibited superior outcomes in terms of operating time, duration, postoperative hospital stay, estimated blood loss, and complications, in comparison to the CRLA group. Further analysis revealed that periadrenal stranding could be the underlying cause for this discrepancy.

CONCLUSIONS

The MRLA effectively overcame the impact of adhesive periadrenal fat (APAF) compared to CRLA. We recommend to employ the MRLA for patients with preoperative CT images indicating periadrenal fat adhesion.

Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study

Objectives

The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m2. This paper aims to summarize our institution's seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm.

Patients and methods

Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang's technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05.

Results

In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05).

Conclusion

MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases.

Patient summary

We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.

The Impact of Obesity on Mortality and Complications in Posterior Retroperitoneoscopic Adrenalectomy

Background Obesity is a global epidemic. It influences surgical technique, ergonomics, safety, and outcomes. However, there is a paucity of evidence of obesity-related impact in posterior retroperitoneoscopic adrenalectomy (PRA). This study compared perioperative outcomes of obese and non-obese participants undergoing PRA. Methodology  This is a multi-center retrospective cohort study of elective PRA from March 2014 to December 2022. Patient demographics, surgical techniques, clinicopathological parameters, and outcomes, including overall complication rate, were analyzed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Results Seventy-five patients underwent a PRA, of which 97.3% were completed retroperitoneoscopically. The overall complication rate was (9.3%), and on subgroup analysis, the obese cohort had a lower percentage complication profile at 6.5%. Male participants comprised 52%, with a median age of 55 (IQR=19). The median BMI was 29.0 (IQR=8), of which 41% were obese, and 40% were overweight. Univariate analysis showed that being obese was not significantly associated with a higher complication rate (p=0.471). In addition, there was no significant increase in conversion (p=0.508), bleeding/transfusion (p=0.508), surgical site infection (SSI; p=1.000), incisional hernia (p=1.000), ICU or high dependency unit admission (p=0.292) and any-cause mortality (p=1.000). No sentinel deaths directly related to PRA were recorded. Procedure duration was longer in obese (117 mins) vs. non-obese participants (88.9 mins, p=0.022). However, there was no significant difference in the length-of-hospital stay (p=0.592). The cohort conversion rate was (2.7%), and tumor size was associated with a higher conversion rate (35.4 vs. 62.5mm, p=0.040). Conclusion Posterior retroperitoneoscopic adrenalectomy can be a safe procedure in obese populations, and obesity does not increase perioperative morbidity or mortality.