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Baylan B, Sarıkaya Y. Is the Mayo adhesive probability score predictive of post-operative Clavien-Dindo complication grade in laparoscopic adrenalectomy? J Minim Access Surg 2025:01413045-990000000-00151. [PMID: 40346974 DOI: 10.4103/jmas.jmas_257_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 04/02/2025] [Indexed: 05/12/2025] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy (LA) continues to be considered the optimum approach to the surgical treatment of small benign adrenal tumours. The present study explores the correlation between the Mayo adhesive probability (MAP) score, derived from computed tomography images and delineating such perinephric fat characteristics as thickness and adhesiveness, and post-operative complications in patients undergoing LA. PATIENTS AND METHODS Data of patients who underwent LA between 2013 and 2023 were subjected to a retrospective analysis, and MAP scores were calculated for all patients. Intraoperative and post-operative surgical outcomes, as well as any complications, were categorised using Modified Clavien-Dindo grading, and the relationship between their MAP scores and outcomes was analysed. RESULTS The mean body mass index, rate of overweight patients, Clavien-Dindo scores of II, III or IV, surgical time, hospitalisation duration, transfusion requirement and post-operative blood loss of the group of patients with MAP scores of 2-3 were significantly higher than those in the group with MAP scores in the 0-1 range (P < 0.05). Each one-point increase in MAP score led to a 2.559-times greater probability of a Clavien-Dindo Grade > I (95% confidence interval: 1.391-4.708, P < 0.05). CONCLUSION A high MAP score is associated with Grade II and higher Clavien-Dindo complications in LA.
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Affiliation(s)
- Burhan Baylan
- Department of Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkiye
| | - Yasin Sarıkaya
- Department of Radiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkiye
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2
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Milluy M, Klein C, Capon G, Bernhard JC, Bladou F, Haissaguerre M, Cremer A, Doublet J, Robert G, Alezra E. Feasibility of outpatient laparoscopic adrenalectomy for primary aldosteronism. THE FRENCH JOURNAL OF UROLOGY 2025; 35:102752. [PMID: 39341461 DOI: 10.1016/j.fjurol.2024.102752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 09/18/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVE Laparoscopic adrenalectomy (LA) has emerged as the gold standard for the management of adrenal diseases. Despite its low complication rate, the utilization of LA in outpatient settings remains limited. This study explored the feasibility of outpatient LA for primary aldosteronism (PA). DESIGN AND METHODS A retrospective analysis was conducted by reviewing the medical records of consecutive LA procedures performed for PA in our department from 2013 to 2021. A successful outpatient procedure was defined as same-day discharge, less than 12hours after admission, with no readmission within 48hours. A postoperative day one (D1) follow-up call by a nurse assessed complications, pain, and patient satisfaction (Numeric Rating Scale [0-10]). Follow-up visits were scheduled at one, three, and six months. RESULTS During the study period, 76 LAs were performed for PA, with 60 (78.9%) being outpatient procedures. Sixteen patients (21.9%) were not selected for outpatient procedures. The main reasons for contraindicating outpatient procedures were anesthetic or social issues. The success rate of the outpatient procedures was 95% (57/60), with no reported surgical complications. Prolonged hospitalization occurred due to medical reasons such as pain or vomiting. There were no readmissions within 48hours after discharge. The mean pain and patient satisfaction, evaluated at D1, were 2.1/10 and 9.4/10, respectively. At 6 months, 32 patients (59.2%) were cured without any antihypertensive drugs, and 15 (27.8%) were improved (reduction of their antihypertensive treatment). CONCLUSION Outpatient LA for PA has demonstrated feasibility with a high success rate, no readmissions, low postoperative pain, and a high level of patient satisfaction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Marie Milluy
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France.
| | - Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Grégoire Capon
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Jean-Christophe Bernhard
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Frank Bladou
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Magali Haissaguerre
- Department of Endocrinology, Bordeaux Haut Levesque University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Antoine Cremer
- Department of Cardiology, Bordeaux Saint-André University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Julien Doublet
- Department of Cardiology, Bordeaux Saint-André University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
| | - Eric Alezra
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France; University of Bordeaux, Bordeaux, France
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Aydın YM, Günseren KÖ, Çiçek MÇ, Aslan ÖF, Gül ÖÖ, Cander S, Yavaşcaoğlu İ. The effect of mass functionality on laparoscopic adrenalectomy outcomes. Langenbecks Arch Surg 2024; 409:212. [PMID: 38985178 DOI: 10.1007/s00423-024-03409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE This study aimed to determine the effect of adrenal mass functionality and different hormone subtypes synthesized by the adrenal masses on laparoscopic adrenalectomy (LA) outcomes. MATERIALS AND METHODS The study included 298 patients, 154 of whom were diagnosed with nonfunctional masses. In the functional group, 33, 62, and 59 patients had Conn syndrome, Cushing's syndrome, and pheochromocytoma, respectively. The variables were analyzed between the functional and nonfunctional groups and then compared among functional masses through subgroup analysis. RESULTS The incidence of diabetes mellitus, hypertension, and obesity, blood loss, and length of hospital stay (LOH) were significantly higher in the functional group than in the nonfunctional group. In the subgroup analysis, patients with pheochromocytoma had significantly lower body mass index but significantly higher mass size, blood loss, and LOH than the other two groups. A positive correlation was found between mass size and blood loss in patients with pheochromocytoma (p ≤ 0.001, r = 0.761). However, no significant difference in complications was found among the groups. CONCLUSIONS In this study, patients with functional adrenal masses had higher comorbidity rates and American Society of Anesthesiologists scores. Moreover, blood loss and LOH were longer on patients with functional adrenal masses who underwent LA. Mass size, blood loss, and LOH in patients with pheochromocytoma were significantly longer than those in patients with other functional adrenal masses. Thus, mass functionality did not increase the complications.
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Affiliation(s)
- Yavuz Mert Aydın
- Department of Urology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey.
| | - Kadir Ömür Günseren
- Department of Urology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey
| | - Mehmet Çağatay Çiçek
- Department of Urology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey
| | - Ömer Faruk Aslan
- Department of Urology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey
| | - Özen Öz Gül
- Department of Endocrinology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey
| | - Soner Cander
- Department of Endocrinology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey
| | - İsmet Yavaşcaoğlu
- Department of Urology, Bursa Uludag University, Gorukle Campus, Bursa, 16059, Turkey
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Kira S, Sawada N, Nakagomi H, Ihara T, Furuya R, Takeda M, Mitsui T. Mayo Adhesive Probability Score Is Associated with the Operative Time in Laparoscopic Adrenalectomy. J Laparoendosc Adv Surg Tech A 2021; 32:595-599. [PMID: 34491848 DOI: 10.1089/lap.2021.0459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Laparoscopic adrenalectomy (LA) is the standard treatment for adrenal benign tumors, including primary aldosteronism (PA) or Cushing's syndrome (CS). Several obesity-related factors were associated with prolonged total operative time (OT), but perinephric fat characteristics were not assessed. We investigated whether the Mayo adhesive probability (MAP) score, which evaluates perinephric fat characteristics, was associated with OT for LA. Methods: This single-center, retrospective cohort study examined 141 consecutive patients who underwent LA for PA or CS. We reviewed patients' characteristics and OT. MAP scores were recorded using preoperative imaging. The correlation among characteristics data, MAP score, and OT was evaluated. Results: Overall, we assessed 82 women and 59 men. Adrenal tumors were found in 80 PA and 61 CS patients. There were 74 left-sided and 67 right-sided tumors. For all patients, the median age, body mass index, and tumor size were 56 years (interquartile range [IQR] 46-65), 24.1 kg/m2 (IQR 21.7-26.8), and 19 mm (IQR 13-26), respectively. A total of 91 patients had MAP scores of 0, and 50 had MAP >0. The median OT was 183.5 minutes (IQR: 156-224 minutes) in the MAP >0 group and 162 minutes (IQR: 135-194 minutes) in the MAP = 0 group. In single variable analysis (unadjusted), MAP scores >0 and left-sided tumors were correlated with longer OT. Multivariable regression analysis revealed that this correlation was only significant for MAP scores >0. Conclusions: MAP score may be useful in preoperative planning for PA or CS patients undergoing LA.
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Affiliation(s)
- Satoru Kira
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Norifumi Sawada
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Hiroshi Nakagomi
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tatsuya Ihara
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Ryouta Furuya
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Masayuki Takeda
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Takahiko Mitsui
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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Laurent E, Klein C, Najah H. Left lateral trans-peritoneal laparoscopic adrenalectomy. J Visc Surg 2021; 158:513-517. [PMID: 33994133 DOI: 10.1016/j.jviscsurg.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- E Laurent
- Department of Digestive and Endocrine Surgery, University hospital of Bordeaux, Haut-Lévêque Hospital, avenue de Magellan, 33604 Pessac cedex, France
| | - C Klein
- Department of Digestive and Endocrine Surgery, University hospital of Bordeaux, Haut-Lévêque Hospital, avenue de Magellan, 33604 Pessac cedex, France
| | - H Najah
- Department of Digestive and Endocrine Surgery, University hospital of Bordeaux, Haut-Lévêque Hospital, avenue de Magellan, 33604 Pessac cedex, France.
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Evolution of adrenal surgery in a tertiary referral centre. Ir J Med Sci 2020; 189:1305-1310. [PMID: 32140992 DOI: 10.1007/s11845-020-02204-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy have largely replaced open adrenal surgery, particularly in benign disease. Laparoscopic surgery results in less post-operative pain, fewer surgical site complications and reduced length of hospital stay. The aim of this retrospective study was to analyse the characteristics of patients and evolution of surgical technique in adrenal surgery at Cork University Hospital over a 12-year period. METHODS All cases of adrenalectomy between January 1st, 2007 and December 31st, 2018 were retrospectively reviewed. Patient demographics, diagnosis, surgical approach, length of hospital stay, histology and complications were evaluated. Comparisons were made between open, laparoscopic transperitoneal and retroperitoneoscopic adrenalectomy cases. RESULTS There were 57 adrenalectomies performed on 55 patients over the 12-year period. Twenty-six patients (46%) were male, and the mean age was 49 years (range 14-84 years). Twenty-two (39%) right-sided adrenalectomies were performed, 33 (57%) left sided and 2 (4%) patients underwent bilateral surgery. Seventeen adrenalectomies were performed using an open transperitoneal approach, 30 via a laparoscopic transperitoneal approach and 10 using the retroperitoneoscopic technique. Adenoma and pheochromocytoma were the most common indications for surgery (42% and 40%, respectively). Seven percent were performed for malignancy and 5% for other benign indications. The complication rate for open adrenalectomy was 18% versus 10% in laparoscopic transperitoneal adrenalectomy and 0% for retroperitoneoscopic adrenalectomy. Two patients (7%) undergoing laparoscopic transperitoneal surgery required conversion to an open procedure. There were no 30-day mortalities and no disease recurrence within the study time frame. The mean length of hospital stay was 7.6 days in the open group, 5.8 days for the laparoscopic transperitoneal group and 3 days for the retroperitoneoscopic group (p = 0.03). CONCLUSIONS Adrenalectomy is a safe procedure and in our setting was primarily performed for pheochromocytoma and non-functioning adenomas. Minimally invasive adrenalectomy has become the standard of care internationally and is associated with fewer complications, shorter hospital stay and a low conversion rate.
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Perivoliotis K, Baloyiannis I, Sarakatsianou C, Tzovaras G. Comparing the efficacy and safety of laparoscopic and robotic adrenalectomy: a meta-analysis and trial sequential analysis. Langenbecks Arch Surg 2020; 405:125-135. [PMID: 32133562 DOI: 10.1007/s00423-020-01860-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE A systematic literature review and a meta-analysis were designed and conducted, in order to provide an up-to-date comparison of the robotic (RA) and laparoscopic (LA) adrenalectomy in terms of perioperative efficacy and safety. METHODS The present meta-analysis was completed in accordance with the guidelines provided by the PRISMA study group and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic scholar databases (Medline, Web of Science, Scopus) were screened. For the reduction of type I errors, a trial sequential analysis (TSA) was performed. RESULTS Overall, 21 studies and 2997 patients were included in this study. RA was associated with a significantly lower open conversion rate (OR: 1.79; 95%CI: 1.10, 2.92) and length of hospitalization (LOS WMD: 0.52; 95%CI: 0.2, 0.84). Marginal results regarding blood loss were recorded (WMD: 2.02; 95%CI: 0.0, 4.03). TSA could not validate the superiority of RA in open conversion rate and blood loss. LA and RA were similar in terms of operative duration (P = 0.18) and positive margin (P = 0.81), complications (P = 0.94) and mortality rate (P = 0.45). CONCLUSIONS Even though RA and LA were equivalent regarding perioperative safety, RA was associated with a favorable LOS.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
| | - Chamaidi Sarakatsianou
- Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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8
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Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing. Surg Endosc 2020; 35:673-683. [PMID: 32072291 DOI: 10.1007/s00464-020-07432-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy is the standard surgical approach to adrenal lesions. Adrenal vessel sealing is the critical surgical phase of laparoscopic adrenalectomy. This study aimed at comparing perioperative outcomes of laparoscopic transperitoneal adrenalectomy by means of radiofrequency energy-based device (LARFD) to those performed with traditional clipping device (LACD), while focusing on the different adrenal vessel control techniques. METHODS Patients who underwent adrenalectomy for adrenal disease between January 1994 and April 2019 at the Surgical Clinic, Polytechnic University of Marche were included in the study. Overall, 414 patients met inclusion criteria for study eligibility: 211 and 203 patients underwent LARFD and LACD, respectively. Multiple models of quantile regression, logistic regression and Poisson finite mixture regression were used to assess the relationship between operative time, conversion to open procedure, length of stay (LoS), surgical procedure and patient characteristics, respectively. RESULTS LARFD reduced operative time of about 12 min compared to LACD. Additional operative time-related factors were surgery side, surgery approach, conversion to open procedure and trocar number. The probability of conversion to open procedure decreased by about 76% for each added trocar, whereas it increased by about 49% for each added centimeter of adrenal lesion and by about 25% for each added year of surgery. Two patient clusters were identified based on the LoS: long-stay and short-stay. In the long-stay cluster, LoS decreased of about 30% in LARFD group and it was significantly associated with conversion to open procedure and postoperative complications, whereas in short-stay cluster only postoperative complications had a significant effect on LoS. CONCLUSION Laparoscopic transperitoneal adrenalectomy performed by means of radiofrequency energy-based device for the sealing of adrenal vessels is an effective procedure reducing operative time with potentially improved postoperative outcomes.
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9
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Mihai R, Donatini G, Vidal O, Brunaud L. Volume-outcome correlation in adrenal surgery-an ESES consensus statement. Langenbecks Arch Surg 2019; 404:795-806. [PMID: 31701230 PMCID: PMC6908553 DOI: 10.1007/s00423-019-01827-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Published data in the last decade showed that a majority of adrenal operations are done by surgeons performing only one such case per year and based on the distribution of personal workloads 'high-volume' surgeons are defined as those doing 4 or more cases/year. PURPOSE This paper summarises literature data identified by a working group established by the European Society of Endocrine Surgeons (ESES). The findings were discussed during ESES-2019 conference and members agreed on a consensus statement. RESULTS The annual of adrenal operations performed yearly in individual countries was reported to be 800/year in UK and over 1600/year in France. The learning curve of an individual surgeon undertaking laparoscopic, retroperitoneoscopic or robotic adrenalectomy is estimated to be 20-40 cases. Preoperative morbidity and length of stay are more favourable in high-volume centres. CONCLUSION The main recommendations are that adrenal surgery should continue only in centres performing at least 6 cases per year, surgery for adrenocortical cancer should be restricted to centres performing at least 12 adrenal operations per year, and an integrated multidisciplinary team should be established in all such centres. Clinical information regarding adrenalectomies should be recorded prospectively and contribution to the established EUROCRINE and ENSAT databases is strongly encouraged. Surgeons wishing to develop expertise in this field should seek mentorship and further training from established adrenal surgeons.
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Affiliation(s)
- Radu Mihai
- Churchill Cancer Centre, Oxford University NHS Hospitals Foundation Trust, Oxford, UK
| | - Gianluca Donatini
- Department of Surgery and INSERM U1082, CHU Poitiers, University of Poitiers, Poitiers, France
| | - Oscar Vidal
- ICMDiM, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Laurent Brunaud
- Department of Surgery and INSERM U954, CHU Nancy (Brabois), Université de Lorraine, Vandoeuvre les Nancy, France
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10
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Gunseren KO, Cicek MC, Vuruskan H, Kordan Y, Yavascaoglu I. Challenging risk factors for right and left laparoscopic adrenalectomy: A single centre experience with 272 cases. Int Braz J Urol 2019; 45:747-753. [PMID: 31136115 PMCID: PMC6837586 DOI: 10.1590/s1677-5538.ibju.2019.0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 03/20/2023] Open
Abstract
Purpose This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes. Materials and Methods A total of 272 patient’s medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups. Results 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the first 20 cases, after this learning period has been completed, there was no significant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant. Conclusions During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.
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Affiliation(s)
- Kadir Omur Gunseren
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
| | - Mehmet Cagatay Cicek
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
| | - Yakup Kordan
- Departmet of Urology, Koc University, School of Medicine, Nilufer, Bursa, Turkey
| | - Ismet Yavascaoglu
- Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey
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Abstract
In the last three decades, endoscopic adrenalectomy has become the gold standard for the surgical treatment of most adrenal diseases. Gagner et al., first reported in 1992, the lateral trans-abdominal laparoscopic approach to adrenalectomy. Afterwards, several retrospective and comparative studies addressed the advantages of minimally invasive adrenalectomy specifically consistent in less postoperative pain, improved patients' satisfaction, shorter hospital stay and recovery time when compared to open adrenalectomy. The lateral transabdominal approach to the adrenals is currently one of the most widely used, since it allows an optimal comprehensive view of the adrenal region and surrounding structures, and provides and adequate working space. On the other hand, from a technical point of view, essential requirements for a successful laparoscopic adrenalectomy are an appropriate knowledge of retroperitoneal anatomy, a gentle tissue manipulation and a precise haemostasis technique in order to identify appropriately the structures of interest and avoid the troublesome 'oozing' that could complicate the surgical procedure.
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Affiliation(s)
- Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Rocco Bellantone
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italy
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12
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Arezzo A, Bullano A, Cochetti G, Cirocchi R, Randolph J, Mearini E, Evangelista A, Ciccone G, Bonjer HJ, Morino M, Cochrane Metabolic and Endocrine Disorders Group. Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults. Cochrane Database Syst Rev 2018; 12:CD011668. [PMID: 30595004 PMCID: PMC6517116 DOI: 10.1002/14651858.cd011668.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy is an accepted treatment worldwide for adrenal gland disease in adults. The transperitoneal approach is more common. The retroperitoneal approach may be preferred, to avoid entering the peritoneum, but no clear advantage has been demonstrated so far. OBJECTIVES To assess the effects of laparoscopic transperitoneal adrenalectomy (LTPA) versus laparoscopic retroperitoneal adrenalectomy (LRPA) for adrenal tumours in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, ICTRP Search Portal, and ClinicalTrials.gov to 3 April 2018. We applied no language restrictions. SELECTION CRITERIA Two review authors independently scanned the abstract, title, or both sections of every record retrieved to identify randomised controlled trials (RCTs) on laparoscopic adrenalectomy for preoperatively assessed adrenal tumours. Participants were affected by corticoid and medullary, benign and malignant, functional and silent tumours or masses of the adrenal gland, which were assessed by both laboratory and imaging studies. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed trials for risk of bias, and evaluated overall study quality using GRADE criteria. We calculated the risk ratio (RR) for dichotomous outcomes, or the mean difference (MD) for continuous variables, and corresponding 95% confidence interval (CI). We primarily used a random-effects model for pooling data. MAIN RESULTS We examined 1069 publications, scrutinized 42 full-text publications or records, and included five RCTs. Altogether, 244 participants entered the five trials; 127 participants were randomised to retroperitoneal adrenalectomy and 117 participants to transperitoneal adrenalectomy. Two trials had a follow-up of nine months, and three trials a follow-up of 31 to 70 months. Most participants were women, and the average age was around 40 years. Three trials reported all-cause mortality; in two trials, there were no deaths, and in one trial with six years of follow-up, four participants died in the LRPA group and one participant in the LTPA group (164 participants; low-certainty evidence). The trials did not report all-cause morbidity. Therefore, we analysed early and late morbidity, and included specific adverse events under these outcome measures. The results were inconclusive between LRPA and LTPA for early morbidity (usually reported within 30 to 60 days after surgery; RR 0.56, 95% CI 0.27 to 1.16; P = 0.12; 5 trials, 244 participants; very low-certainty evidence). Nine out of 127 participants (7.1%) in the LRPA group, compared with 16 out of 117 participants (13.7%) in the LTPA group experienced an adverse event. Participants in the LRPA group may have a lower risk of developing late morbidity (reported as latest available follow-up; RR 0.12, 95% CI 0.01 to 0.92; P = 0.04; 3 trials, 146 participants; very low-quality evidence). None of the 78 participants in the LRPA group, compared with 7 of the 68 participants (10.3%) in the LTPA group experienced an adverse event.None of the trials reported health-related quality of life. The results were inconclusive for socioeconomic effects, assessed as time to return to normal activities and length of hospital stay, between the intervention and comparator groups (very low-certainty evidence). Participants who had LRPA may have had an earlier start on oral fluid or food intake (MD -8.6 hr, 95% CI -13.5 to -3.7; P = 0.0006; 2 trials, 89 participants), and ambulation (MD -5.4 hr, 95% CI -6.8 to -4.0 hr; P < 0.0001; 2 trials, 89 participants) than those in the LTPA groups. Postoperative and operative parameters (duration of surgery, operative blood loss, conversion to open surgery) showed inconclusive results between the intervention and comparator groups. AUTHORS' CONCLUSIONS The body of evidence on laparoscopic retroperitoneal adrenalectomy compared with laparoscopic transperitoneal adrenalectomy is limited. Late morbidity might be reduced following laparoscopic retroperitoneal adrenalectomy, but we are uncertain about this effect because of very low-quality evidence. The effects on other key outcomes, such as all-cause mortality, early morbidity, socioeconomic effects, and operative and postoperative parameters are uncertain. LRPA might show a shorter time to oral fluid or food intake and time to ambulation, but we are uncertain whether this finding can be replicated. New long-term RCTs investigating additional data, such as health-related quality of life, surgeons' level of experience, treatment volume of surgical centres, and details on techniques used are needed.
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Affiliation(s)
- Alberto Arezzo
- University of TorinoDepartment of Surgical SciencesCorso Achille Mario Dogliotti 14TurinItaly10126
| | - Alberto Bullano
- University of TorinoDepartment of Surgical SciencesCorso Achille Mario Dogliotti 14TurinItaly10126
| | - Giovanni Cochetti
- University of PerugiaDepartment of Surgical and Biomedical SciencesSant’Andrea delle FrattePerugiaItaly06100
| | - Roberto Cirocchi
- University of PerugiaDepartment of General SurgeryTerniItaly05100
| | - Justus Randolph
- Mercer UniversityGeorgia Baptist College of Nursing3001 Mercer University Dr.AtlantaGAUSA30341
| | - Ettore Mearini
- University of PerugiaDepartment of Surgical and Biomedical SciencesSant’Andrea delle FrattePerugiaItaly06100
| | - Andrea Evangelista
- Città della Salute e della ScienzaUnit of Cancer EpidemiologyTorinoItaly
| | - Giovannino Ciccone
- Città della Salute e della ScienzaUnit of Cancer EpidemiologyTorinoItaly
| | - H. Jaap Bonjer
- Erasmus Medical CenterDepartment of SurgeryPO Box 2040RotterdamNetherlands3000 CA
| | - Mario Morino
- University of TurinDigestive and Colorectal Surgery, Centre for Minimally Invasive SurgeryCorso Achille Mario Dogliotti 14TurinItaly10126
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Role of indo-cyanine green (ICG) fluorescence in laparoscopic adrenalectomy: a retrospective review of 55 Cases. Surg Endosc 2018; 32:4649-4657. [DOI: 10.1007/s00464-018-6309-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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14
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Evaluation of Open and Minimally Invasive Adrenalectomy: A Systematic Review and Network Meta-analysis. World J Surg 2018. [PMID: 28634842 DOI: 10.1007/s00268-017-4095-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adrenalectomy can be performed via open and various minimally invasive approaches. The aim of this systematic review was to summarize the current evidence on surgical techniques of adrenalectomy. METHODS Systematic literature searches (MEDLINE, EMBASE, Web of Science, Cochrane Library) were conducted to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing at least two surgical procedures for adrenalectomy. Statistical analyses were performed, and meta-analyses were conducted. Furthermore, an indirect comparison of RCTs and a network meta-analysis of CCTs were carried out for each outcome. RESULTS Twenty-six trials (1710 patients) were included. Postoperative complication rates did not show differences for open and minimally invasive techniques. Operation time was significantly shorter for open adrenalectomy than for the robotic approach (p < 0.001). No differences were found between laparoscopic and robotic approaches. Network meta-analysis showed open adrenalectomy to be the fastest technique. Blood loss was significantly reduced in the robotic arm compared with open and laparoscopic adrenalectomy (p = 0.01). Length of hospital stay (LOS) was significantly lower after conventional laparoscopy than open adrenalectomy in CCTs (p < 0.001). Furthermore, both retroperitoneoscopic (p < 0.001) and robotic access (p < 0.001) led to another significant reduction of LOS compared with conventional laparoscopy. This difference was not consistent in RCTs. Network meta-analysis revealed the lowest LOS after retroperitoneoscopic adrenalectomy. CONCLUSION Minimally invasive adrenalectomy is safe and should be preferred over open adrenalectomy due to shorter LOS, lower blood loss, and equivalent complication rates. The retroperitoneoscopic access features the shortest LOS and operating time. Further high-quality RCTs are warranted, especially to compare the posterior retroperitoneoscopic and the transperitoneal robotic approach.
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15
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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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16
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Vorselaars WM, Postma EL, Mirallie E, Thiery J, Lustgarten M, Pasternak JD, Bellantone R, Raffaelli M, Fahey T, Vriens MR, Bresler L, Brunaud L, Zarnegar R. Hemodynamic instability during surgery for pheochromocytoma: comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients. Surgery 2018; 163:176-182. [DOI: 10.1016/j.surg.2017.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/29/2017] [Accepted: 05/26/2017] [Indexed: 10/18/2022]
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Anderson KL, Thomas SM, Adam MA, Pontius LN, Stang MT, Scheri RP, Roman SA, Sosa JA. Each procedure matters: threshold for surgeon volume to minimize complications and decrease cost associated with adrenalectomy. Surgery 2018; 163:157-164. [DOI: 10.1016/j.surg.2017.04.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/22/2017] [Accepted: 04/05/2017] [Indexed: 02/02/2023]
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Alemanno G, Bergamini C, Prosperi P, Valeri A. Adrenalectomy: indications and options for treatment. Updates Surg 2017; 69:119-125. [DOI: 10.1007/s13304-017-0441-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/01/2017] [Indexed: 12/24/2022]
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19
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Singaporewalla RM, Lee DJK, Tan YP. Salvage Technique for Intraoperative Hemorrhage during Laparoscopic Resection of Large Pheochromocytoma: A Case Report and Literature Review. WORLD JOURNAL OF ENDOCRINE SURGERY 2017; 9:27-31. [DOI: 10.5005/jp-journals-10002-1204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
ABSTRACTAimWe described the use of a hand-port assisted laparoscopic adrenalectomy for excising a large 10 cm vascular left adrenal pheochromocytoma. The useful technical tips and important pitfalls to avoid for a successful outcome are discussed in this article.IntroductionA 64-year-old man who was investigated for microalbuminuria was found to have a 10-cm left adrenal mass. Blood investigation and imaging confirmed it to be a pheochromocytoma.Case reportInitial mobilization of the adrenal mass was performed laparoscopically using two 5-mm ports in the epigastric. While dissecting the inferomedial pedicle, the aberrant adrenal vessel was injured and resulted in torrential bleeding. A gelport for hand assistance was inserted as a salvage approach for hemostasis.ConclusionHand-port assisted laparoscopic adrenalectomy is a very practical and easy-to-adopt technique that preserves the minimally invasive surgical advantages in patients with large adrenal masses.Clinical significance: We advocate the use of hand-assisted laparoscopic adrenalectomy technique for complex pheochromocytoma as an alternative for surgeons with vast experience in laparoscopic adrenalectomy.How to cite this articleLee DJK, Tan YP, Singaporewalla RM. Salvage Technique for Intraoperative Hemorrhage during Laparoscopic Resection of Large Pheochromocytoma: A Case Report and Literature Review. World J Endoc Surg 2017;9(1):27-31.
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20
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Abstract
OBJECTIVE Adrenal hemorrhages arise as a result of a number of conditions and may exhibit a variety of appearances on computed tomography (CT). On occasion, patients will undergo adrenalectomy for treatment of a presumptive adrenal neoplasm that on surgical pathology is identified as an adrenal hemorrhage. We evaluated the CT appearance of surgically resected adrenal masses from our institution over a period of 15 years that ultimately proved to be adrenal hematomas. METHODS A surgical pathology archive was queried for all cases of adrenal hemorrhage. Only cases with a corresponding diagnostic CT were included. Cases were excluded if an underlying adrenal mass was present. For the remaining cases, the CT appearances were evaluated by 2 radiologists quantitatively and qualitatively. RESULTS Our search yielded 18 cases of adrenal hemorrhage, of which 5 cases had corresponding CT and no underlying secondary process within the adrenal. All of the adrenal hematomas in this series demonstrated an ovoid morphology and were well defined, with an average maximum diameter of 8.9 cm and highly variable attenuation on noncontrast CT (average attenuation range, 13.1-44.0 Hounsfield units [HU]). Four of the 5 lesions had degrees of peripheral enhancement that was either thin and somewhat uniform or heterogeneous and irregular. None of the lesions demonstrated invasion of the periadrenal fat or adjacent organs. CONCLUSIONS Adrenal hematomas with a mass-like configuration offer a potential diagnostic dilemma for radiologists and surgeons. Although it is rare that an adrenal hemorrhage is surgically resected, awareness of the potential appearances of these lesions is important to spare patients from unnecessarily aggressive surgery.
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21
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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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Paduraru DN, Nica A, Carsote M, Valea A. Adrenalectomy for Cushing's syndrome: do's and don'ts. J Med Life 2016; 9:334-341. [PMID: 27928434 PMCID: PMC5141390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/14/2016] [Indexed: 11/06/2022] Open
Abstract
Aim. To present specific aspects of adrenalectomy for Cushing's syndrome (CS) by introducing well established aspects ("do's") and less known aspects ("don'ts"). Material and Method. This is a narrative review. Results. The "do's" for laparoscopic adrenalectomy (LA) are the following: it represents the "gold standard" for secretor and non-secretor adrenal tumors and the first line therapy for CS with an improvement of cardio-metabolic co-morbidities; the success rate depending on the adequate patients' selection and the surgeon's skills. The "don'ts" are large (>6-8 centimeters), locally invasive, malignant tumors requiring open adrenalectomy (OA). Robotic adrenalectomy is a new alternative for LA, with similar safety and conversion rate and lower pain drugs use. The "don'ts" are the following: lack of randomized controlled studies including oncologic outcome, different availability at surgical centers. Related to the sub-types of CS, the "do's" are the following: adrenal adenomas which are cured by LA, while adrenocortical carcinoma (ACC) requires adrenalectomy as first line therapy and adjuvant mitotane therapy; synchronous bilateral adrenalectomy (SBA) is useful for Cushing's disease (only cases refractory to pituitary targeted therapy), for ectopic Cushing's syndrome (cases with unknown or inoperable primary site), and for bilateral cortisol producing adenomas. The less established aspects are the following: criteria of skilled surgeon to approach ACC; the timing of surgery in subclinical CS; the need for adrenal vein catheterization (which is not available in many centers) to avoid unnecessary SBA. Conclusion. Adrenalectomy for CS is a dynamic domain; LA overstepped the former OA area. The future will improve the knowledge related to RA while the cutting edge is represented by a specific frame of intervention in SCS, children and pregnant women. Abbreviations: ACC = adrenocortical carcinoma, ACTH = Adrenocorticotropic Hormone, CD = Cushing's disease, CS = Cushing's syndrome, ECS = Ectopic Cushing's syndrome, LA = laparoscopic adrenalectomy, OA = open adrenalectomy, PA = partial adrenalectomy, RA = robotic adrenalectomy, SCS = subclinical Cushing' syndrome.
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Affiliation(s)
- D N Paduraru
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Department of Surgery, University Emergency Hospital, Bucharest, Romania
| | - A Nica
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Department of Anesthesiology, University Emergency Hospital, Bucharest, Romania
| | - M Carsote
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; Department of Endocrinology, "C. I. Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - A Valea
- "I. Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania; Department of Endocrinology, Clinical County Hospital, Cluj-Napoca, Romania
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Ball MW, Hemal AK, Allaf ME. International Consultation on Urological Diseases and European Association of Urology International Consultation on Minimally Invasive Surgery in Urology: laparoscopic and robotic adrenalectomy. BJU Int 2016; 119:13-21. [PMID: 27431446 DOI: 10.1111/bju.13592] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to provide an evidence-based systematic review of the use of laparoscopic and robotic adrenalectomy in the treatment of adrenal disease as part of the International Consultation on Urological Diseases and European Association of Urology consultation on Minimally Invasive Surgery in Urology. A systematic literature search (January 2004 to January 2014) was conducted to identify comparative studies assessing the safety and efficacy of minimally invasive adrenal surgery. Subtopics including the role of minimally invasive surgery for pheochromocytoma, adrenocortical carcinoma (ACC) and large adrenal tumours were examined. Additionally, the role of transperitoneal and retroperitoneal approaches, as well as laparoendoscopic single-site (LESS) and robotic adrenalectomy were reviewed. The major findings are presented in an evidence-based fashion. Large retrospective and prospective data were analysed and a set of recommendations provided by the committee was produced. Laparoscopic surgery should be considered the first-line therapy for benign adrenal masses requiring surgical resection and for patients with pheochromocytoma. While a laparoscopic approach may be feasible for selected cases of ACC without adjacent organ involvement, an open surgical approach remains the 'gold standard'. Large adrenal tumours without preoperative or intra-operative suspicion of ACC may be safely resected via a laparoscopic approach. Both transperitoneal and retroperitoneal approaches to laparoscopic adrenalectomy are safe. The approach should be chosen based on surgeon training and experience. LESS and robotic adrenalectomy should be considered as alternatives to laparoscopic adrenalectomy but require further study.
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Affiliation(s)
- Mark W Ball
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mohamad E Allaf
- James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Novitsky YW, Kercher KW, Harrell AG, Heniford BT. Laparoscopic Expertise Increases Hospital Volume of Adrenal Surgery. Surg Innov 2016; 13:109-14. [PMID: 17012151 DOI: 10.1177/1553350606291370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The laparoscopic approach is preferred for most adrenal tumors but technical challenges limit its use. We evaluated the effects of the availability of laparoscopic expertise on the volume of the adrenal surgery at a tertiary care hospital. Patients undergoing adrenalectomy 5 years before and 5 years after an advanced laparoscopic program was established were retrospectively reviewed. The average annual volume increased from 2 cases during the first period to 15 cases during the 5 years (1999-2003) after laparoscopic expertise became available. The average distance of travel to the hospital was significantly greater for the latter patients and significantly more patients were referred from outside of a 30-mile radius. Although the average statewide annual number of adrenalectomies has not significantly changed, the proportion of adrenalectomies performed at our institution rose. Offering a laparoscopic approach has altered physicians’ referral patterns and has significantly increased the volume of adrenal surgery at the institution.
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Affiliation(s)
- Yuri W Novitsky
- Department of Surgery, Division of GI and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
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Sood A, Majumder K, Kachroo N, Sammon JD, Abdollah F, Schmid M, Hsu L, Jeong W, Meyer CP, Hanske J, Kalu R, Menon M, Trinh QD. Adverse Event Rates, Timing of Complications, and the Impact of Specialty on Outcomes Following Adrenal Surgery: An Analysis of 30-Day Outcome Data From the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Urology 2015; 90:62-8. [PMID: 26743396 DOI: 10.1016/j.urology.2015.12.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report on 30-day adverse event rates and timing of complications following adrenal surgery; further, to investigate the impact of specialty (general surgery vs urology) on these outcomes using a large prospective multi-institutional data registry. MATERIALS AND METHODS Within the American College of Surgeons National Surgical Quality Improvement Program (2005-2012), patients undergoing adrenalectomy were identified (CPT-codes: 60540, 60545, 60650). Outcomes evaluated included complications, blood transfusion, length of stay, reintervention, readmission, and mortality. Complications were further evaluated in relation to discharge status (pre-/postdischarge). Multivariable regression models assessed association between specialty and 30-day morbidity/mortality. RESULTS During the study period, 4844 patients underwent adrenalectomy (95.7% general surgery). The overall complication rate was 7.5% (n = 363); 43.2% of the complications occurred postdischarge with a substantial proportion of major complications, including cardiac, pulmonary, renal, neurologic, septic, and deep venous thrombosis/pulmonary embolism also occurring postdischarge (29.9%). The overall blood transfusion, reintervention, readmission, and mortality rates were 3.9%, 2.0%, 6.4%, and 0.6%, respectively. In adjusted analyses, specialty did not have an effect on any of the outcomes (P > .05 all). CONCLUSION One in 13 patients suffers a complication postadrenalectomy. Approximately 40% of these complications occur postdischarge, primarily within the first 2 weeks of surgery. Accurate knowledge regarding 30-day adverse event rates and timing of complications that this study provides may facilitate improved patient-physician communication and encourage early patient follow-up in this critical window. Lastly, specialty does not seem to affect outcomes in American College of Surgeons National Surgical Quality Improvement Program participant hospitals.
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Affiliation(s)
- Akshay Sood
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | | | - Naveen Kachroo
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Jesse D Sammon
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Firas Abdollah
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Marianne Schmid
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Linda Hsu
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Wooju Jeong
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Christian P Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Julian Hanske
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Richard Kalu
- Department of Surgery, Henry Ford Health System, Detroit, MI
| | - Mani Menon
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Ball MW, Allaf ME. Robotic adrenalectomy: the jury is still out. Gland Surg 2015; 4:277-8. [PMID: 26311226 DOI: 10.3978/j.issn.2227-684x.2015.04.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/26/2015] [Indexed: 01/08/2023]
Abstract
A minimally-invasive approach is the gold standard for surgical management of the majority of adrenal masses. While laparoscopy has traditionally been used, robotic adrenalectomy is becoming increasingly utilized. This article discusses a recent systematic review and meta-analysis from European Urology that analyzed evidence comparing laparoscopic and robotic adrenalectomy. Robotic adrenalectomy is associated with lower blood loss, length of stay and fewer complications compared to laparoscopic adrenalectomy; however information on efficacy and cost are not addressed. Ultimately, well-done randomized controlled trials (RCTs) are necessary to determine the benefits and cost of robotics in adrenal surgery.
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Affiliation(s)
- Mark W Ball
- The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
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Effectiveness and safety of laparoscopic adrenalectomy of large pheochromocytoma: a prospective, nonrandomized, controlled study. Am J Surg 2015; 210:230-5. [DOI: 10.1016/j.amjsurg.2014.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/18/2014] [Accepted: 11/23/2014] [Indexed: 01/25/2023]
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Kang T, Gridley A, Richardson WS. Long-term outcomes of laparoscopic adrenalectomy for adrenal masses. J Laparoendosc Adv Surg Tech A 2015; 25:182-186. [PMID: 25654541 DOI: 10.1089/lap.2014.0430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy is the gold standard procedure for most adrenal masses. However, long-term data regarding this procedure are limited. We report our institution's experience with laparoscopic adrenalectomy, determine if this procedure results in durable weight loss and resolves hypertension, diabetes mellitus, or hyperlipidemia, and identify predictors of pathology in nonfunctioning tumors. MATERIALS AND METHODS We retrospectively reviewed laparoscopic adrenalectomies performed for adrenal masses between May 2000 and September 2010 by nine surgeons at a single institution. Data gathered included demographics, body mass index (BMI), preoperative and postoperative imaging and biochemical testing results, length of stay, complications, pathology, medications, and resolution of hypertension, diabetes, or hyperlipidemia. RESULTS We removed 96 adrenal glands in 95 patients. Their average age was 55.6 years. The average length of stay was 1.8 days. Average BMI was 32.9 kg/m(2) preoperatively and 31.9 kg/m(2) postoperatively (P=.46). We experienced no conversions to open procedure and no perioperative mortality. Minor complications occurred at a rate of 1.2%. Indications for adrenalectomy were nonfunctioning tumor (n=35), pheochromocytoma (n=18), aldosteronoma (n=17), subclinical Cushing's syndrome (n=15), Cushing's syndrome (n=9), and sex hormone-secreting tumor (n=1). Hypertension improved or resolved in 63% of patients with Cushing's syndrome, 56% with aldosteronoma, and 47% with pheochromocytoma. When adrenalectomy was performed for nonfunctioning tumors, neoplasia was identified in 22.9% of patients. The most predictive factors for neoplasia were previous history of cancer and abnormal appearance on computed tomography, magnetic resonance imaging, or positron emission tomography scan. CONCLUSIONS Laparoscopic adrenalectomy is a safe procedure with a low complication rate and short hospital stay. Hypertension improves in the majority of patients with Cushing's syndrome and aldosteronoma and just under the majority of those with pheochromocytoma. In our study, abnormal radiologic appearance was a better predictor of neoplasia than size.
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Affiliation(s)
- Thomas Kang
- Department of General Surgery, Ochsner Clinic Foundation , New Orleans, Louisiana
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Sommerey S, Foroghi Y, Chiapponi C, Baumbach SF, Hallfeldt KKJ, Ladurner R, Gallwas JKS. Laparoscopic adrenalectomy—10-year experience at a teaching hospital. Langenbecks Arch Surg 2015; 400:341-7. [DOI: 10.1007/s00423-015-1287-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/08/2015] [Indexed: 02/07/2023]
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30
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Ball MW, Allaf ME. Robot-Assisted Adrenalectomy (Total, Partial, & Metastasectomy). Urol Clin North Am 2014; 41:539-47. [DOI: 10.1016/j.ucl.2014.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Riedinger CB, Tobert CM, Lane BR. Laparoendoscopic single site, laparoscopic or open surgery for adrenal tumors: Selecting the optimal approach. World J Clin Urol 2014; 3:54-65. [DOI: 10.5410/wjcu.v3.i2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/07/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
Numerous surgical modalities are available to treat adrenal lesions. Minimally-invasive approaches for adrenalectomy are indicated in most circumstances, and new evidence continues to be accumulated. In this context, current indications for open surgical adrenalectomy (OS-A), minimally-invasive adrenalectomy (MI-A), and laparoendoscopic single-site adrenalectomy (LESS-A) remain unclear. A comprehensive English-language literature review was performed using MEDLINE/PubMED to identify articles and guidelines pertinent to the surgical management of adrenal tumors. A comprehensive chart review was performed for three illustrative cases. Clinical recommendations were generated based on relevant literature and the expertise of the investigator group. MI-A offers advantages over OS-A in properly selected patients, who experience fewer complications, lower blood loss, and shorter hospital stays. Robot-assisted laparoscopic and retroperitoneoscopic adrenalectomy may offer advantages over transperitoneal surgery, and LESS-A may be an even less-invasive option that will require further evaluation. MI-A remains the surgical treatment of choice for most adrenal lesions. Tumor size and stage are the primary indications for selecting alternative treatment modalities. OS-A remains the gold standard for large tumors (> 10 cm) and suspected or known advanced stage malignancy. LESS-A appears to be an appropriate initial approach for small tumors (< 4-5 cm), including pheochromocytoma and isolated adrenal metastases.
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Agha A, Iesalnieks I, Hornung M, Phillip W, Schreyer A, Jung M, Schlitt HJ. Laparoscopic trans- and retroperitoneal adrenal surgery for large tumors. J Minim Access Surg 2014; 10:57-61. [PMID: 24761076 PMCID: PMC3996732 DOI: 10.4103/0972-9941.129943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 12/26/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Laparoscopic adrenalectomy for tumors larger than 6 cm is currently a matter of controversial discussion because of difficult mobilization from surrounding organs and a possible risk of capsule rupture. MATERIALS AND METHODS Data of consecutive patients undergoing laparoscopic adrenalectomy between 1/1994 and 7/2012 were collected and analysed retrospectively. Intra- and postoperative morbidity in patients with tumors ≤6 cm (group 1, n = 227) were compared to patients with tumors >6 cm, (group 2, n = 52). RESULTS Incidence of adrenocortical carcinoma was significantly higher in group 2 patients (6.3% vs. 0.4%, P = 0.039) whereas the incidence of aldosterone-producing adenoma was lower (2% vs. 25%, P = 0.001). Mean duration of surgery was longer (105 min vs. 88 min, P = 0.03) and the estimated blood loss was higher (470 mL vs. 150 mL) in group 2 patients. Intraoperative bleeding rate (5.7% vs. 0.8%, P = 0.041), and the conversion rate were significantly higher (5.7% vs. 1.3%, P = 0.011) in group 2. Also, postoperative complication rate was significantly higher in group 2 (11.5% vs. 3.0%, P = 0.022). However, only two major complications occurred, one in each group. CONCLUSION Minimally invasive adrenal surgery can be performed by an experienced surgeon even in patients with large tumors (>6 cm) with an increased but still acceptable intra- and postoperative morbidity.
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Affiliation(s)
- Ayman Agha
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Igors Iesalnieks
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany ; Department of Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Matthias Hornung
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Wiggermann Phillip
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Schreyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
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Cyriac J, Weizman D, Urbach DR. Laparoscopic adrenalectomy for the management of benign and malignant adrenal tumors. Expert Rev Med Devices 2014; 3:777-86. [PMID: 17280543 DOI: 10.1586/17434440.3.6.777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland. Many published studies support the use of laparoscopic adrenalectomy, with comparisons to open adrenalectomy suggesting many advantages to laparoscopy, including less postoperative pain, shorter hospital stay and earlier return to work. Adrenalectomy is usually required for the removal of adrenal tumors causing excess hormone production or because a malignant adrenal tumor cannot be excluded. Current controversies include the appropriateness of laparoscopic adrenalectomy for large or malignant tumors, the role of partial adrenalectomy and the management of some conditions with uncertain natural history (such as subclinical hypercortisolism). With the increased use of sensitive cross-sectional imaging, the detection of clinically inapparent adrenal masses is likely to continue to increase. Due to the fact that malignancy cannot be excluded with certainty in some patients with cortical adenomas, it is expected that the rate of laparoscopic adrenalectomy will continue to increase.
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Affiliation(s)
- Jamie Cyriac
- University of Toronto, Toronto, Ontario, Canada.
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34
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Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013; 27:3960-3980. [PMID: 24018761 DOI: 10.1007/s00464-013-3169-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 08/02/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Dimitrios Stefanidis
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, CMC Surgical Specialty Center, Suite 300, 1025 Morehead Medical Plaza, Charlotte, NC, 28204, USA,
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Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project. J Surg Res 2013; 184:216-20. [PMID: 23664532 DOI: 10.1016/j.jss.2013.04.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/30/2013] [Accepted: 04/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data. The objective of our analysis was to compare the 30-d outcomes after laparoscopic versus open adrenalectomy using this data source. METHODS The ACS-NSQIP Participant User Files for 2005-2010 were used for this retrospective analysis, which included all patients with (1) a primary Current Procedural Terminology code for open or laparoscopic adrenalectomy and (2) a postoperative International Classification of Diseases, Ninth Revision (ICD-9) code for adrenal gland pathology. Primary outcomes were 30-d postoperative mortality, overall complication rate, and length of postoperative hospitalization. The association between surgical approach and primary outcomes were determined after adjusting for a comprehensive array of patient- and procedure-related factors. RESULTS A total of 3100 patients were included for analysis (644 undergoing open versus 2456 undergoing laparoscopic adrenalectomy). Patients undergoing a laparoscopic procedure had significantly lower postoperative morbidity and shorter length of stay than patients undergoing an open procedure after adjustment for patient- and procedure-related factors. Similar findings were demonstrated for all indications, including malignancy. CONCLUSIONS To our knowledge, the present study represents the largest comparison to date of laparoscopic versus open adrenalectomy. Our findings suggest that the laparoscopic approach is associated with sizeable reductions in postoperative morbidity and length of postoperative hospitalization.
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Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 2013; 153:111-119. [PMID: 22939744 DOI: 10.1016/j.surg.2012.05.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 05/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomies are being performed increasingly, either with transperitoneal or retroperitoneal approaches. Studies comparing the 2 approaches have not shown the superiority of either technique, but these studies are limited by small sample sizes and single-institution designs. To overcome these limitations, we performed a meta-analysis of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy. METHODS A systematic review of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy was conducted. Study endpoints included perioperative outcomes and measures of postoperative recovery. Meta-analysis was performed using a random effects model, pooling variables evaluated by more than 3 studies. RESULTS Twenty-one studies comparing a total of 1,205 lateral transperitoneal adrenalectomies and 688 retroperitoneal adrenalectomies were suitable for meta-analysis. Patients in the 2 groups were similar in term of age, sex, body mass index, lesion size and location, and rates of malignancy. There were no statistically significant differences between lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy in terms of operative time, blood loss, hospital stay, time to oral intake, overall and major morbidity, and mortality. CONCLUSION Both lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy are associated with very low rates of perioperative complications. According to our meta-analysis, clinical outcomes after either technique are similar. For most adrenal lesions requiring operation, minimally invasive adrenalectomy can be performed safely and effectively with either transperitoneal or the retroperitoneal approach. Additional studies may be needed to analyze if any difference in long-term results exist.
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Affiliation(s)
- Giuseppe Nigri
- Department of Surgery, Sapienza University of Rome, Rome, Italy.
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37
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Abstract
UNLABELLED Laparoscopic adrenalectomy (LA) has become the "gold standard" for treatment of most of adrenal tumors in last few years. It has many benefits comparing to open surgery, but still is considered as complicated procedure requiring experienced surgical team. THE AIM OF THE STUDY was to assess the learning curve of laparoscopic adrenalectomy and the outcome of the first consecutive 154 LA. MATERIAL AND METHODS 154 consecutive patients undergoing LA between 2007 and 2010 were reviewed. Collected data included: patients demographics, clinical and histological diagnosis, side and length of operation, conversions to open surgery, complications and hospitalization time. Learning curve was evaluated by dividing all patients into three groups (group I - first 50 patients, group II - second 50 patients and group III last 54 patients). Differences between the groups were analyzed. RESULTS There were 154 LAs performed. Indications for LA were hormonally inactive adrenal adenoma(n=57), Conn's syndrome (n=30), Cushing's syndrome (n=28), pheochromocytoma (n=27), adrenal cyst (n=8), and others (n=4). Mean tumor size was 45.28 mm. There were 79 left-sided and 75 right-sided procedures and the average time of hospitalization was 4.64 days. Mean operative time was statistically different between the groups (216.2 min. - 164.6 min. - 131.9 min.; p<0.01) as well as the number of conversions to open surgery (18% - 4% - 3.7%; p=0.013). There was not any significant difference in the number of complications between analyzed groups (2% - 2% -3.7%). CONCLUSION To improve the outcome of LA it is necessary to perform approximately 40 to 50 procedures.
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Perioperative Outcomes After Adrenalectomy for Malignant Neoplasm in Laparoscopic Era. Surg Laparosc Endosc Percutan Tech 2012; 22:523-5. [DOI: 10.1097/sle.0b013e3182747b92] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Surgical treatment options for aldosteronomas. Wideochir Inne Tech Maloinwazyjne 2012; 7:260-7. [PMID: 23362425 PMCID: PMC3557732 DOI: 10.5114/wiitm.2011.29898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/03/2012] [Accepted: 05/29/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction Single access retroperitoneoscopic adrenalectomy (SARA) is the most feasible approach for removing aldosteronomas. Aim To analyse the advantages and disadvantages of surgical approaches to treating small adrenal tumours. Material and methods In the period 2002-2011, 31 patients were operated on at Vilnius University Hospital Santariskiu Clinics for aldosteronomas. Adrenalectomies were performed in the lateral laparoscopic (group A, n = 6), the endoscopic retroperitoneal (group B, n = 20), and the single incision laparoscopic surgery (SILS) and SARA (group C, n = 5) approaches. Seventy five percent of patients were operated on by the same surgeon. The duration of adrenalectomies, and intraoperative and postoperative complications were compared. The possibility of minimally invasive adrenalectomies was evaluated. Results According to the patients’ age, body mass index and tumour size, the groups were equal. The average duration of surgery in group A was shorter than in groups B and C (91 ±23 min vs. 118 ±57 min vs. 144 ±88 min). Right laparoscopic adrenalectomy was longer than the left (105 ±26 min vs. 77 ±6 min), whereas right endoscopic retroperitoneal adrenalectomy was shorter than the left (109 ±50 min vs. 126 ±57 min). The best cosmetic view was in group C. The SARA method was converted into the endoscopic retroperitoneal approach and then into the laparoscopic for one patient. There were no intraoperative or postoperative complications. Conclusions Evaluating the minimal invasion of the method, its abilities and simplicity of conversion into another type of endoscopic surgical way, the SARA approach should be the first option for removing aldosteronomas.
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40
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Trends in adrenal surgery: institutional review of 528 consecutive adrenalectomies. Langenbecks Arch Surg 2012; 397:1099-107. [DOI: 10.1007/s00423-012-0973-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 06/06/2012] [Indexed: 01/28/2023]
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Abstract
BACKGROUND Laparoscopic adrenalectomy is considered the treatment of choice in the surgical management of the most majority of the adrenal diseases. Nevertheless, one of the much discussed topics is the dimensional cut-off for the laparoscopic treatment and it is not clear if laparoscopy should be used in large adrenal masses.Introduction. Laparoscopic adrenalectomy is the goal standard in benign adrenal masses smaller than 6 cm, while its advantages in masses larger than this cut-off and in malignant lesions is still discussed. MATERIALS AND METHODS We present six cases of laparoscopic adrenalectomy since November 2008 for masses between 7 and 15 cm; 4 men and 2 women. 3 right and 3 left. A complete adrenal endocrinological evaluation demonstrated that the lesions were not secreting tumors. All patients were studied with CT scan.The technique was performed using a flank approach with a 45° tilt. We used 5 trocars in patients who had the masses on the right side, and 4 in those who had the lesions on the left side. After creating an adequate pneumoperitoneum through an open access, the posterior peritoneum cutting, mobilization of the colon, medial dissection of the adrenal gland, and ligation of the main adrenal vein were performed. The adrenal gland was carefully dissected by Ultracision. The mass was extracted by endobag through an additional subcostal port. The mean operative time was 120 minutes. Blood loss was about 50 cc. The drainage was removed on day 2 after surgery and the patient was discharged on day 3. No postoperative complication occurred. The anatomopathologic exam gave evidence of myelolipoma and hemorrhagic cyst. DISCUSSION The benefits of the laparoscopic approach are widely demonstrated and consist of a shorter hospital stay, reduced morbility, decreased analgesic requirement, and reduced intraoperative blood loss. One of the most discussed topics is the dimensional cut-off and it is not clear if the laparoscopy approach should be used in large adrenal masses (considering the longer operative time and increasing blood loss). Many surgeons performed laparoscopic adrenalectomy for masses of up to 13 cm, thus demonstrating that this procedure is safe and effective. A limitation of laparoscopic approach for adrenal giant masses is the increased risk to treat an adrenal cortical carcinoma. CONCLUSIONS Our experience, supported by the literature, demonstrates that the laparoscopic adrenalectomy is a feasible and effective surgical technique also in the case of giant masses. Preoperative diagnosis has a predominant role to determine the contraindication of this technique (invasive adrenal carcinoma).
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Lafemina J, Brennan MF. Adrenocortical carcinoma: past, present, and future. J Surg Oncol 2012; 106:586-94. [PMID: 22473597 DOI: 10.1002/jso.23112] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 03/08/2012] [Indexed: 12/14/2022]
Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy. Due to its rarity, heterogeneity, and a lack of a comprehensive understanding of the pathogenesis, little progress has been made in treatment and outcomes. The current review explores the past, present, and future of the understanding and treatment of this disease process.
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Affiliation(s)
- Jennifer Lafemina
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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No outcome differences between a laparoscopic and retroperitoneoscopic approach in synchronous bilateral adrenal surgery. World J Surg 2012; 35:2698-702. [PMID: 21976006 DOI: 10.1007/s00268-011-1294-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Two main approaches have been described for endoscopic adrenalectomy: the transperitoneal approach with the patient in the lateral decubitus position (LA) and the retroperitoneal approach with the patient in the prone position (ERA). The goal of the present study was to compare the results of LA and ERA for endoscopic bilateral synchronous adrenalectomy. PATIENTS AND METHODS Between 1994 and 2008, 34 patients underwent bilateral synchronous adrenalectomy in two referral centers: 20 patients underwent LA in Pisa (group A), and 14 patients underwent ERA in Halle (group B). Sex, age, preoperative diagnosis, body mass index, preoperative medical treatments, diameter of glands, blood loss, operative time, complications, conversion, intensive care unit stay, day of first oral intake, length of postoperative recovery, histology report, and outcome were analyzed. RESULTS There were 7 men and 13 women in group A and 6 men and 8 women in group B. Mean age was 48.1 years in group A and 38.9 years in group B. Body mass index was similar in the two groups. Diameters of the glands were larger in group A than in group B, at 61.1 versus 42.8 mm for the right side and 64.1 versus 37.4 mm for the left side. Mean hospital stay was longer in group B (8.2 versus 5.25 days; P = 0.002), whereas the intensive care unit stay was longer in group A (1.44 versus 1 day). CONCLUSIONS It is not possible to determine which of the two approaches is better; both are feasible, safe, and effective and patient outcomes are almost the same.
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Tazi F, Ahsaini M, Khalouk A, Mellas S, Stuurman-Wieringa RE, Elfassi MJ, Farih MH. Giant primary adrenal hydatid cyst presenting with arterial hypertension: a case report and review of the literature. J Med Case Rep 2012; 6:46. [PMID: 22297078 PMCID: PMC3284872 DOI: 10.1186/1752-1947-6-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/01/2012] [Indexed: 12/17/2022] Open
Abstract
Introduction A primary hydatid cyst of the adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in Morocco, where echinococcal disease is endemic. Case presentation We report the case of a 64-year-old Moroccan man who presented with the unusual symptom of arterial hypertension associated with left flank pain. Computed tomography showed a cystic mass of his left adrenal gland with daughter cysts filing the lesion (Type III). Despite his negative serology tests, the diagnosis of a hydatid cyst was confirmed on surgical examination. Our patient underwent surgical excision of his left adrenal gland with normalization of blood pressure. No recurrence has occurred after 36 months of follow-up. Conclusion There are two remarkable characteristics of this case report; the first is the unusual location of the cyst, the second is the association of an adrenal hydatid cyst with arterial hypertension, which has rarely been reported in the literature.
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Affiliation(s)
- Fadl Tazi
- Department of Urology, Hospital University Center Hassan II, 30000 Fez, Morocco.
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45
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Sioka E, Symeonidis D, Chatzinikolaou I, Koukoulis G, Pavlakis D, Zacharoulis D. A giant adrenal cyst difficult to diagnose except by surgery. Int J Surg Case Rep 2011; 2:232-4. [PMID: 22096737 DOI: 10.1016/j.ijscr.2011.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Adrenal cysts represent rare clinical entities. Although surgical indications are well defined, pitfalls arise from the failure to establish an accurate preoperative diagnosis. Cystic lesions of other abdominal organs especially the pancreas complicate the diagnostic field. PRESENTATION OF CASE We present the case of a giant adrenal cyst in a young female causing diagnostic dilemma. Imaging studies revealed a large cystic lesion of uncertain origin located between the spleen and the tail of the pancreas. It was decided to perform a laparotomy which confirmed the presence of an adrenal cyst and enucleation of the cyst was performed. Examination at one year confirmed no complications. DISCUSSION Adrenal cysts should always be included in the differential diagnosis of cystic abdominal lesions. CONCLUSION When the preoperative diagnosis is uncertain, surgical intervention can be both diagnostic and therapeutic.
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Affiliation(s)
- Eleni Sioka
- Department of General Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
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Ramacciato G, Nigri GR, Petrucciani N, Di Santo V, Piccoli M, Buniva P, Valabrega S, D'Angelo F, Aurello P, Mercantini P, Del Gaudio M, Melotti G. Minimally Invasive Adrenalectomy: A Multicenter Comparison of Transperitoneal and Retroperitoneal Approaches. Am Surg 2011. [DOI: 10.1177/000313481107700414] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally invasive adrenalectomy (MIA) is both feasible and safe with either transperitoneal or retroperitoneal entry. However, only a few studies have rigorously compared these two techniques. The aim of the current study is to compare transperitoneal and retroperitoneal adrenalectomy to detect significant differences in patient selection and perioperative outcomes. Between 1995 and 2009, 171 patients underwent MIA through transperitoneal (n = 127) or retroperitoneal access (n = 44). The respective cohorts were then examined retrospectively through matched and unmatched comparisons. Multivariate analyses of intraoperative blood loss, postoperative morbidity, and length of hospital stay were performed. Surgical indications were benign lesions (70.2%), malignant tumors (11.1%), and pheochromocytomas (18.7%). The postoperative morbidity rate was 15.8 per cent, but mortality was null. The rate of conversion to open surgery was 5.3 per cent. Blood loss and operative time were significantly lower with the transperitoneal approach, whereas time to oral intake was shorter for the retroperitoneal group. Tumor size less than 4.5 cm was associated with less blood loss, shorter hospital stay, and lower postoperative morbidity. Laparoscopic and retroperitoneal routes are both effective and safe for excising adrenal lesions. In the present study, however, laparoscopic adrenalectomy demonstrated shorter operative times with less blood loss. Regardless of this, we remain cautious in recommending one procedure preferentially. Other important measures of clinical outcome such as required pain control, ease of patient recovery, and cost considerations were not included in this analysis. Further randomized trials, with large patient numbers, are therefore desirable for defining an optimal surgical method.
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Affiliation(s)
- Giovanni Ramacciato
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Giuseppe R. Nigri
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Niccolò Petrucciani
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | | | - Michaela Piccoli
- Department of General Surgery, Ospedale S. Agostino-Estense, Modena, Italy
| | - Paolo Buniva
- Department of General Surgery, Ospedale S. Agostino-Estense, Modena, Italy
| | - Stefano Valabrega
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Paolo Aurello
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Paolo Mercantini
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Massimo Del Gaudio
- Department of Surgery, St. Andrea Hospital, II School of Medicine, Sapienza University, Rome, Italy
| | - Gianluigi Melotti
- Department of General Surgery, Ospedale S. Agostino-Estense, Modena, Italy
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Abstract
The first laparoscopic adrenalectomy was performed and described by Gagner in 1992. Since then, this technique has become more and more widespread and there is common agreement in the literature that it is the gold standard for adrenalectomy. Laparoscopic adrenalectomy is indicated in benign adrenal masses, and it is routinely performed in masses smaller than 5 to 7 cm. The laparoscopic procedure in masses larger than this cut-off is discussed, although many investigators agree about its feasibility, safety and effectiveness. We present this case: man, 39 years old, large palpable mass in the right hypochondrium. Computed tomography scan (CT) suggested the diagnosis of giant adrenal myelolipoma (15x12x7 cm). Complete adrenal endoclinologic evaluation showed that the lesion was not a secreting tumor. Laparoscopic adrenalectomy was performed with good results.
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Garduno-García JDJ, Reza-Albarrán A, Márquez MAE, Pérez FJG. [Adrenal adenoma as a cause of Cushing's syndrome: twenty years' experience in a referral center in Mexico]. ACTA ACUST UNITED AC 2010; 57:421-5. [PMID: 20863774 DOI: 10.1016/j.endonu.2010.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/02/2010] [Accepted: 06/03/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cushing's syndrome (CS) includes a wide range of clinical and laboratory abnormalities and is the final outcome of chronic glucocorticoid exposure. Adrenal adenomas are an uncommon cause of adult CS. OBJECTIVE To describe the characteristics and outcome of patients with CS caused by adrenal adenomas in a referral center. METHODS We performed a retrospective cross-sectional observational study of patients with a diagnosis of CS caused by adrenal adenomas managed in our center over a 20-year period. Our clinical experience in the diagnosis and treatment of this entity was analyzed. RESULTS There were a total of 20 patients, 19 women and one man. The mean age was 25.9 years (14 to 52). The most frequently recorded clinical data were hirsutism and moon face. The mean morning cortisol level was 26.9±10.7 mcg/dl, the mean afternoon level was 24.4±8.5 mcg/dl and the mean corticotropin (ACTH) concentration was 24±19.4 pg/ml. Only four patients (20%) had ACTH levels below 5 pg/ml. The results of dynamic testing with dexamethasone suggested adrenal adenoma in 100% of the patients. Seventy percent of adenomas were found in the left gland. The mean size of the lesion was 2.8±0.47 cm. CONCLUSIONS In dynamic testing, the criteria of non-suppression with high doses of dexamethasone were evident in almost all patients. ACTH measurement in our center was not reliable in identifying adrenal adenoma as a cause of CS.
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Affiliation(s)
- José de Jesús Garduno-García
- Servicio de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zurbirán, México Distrito Federal, México.
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49
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Outcomes after laparoscopic adrenalectomy. Surg Endosc 2010; 25:784-94. [DOI: 10.1007/s00464-010-1256-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 07/10/2010] [Indexed: 01/08/2023]
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Murphy MM, Witkowski ER, Ng SC, McDade TP, Hill JS, Larkin AC, Whalen GF, Litwin DE, Tseng JF. Trends in adrenalectomy: a recent national review. Surg Endosc 2010; 24:2518-26. [PMID: 20336320 DOI: 10.1007/s00464-010-0996-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 02/26/2010] [Indexed: 12/20/2022]
Abstract
BACKGROUND Adrenalectomy remains the definitive therapy for most adrenal neoplasms. Introduced in the 1990s, laparoscopic adrenalectomy is reported to have lower associated morbidity and mortality. This study aimed to evaluate national adrenalectomy trends, including major postoperative complications and perioperative mortality. METHODS The Nationwide Inpatient Sample was queried to identify all adrenalectomies performed during 1998-2006. Univariate and multivariate logistic regression were performed, with adjustments for patient age, sex, comorbidities, indication, year of surgery, laparoscopy, hospital teaching status, and hospital volume. Annual incidence, major in-hospital postoperative complications, and in-hospital mortality were evaluated. RESULTS Using weighted national estimate, 40,363 patients with a mean age of 54 years were identified. Men made up 40% of these patients, and 77% of the patients were white. The majority of adrenalectomies (83%) were performed for benign disease. The annual volume of adrenalectomies increased from 3,241 in 1998 to 5,323 in 2006 (p < 0.0001, trend analysis). The overall in-hospital mortality was 1.1%, with no significant change. Advanced age (< 45 years as the referent; ≥ 65 years: adjusted odds ratio [AOR], 4.10; 95%; confidence Interval [CI], 1.66-10.10) and patient comorbidities (Charlson score 0 as the referent; Charlson score ≥ 2: AOR, 4.33; 96% CI, 2.34-8.02) were independent predictors of in-hospital mortality. Indication, year, hospital teaching status, and hospital volume did not independently affect perioperative mortality. Major postoperative in-hospital complications occurred in 7.2% of the cohort, with a significant increasing trend (1998-2000 [5.9%] vs 2004-2006 [8.1%]; p < 0.0001, trend analysis). Patient comorbidities (Charlson score 0 as the referent; Charlson score ≥ 2: AOR, 4.77; 95% CI, 3.71-6.14), recent year of surgery (1998-2000 as the referent; 2004-2006: AOR, 1.40; 95% CI, 1.09-1.78), and benign disease (malignant disease as the referent; benign disease: AOR, 1.98; 95% CI, 1.55-2.53) were predictive of major postoperative complications at multivariable analyses, whereas laparoscopy was protective (no laparoscopy as the referent; laparoscopy: AOR, 0.62; 95% CI, 0.47-0.82). CONCLUSION Adrenalectomy is increasingly performed nationwide for both benign and malignant indications. In this study, whereas perioperative mortality remained low, major postoperative complications increased significantly.
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Affiliation(s)
- Melissa M Murphy
- Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, 55 Lake Avenue North, Suite S3-752, Worcester, MA 01655, USA.
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