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Tan Q, Lin F, He Y, Luo S. A comparative study of retroperitoneal laparoscopic adrenalectomy via intra and extra perinephric fat approaches. BMC Urol 2025; 25:72. [PMID: 40175968 PMCID: PMC11966895 DOI: 10.1186/s12894-025-01762-2] [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: 01/14/2024] [Accepted: 03/25/2025] [Indexed: 04/04/2025] Open
Abstract
OBJECTIVE To investigate the safety and effectiveness of retroperitoneal adrenalectomy via extra and intra perinephric fat approaches to provide experience and basis for resection of adrenal tumors through the retroperitoneal cavity. METHODS The clinical data of 284 patients undergoing retroperitoneal adrenalectomy in our hospital from December 2017 to March 2023 were collected. The basic characteristics of the two groups of patients and the changes in perioperative indicators were retrospectively analyzed. RESULTS A total of 117 patients with intra perinephric fat approach (IPFA) were included,and 167 patients with extra perinephric fat approach (EPFA) were included. The estimated blood loss in the IPFA group (123.59 ± 50.76 ml) was higher than that in the EPFA group (99.10 ± 99.51 ml) (p = 0.015),and the operative time in the IPFA group(105.25 ± 42.25 min) was longer than that in the EPFA group(81.75 ± 30.45 min) (p < 0.001).The hospitalization expenses of IPFA patients (36,306.39 ± 7544.25RMB) were higher compared with patients receiving EPFA (32,122.77 ± 7284.00RMB) (p < 0.001).There were no significant differences between the two groups in terms of tumor size,blood transfusion times and postoperative hospitalization time. CONCLUSION Retroperitoneal laparoscopic adrenalectomy is a safe and effective procedure that can be performed via extra and intra perinephric fat approaches.IPFA is associated with higher estimated blood loss, and the operation time of EPFA is shorter than IPFA. The choice of surgical approach may depend primarily on the experience of the surgeon, the characteristics of adrenal tumor, and the nature of perirenal adipose tissue.
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Affiliation(s)
- Qi Tan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road,Yuzhong District, Chongqing, 400016, China
| | - Fan Lin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road,Yuzhong District, Chongqing, 400016, China
| | - Yunfeng He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road,Yuzhong District, Chongqing, 400016, China
| | - Shengjun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road,Yuzhong District, Chongqing, 400016, China.
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Verhoeff K, Parente A, Wang Y, Wang N, Wang Z, Śledziński M, Hellmann A, Raffaelli M, Pennestrì F, Sywak M, Papachristos AJ, Palazzo FF, Sung TY, Kim BC, Lee YM, Eatock F, Anderson H, Iacobone M, Daukša A, Makay O, Turk Y, Atalay HB, van Dijkum EJMN, Engelsman AF, Holscher I, Materazzi G, Rossi L, Becucci C, Shore SL, Fung C, Waghorn A, Mihai R, Balasubramanian SP, Pannu A, Tatarano S, Velázquez-Fernández D, Miller JA, Serrao-Brown H, Chen Y, Demarchi MS, Djafarrian R, Doran H, Wang K, Stechman MJ, Perry H, Hubbard J, Lamas C, Mercer P, MacPherson J, Lumbiganon S, Calatayud M, Hanzu FA, Vidal O, Araujo-Castro M, Ojeda CM, Papavramidis T, de Vera Gómez PR, Aldrees A, Altwjry T, Valdés N, Álvarez-Escola C, García Sanz I, Blanco Carrera C, Manjón-Miguélez L, De Miguel Novoa P, Recasens M, García Centeno R, Robles Lázaro C, Van Den Heede K, Van Slycke S, Michalopoulou T, Aspinall S, Melvin R, Lau JWL, Cheah WK, Tang MH, Oh HB, Ayuk J, Sutcliffe RP. Outcomes for Patients with Obesity Undergoing Adrenalectomy for Pheochromocytoma: An International Multicenter Analysis. Ann Surg Oncol 2025; 32:1709-1720. [PMID: 39633172 DOI: 10.1245/s10434-024-16591-0] [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: 05/28/2024] [Accepted: 11/12/2024] [Indexed: 12/07/2024]
Abstract
OBJECTIVE The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications. PATIENTS AND METHODS Obese (body mass index (BMI) ≥ 30 kg/m2) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI). RESULTS Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m2 was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35). CONCLUSIONS Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings.
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Affiliation(s)
- Kevin Verhoeff
- Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada
| | - Alessandro Parente
- Department of Surgery, Division of General Surgery, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, AB, Canada.
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital, Birmingham, UK.
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
| | - Yanbo Wang
- Department of Urology, The First Affiliated Hospital of Jilin University, Changchun, Jilin, China
| | - Nanya Wang
- Department of Oncology, The First Affiliated Hospital of Jilin University, Changchun, Jilin, China
| | - Zhicheng Wang
- Department of Urology, The First Affiliated Hospital of Jilin University, Changchun, Jilin, China
| | - Maciej Śledziński
- Division of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Andrzej Hellmann
- Division of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pennestrì
- UOC Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Centro di Ricerca in Chirurgia Endocrina e dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mark Sywak
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Alexander J Papachristos
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Fausto F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung-Chang Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Fiona Eatock
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Albertas Daukša
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ozer Makay
- Ozel Saglik Hospital, Centre of Endocrine Surgery, Izmir, Turkiye and School of Medicine, Aristoteleio University of Thessaloniki, Thessaloniki, Greece
| | - Yigit Turk
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Izmir, Türkiye
| | - Hafize Basut Atalay
- Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Izmir, Türkiye
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Anton F Engelsman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Isabelle Holscher
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Leonardo Rossi
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Chiara Becucci
- Endocrine Surgery Unit, University Hospital of Pisa, Pisa, Italy
| | - Susannah L Shore
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Clare Fung
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Alison Waghorn
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Arslan Pannu
- Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Shuichi Tatarano
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - David Velázquez-Fernández
- Servicio de Cirugía Endocrina y Laparoscopia Avanzada, Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Julie A Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Hazel Serrao-Brown
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Yufei Chen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Reza Djafarrian
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Helen Doran
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | - Kelvin Wang
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | | | - Helen Perry
- Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
| | | | - Cristina Lamas
- Endocrinology and Nutrition Department, Hospital Universitario de Albacete, Albacete, Spain
| | - Philippa Mercer
- Endocrine Surgical Unit, Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Janet MacPherson
- Department of Anaesthesia, Christchurch Hospital, Christchurch, New Zealand
| | - Supanut Lumbiganon
- Department of Surgery, Division of Urology, Khon Kaen University, Khon Kaen, Thailand
| | - María Calatayud
- Endocrinology and Nutrition Department, Hospital Universitario, Madrid, Spain
| | | | - Oscar Vidal
- Endocrine Surgery Department, Hospital Clinic University, Barcelona, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Theodosios Papavramidis
- 1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Nuria Valdés
- Department of Endocrinology and Nutrition, Hospital Universitario Cruces, Biobizkaia, Bizkaia CIBERDEM/CIBERER, Endo-ERN, Barakaldo, Spain
| | | | - Iñigo García Sanz
- General and Digestive Surgery Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Laura Manjón-Miguélez
- Endocrinology and Nutrition Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | | | - Mónica Recasens
- Endocrinology and Nutrition Department, Institut Català de la Salut Girona, Girona, Spain
| | - Rogelio García Centeno
- Endocrinology and Nutrition Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Robles Lázaro
- Endocrinology and Nutrition Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Klaas Van Den Heede
- General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Sam Van Slycke
- General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Theodora Michalopoulou
- Department of Endocrinology and Nutrition, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Ross Melvin
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Joel Wen Liang Lau
- Division of Breast and Endocrine Surgery, Department of General Surgery, Ng Teng Fong General Hospital (NTFGH), National University Health System (NUHS), Singapore, Singapore
| | - Wei Keat Cheah
- Division of Breast and Endocrine Surgery, Department of General Surgery, Ng Teng Fong General Hospital (NTFGH), National University Health System (NUHS), Singapore, Singapore
| | - Man Hon Tang
- Division of Breast and Endocrine Surgery, Department of General Surgery, Ng Teng Fong General Hospital (NTFGH), National University Health System (NUHS), Singapore, Singapore
| | - Han Boon Oh
- Division of Breast and Endocrine Surgery, Department of General Surgery, Ng Teng Fong General Hospital (NTFGH), National University Health System (NUHS), Singapore, Singapore
| | - John Ayuk
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary and Liver Transplant Surgery, Queen Elizabeth Hospital, Birmingham, UK
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Passman JE, Wachtel H. Management of Pheochromocytomas and Paragangliomas. Surg Clin North Am 2024; 104:863-881. [PMID: 38944505 DOI: 10.1016/j.suc.2024.02.014] [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] [Indexed: 07/01/2024]
Abstract
Pheochromocytomas and paragangliomas are distinctive neuroendocrine tumors which frequently produce excess catecholamines with resultant cardiovascular morbidity. These tumors have a strong genetic component, with up to 40% linked to hereditary pathogenic variants; therefore, germline genetic testing is recommended for all patients. Surgical resection offers the only potential cure in the case of localized disease. Given the potential for catecholaminergic crises, appropriate perioperative management is crucial, and all patients should undergo alpha-adrenergic blockade before resection. Therapeutic options for metastatic disease are limited and include surgical debulking, radiopharmaceutical therapies, and conventional chemotherapy.
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Affiliation(s)
- Jesse E Passman
- Department of Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 4th Floor, Maloney Building, Philadelphia, PA 19104, USA.
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, 3400 Spruce Street, 4th Floor, Maloney Building, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Özbebit O, Çarkıt S, Karaağaç M, Gök M, Öz B, Doğan S, Öztürk F, Öztürk A, Akcan A. The effect of obesity on the outcomes of laparoscopic adrenal surgery in patients with Cushing syndrome. Ann Surg Treat Res 2024; 107:100-107. [PMID: 39139828 PMCID: PMC11317362 DOI: 10.4174/astr.2024.107.2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose The aim of this study is to investigate the effect of obesity on the results of laparoscopic adrenal surgery in patients with Cushing syndrome. Methods This retrospective study was performed in Department of General Surgery at Erciyes University School of Medicine between January 2010 and January 2023. Our analysis included Cushing syndrome patients who underwent unilateral laparoscopic adrenalectomy (LA) with the transabdominal lateral approach. All patients were evaluated in terms of age, sex, tumor diameter, body mass index (BMI), American Society of Anesthesiologists physical status classification, morbidities, surgery history, tumor side, operative time, conversion to open surgery, complications, and length of hospital stay. Results A total of 90 patients (75 females and 15 males) underwent a transperitoneal LA. Patients were divided into 2 groups according to their BMI: obese group (≥30 kg/m2; n = 53, 58.8%) and nonobese group (<30 kg/m2; n = 37, 41.2%). All patients were classified into 3 subgroups: obese patient group, BMI ≥30-39 kg/m2 (n = 23); morbidly obese patient group, BMI ≥40 kg/m2 (n = 14); and nonobese patient group, BMI <30 kg/m2 (n = 53). There was no significant difference in intraoperative complications, conversion to open surgery, operative time, or length of hospital stay between the groups. Only conversion to open surgery was a risk factor for postoperative complications in univariate and multivariate analyses (odds ratio, 15.4; 95% confidence interval, 1.277-185.599; P = 0.031). Conclusion Our results showed that LA is safe and effective in patients with Cushing syndrome with morbid obesity, allowing acceptable morbidity and length of hospital stay.
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Affiliation(s)
- Orkun Özbebit
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Sedat Çarkıt
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Mustafa Karaağaç
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Mustafa Gök
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Bahadır Öz
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Serap Doğan
- Department of Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Figen Öztürk
- Department of Pathology, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Ahmet Öztürk
- Department of Biostatistics, Erciyes University Faculty of Medicine, Kayseri, Turkiye
| | - Alper Akcan
- Department of General Surgery, Erciyes University Faculty of Medicine, Kayseri, Turkiye
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Saadi A, Mokadem S, Bedoui MA, Zaghbib S, Hermi A, Bellali M, Boussaffa H, Ayed H, Bouzouita A, Allouche M, Chakroun M, Slama RB. A cadaveric anatomical study of the adrenals: vascular relationship. Endocrine 2024; 83:483-487. [PMID: 37932646 DOI: 10.1007/s12020-023-03585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
The adrenal gland is a retroperitoneal organ with intimate relationships with neighboring organs but also with the large retroperitoneal vessels. Our aim was to study the vascular relationships of the adrenal gland with the large abdominal vessels. Our work is an anatomical dissection of 80 fresh cadaveric adrenals. The subjects didn't have a history of retroperitoneal surgery. Dissection conditions were similar to those in the living. All measurements were made in situ. On the right side, the average distance between the adrenal gland and the renal vein (DR) was 13 mm (0-20). In one case, the adrenal gland laid directly on the right renal vein (DR = 0). The average length L, over which the right adrenal gland entered behind the inferior vena cava (IVC), was 8 mm (0-12). In 4 cases, the right adrenal was lateral to the IVC and in 6 cases the length L exceeded 10 mm. On the left side, the mean distance DL, separating the adrenal gland from the left renal vein was 8 mm with extremes ranging from 0 mm to 18 mm. In eleven cases, the adrenal gland laid directly on the left renal vein. The right adrenal gland has a close relationship with the IVC and is often located behind it. This close relationship helps to explain the increased incidence of IVC lesions during surgery. The left adrenal gland has an intimate relationship with the left renal vein and often lies on top of it. This explains the risk of injury to the left renal pedicle during left adrenal surgery.
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Affiliation(s)
- Ahmed Saadi
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Seif Mokadem
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Mohamed Ali Bedoui
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia.
| | - Selim Zaghbib
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Amine Hermi
- University of Tunis El Manar Faculty of Medicine of Tunis, Anatomy department, Tunis, Tunisia
| | - Mohammed Bellali
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of legal and forensic medicine, Tunis, Tunisia
| | - Hamza Boussaffa
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Haroun Ayed
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Abderrazek Bouzouita
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Mohamed Allouche
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Department of legal and forensic medicine, Tunis, Tunisia
| | - Marouene Chakroun
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
| | - Riadh Ben Slama
- University of Tunis El Manar Faculty of Medicine of Tunis, Charles Nicolle Hospital, Urology Department, Tunis, Tunisia
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Fischer A, Schöffski O, Nießen A, Hamm A, Langan EA, Büchler MW, Billmann F. Retroperitoneoscopic adrenalectomy may be superior to laparoscopic transperitoneal adrenalectomy in terms of costs and profit: a retrospective pair-matched cohort analysis. Surg Endosc 2023; 37:8104-8115. [PMID: 37658201 PMCID: PMC10519868 DOI: 10.1007/s00464-023-10395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/13/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND A direct comparison of the cost-benefit analysis of retroperitoneoscopic adrenalectomy (RPA) versus the minimally invasive transperitoneal access (LTA) approach is currently lacking. We hypothesized that RPA is more cost effective than LTA; promising significant savings for the healthcare system in an era of ever more limited resources. METHODS We performed a monocentric retrospective observational cohort study based on data from our Endocrine Surgery Registry. Patients who were operated upon between 2019 and 2022 were included. After pair-matching, both cohorts (RPA vs. LTA) were compared for perioperative variables and treatment costs (process cost calculation), revenue and profit. RESULTS Two homogenous cohorts of 43 patients each (RPA vs. LTA) were identified following matching. Patient characteristics between the cohorts were comparable. In terms of both treatment-associated costs and profit, the RPA procedure was superior to LTA (costs: US$5789.99 for RPA vs. US$6617.75 for LTA, P = 0.043; profit: US$1235.59 for RPA vs. US$653.33 for LTA, P = 0.027). The duration of inpatient treatment and comorbidities significantly influenced the cost of treatment and the overall profit. CONCLUSIONS RPA appears not only to offer benefits over LTA in terms of perioperative morbidity and length of hospital stay, but also has a superior financial cost/benefit profile.
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Affiliation(s)
- Andreas Fischer
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Oliver Schöffski
- Fachbereich Wirtschaftswissenschaften, Lehrstuhl für Gesundheitsmanagement, Friedrich-Alexander-University Erlangen-Nürnberg, Lange Gasse 20, 90403, Nürnberg, Germany
| | - Anna Nießen
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Alexander Hamm
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Ewan A Langan
- Department of Dermatology, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Dermatological Science, University of Manchester, Manchester, UK
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
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Birtwistle L, Leong D, Aniss A, Glover A, Sidhu S, Papachristos A, Sywak M. Minimally invasive adrenalectomy: a cohort study of surgical approach and outcomes. ANZ J Surg 2023; 93:2222-2228. [PMID: 37132079 DOI: 10.1111/ans.18443] [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: 10/31/2022] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND In the context of minimally invasive adrenal surgery, there remains debate about whether the transperitoneal adrenalectomy (TPA) and posterior retroperitoneoscopic adrenalectomy (PRA) approach have equivalent indications. This study aims to examine complication and conversion rates associated with three surgical approaches for adrenal tumours over the last 17 years in a specialized endocrine surgical unit. METHODS All adrenalectomy cases performed in the period 2005-2021 were identified within a prospectively maintained surgical database. A retrospective cohort study was undertaken with patients divided into two cohorts (2005-2013 and 2014-2021). Surgical approach (open adrenalectomy (OA), TPA, PRA), tumour size, histopathology, complication and conversion rates were compared. RESULTS During the study period, 596 patients underwent adrenalectomy with 31 and 40 cases each year per cohort. The dominant surgical approach per cohort significantly changed from TPA (79% versus 17%) to PRA (8% versus 69%, P < 0.001), whilst the frequency of OA remained stable (13% versus 15%). TPA removed larger tumours (3.0 ± 2.9 cm) than PRA (2.8 ± 2.2 cm, P = 0.02), with the median size increasing from 3.0 ± 2.5 to 4.5 ± 3.5 cm per cohort (P < 0.001). The maximum tumour sizes treated by TPA and PRA were 15 and 12 cm, respectively. Adrenocortical adenoma was the commonest pathology treated by either laparoscopic technique. Complication rates were greatest for OA (30.1%) with no significant difference between minimally invasive approaches (TPA 7.3%, PRA 8.3%, P = 0.7). Both laparoscopic techniques had equivalent conversion rates (3.6%). PRA was preferably converted to TPA (2.8%) over OA (0.8%). CONCLUSION This study demonstrates the transition from TPA to PRA, offering similarly low complication and conversion rates.
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Affiliation(s)
- Lucy Birtwistle
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - David Leong
- Endocrine Surgery Unit, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Ahmad Aniss
- Endocrine Surgery Unit, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Anthony Glover
- Endocrine Surgery Unit, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Stan Sidhu
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
- Endocrine Surgery Unit, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Alexander Papachristos
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
- Endocrine Surgery Unit, University of Sydney, Sydney, New South Wales, 2065, Australia
| | - Mark Sywak
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
- Endocrine Surgery Unit, University of Sydney, Sydney, New South Wales, 2065, Australia
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Mills EG, Palazzo FF, Leen E, Wernig F. Emerging Potential of Microwave Ablation for Primary Aldosteronism Resulting From Unilateral Aldosterone-producing Adenoma. JCEM CASE REPORTS 2023; 1:luad077. [PMID: 37908986 PMCID: PMC10580483 DOI: 10.1210/jcemcr/luad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Indexed: 11/02/2023]
Abstract
Primary aldosteronism (PA) is the most prevalent form of secondary hypertension and is most commonly caused by an adrenal adenoma or bilateral adrenal hyperplasia. Minimally invasive adrenalectomy is the treatment of choice for unilateral disease. Here, we report the case of a 57-year-old man with previous bladder cancer who was referred for evaluation of resistant hypertension and hypokalemia. Diagnostic workup indicated PA with computed tomography imaging revealing a left adrenal adenoma and adrenal venous sampling lateralizing to the left adrenal. He was therefore referred for a left adrenalectomy using a retroperitoneoscopic approach. However, surgery was complicated by significant perinephritis related to previous bladder cancer immunotherapy and, in view of an identifiable adrenal adenoma, a partial adrenalectomy was performed. Despite histology confirming removal of an adrenal adenoma, he remained hypertensive and hypokalemic with persistent PA. He underwent a computed tomography-guided percutaneous thermal (microwave) ablation of the residual adrenal nodule with immediate biochemical reversal of PA. Six years postprocedure, he remains biochemically and clinically cured from PA. This article presents the details of the case and reviews the literature on long-term outcomes for patients undergoing thermal ablation and adrenalectomy, suggesting that thermal ablation may be a viable alternative for selected patients.
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Affiliation(s)
- Edouard G Mills
- Section of Investigative Medicine and Endocrinology, Imperial College London, London W12 0NN, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Fausto F Palazzo
- Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Edward Leen
- Imaging Department, Imperial College Healthcare NHS Trust, London W12 0HS, UK
| | - Florian Wernig
- Department of Endocrinology, Imperial College Healthcare NHS Trust, London W12 0HS, UK
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9
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Eichelberger S, Schindera S, Nebiker CA. Prevention of conversion in posterior retroperitoneal adrenalectomy by measuring pre-operative anatomical conditions on cross-sectional imaging (computerised tomography or magnetic resonance imaging). J Minim Access Surg 2023; 19:51-56. [PMID: 36722530 PMCID: PMC10034802 DOI: 10.4103/jmas.jmas_65_22] [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: 02/06/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Abstract
Background In addition to the common laparoscopic lateral transperitoneal adrenalectomy (LTA), the posterior retroperitoneal adrenalectomy (PRA) is becoming increasingly important. Both techniques overlap in their indication, resulting in uncertainty about the preferred approach in some patients. We hypothesise that by determining anatomical characteristics on cross-sectional imaging computerised tomography or magnetic resonance imaging, we can show the limitations of the PRA and prevent patients from being converted to LTA. Methods This retrospective study includes 14 patients who underwent PRA (n = 15) at a single institution between 2016 and 2018. Previously described parameters such as the retroperitoneal fat mass (RPF) were measured on pre-operative imaging. We compared data from one patient who had a conversion with those from 13 patients without conversion. Furthermore, we explored the influence of these parameters on the operative time. Results Conversion to LTA was necessary during 1 PRA procedure. Fourteen PRAs in 13 patients were successfully completed. The mean body mass index was 30 kg/m2 and the mean operation time was 98 min. One patient who underwent a conversion had a substantially higher RPF (25 mm) compared to the patients with successfully completed PRA (median: 5.5 mm [P = 0.001]). Furthermore, the operation time strongly correlated with the RPF (P = 0.004, r = 0.713). Conclusions Surgeons can use pre-operative imaging to assess the anatomical features to determine whether a PRA can be performed. Patients with an RPF under 14.3 mm can be safely treated with PRA. In contrast, LTA access should be considered for patients with a higher RPF (>25 mm).
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10
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Feng Q, Li H, Chen X, Feng X, Li J. Case report: Adrenal myelolipoma resected by laparoscopic surgery. Front Oncol 2022; 12:1058211. [PMID: 36544699 PMCID: PMC9760819 DOI: 10.3389/fonc.2022.1058211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 12/08/2022] Open
Abstract
Introduction Adrenal myelolipomas are benign tumors composed mainly of lipomatous elements with myeloid cells. With the development of medical imaging technology, the detection rate has gradually increased. We report a case of adrenal myelolipoma successfully excised through the laparoscope and reviewed existing literature in recent ten years to summarize the feasibility of the laparoscopic approach for this tumor. Case presentation Herein, we described a case of adrenal myelolipoma resected by laparoscope in a 63-year-old male patient. He did not have any other symptoms except the incidental finding of a left adrenal mass. An abdominal CT examination revealed a mixed-density lesion containing some amount of adipose tissue. In conjunction with the patient's willingness, we performed a laparoscopic operation to remove the lump. The definite diagnosis was confirmed as an adrenal myelolipoma according to the pathology. The patient recovered well postoperatively and without signs of recurrence at a 5-month follow-up. Conclusion Adrenal myelolipoma is commonly benign, asymptomatic, and hormonal inactivity. A surgical strategy is suggested for high-complication-risk patients. The laparoscopic approach is safe and effective with an obvious advantage over open procedures.
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Affiliation(s)
- Qingbo Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hancong Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinyang Chen
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuping Feng
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaxin Li
- Department of Liver Surgery and Liver Transplantation Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Department of General Surgery, Dafang County People’s Hospital, Bijie, Guizhou, China,*Correspondence: Jiaxin Li,
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11
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Zaborowski AM, Prichard RS. Adrenalectomy for metastases. Br J Surg 2022; 109:1030-1031. [PMID: 36076286 DOI: 10.1093/bjs/znac315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Alexandra M Zaborowski
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St Vincent's University Hospital, Dublin, Ireland
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12
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Endo K, Morishima K, Koizumi M, Sasanuma H, Sakuma Y, Lefor AK, Sata N. Lateral retroperitoneal adrenalectomy: Comparison of introduction and education periods of a new surgical procedure in a teaching hospital. A retrospective case series study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Erdemir A, Rasa K. Robotic Adrenalectomy: An Initial Experience in a Turkish Regional Hospital. Front Surg 2022; 9:847472. [PMID: 35846974 PMCID: PMC9277301 DOI: 10.3389/fsurg.2022.847472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDue to the technical advantages and the convenience it provides to surgeons, “robotic adrenalectomy” is a widely used procedure for adrenal surgeries. In this study, we aim to evaluate our robotic adrenalectomy experience and delineate the factors that have a substantial impact on surgical outcomes.MethodsSuccessive 0 transperitoneal robotic operations using the daVinci SI® platform were grouped according to the surgery side, malignant or benign pathologies, for adenoma or non-adenoma lesions, tumor size of less than 4 cm or above, body mass index below or above 30 kg/m2, and with or without laparotomy history. Groups were compared in terms of duration of the operations, amount of bleeding, and the duration of hospitalization.ResultsMorbidity developed in 5 patients (16.6%), and no mortality was observed. We had only one conversion to perform open surgery (3.3%). Operations performed for adenoma significantly last longer when compared with the non-adenoma group (p < 0.05). In the malignant group, the amount of bleeding during surgery was found to be significantly higher (p < 0.05). The blood loss during the surgery was also found to be higher in the adenoma group than in the non-adenoma match (p < 0.05). Phenomenally, operative blood loss was found to be lesser in the bigger tumor size group (>4 cm) than in the smaller size group (p < 0.05).ConclusionOur results corroborate that robotic adrenalectomy may be more challenging for malignant pathologies and adenomas, but we can claim that it is an effective and safe option for all adrenal gland pathologies.
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Saadi A, Mokadem S, Chakroun M, Hermi A, Boussaffa H, Ayed H, Allouche M, Bouzouita A, Derouiche A, Ben Slama MR, Hamdoun M, Chebil M. A cadaveric anatomical study: anatomy and anatomical variations of left adrenal vein. Surg Radiol Anat 2022; 44:689-695. [PMID: 35362770 DOI: 10.1007/s00276-022-02930-x] [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: 11/29/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Control of adrenal vein is the key of adrenal surgery. Its anatomy can present variations. Our aim was to study the anatomy of the main left adrenal vein (LAV) and its anatomical variations. METHODS Our work is based on dissection of 40 cadavers. We studied the number of LAV and the drainage of the main adrenal vein as well as its level of termination. We measured its length, its width and the distance between its termination level and the termination level of the gonadal vein (GV). RESULTS The average length of the LAV was 21 mm its mean width was 5 mm. It ended in 100% of cases at the upper edge of the left renal vein after an anastomosis with the lower phrenic vein in 36 cases (90%) and without anastomosis with the lower phrenic vein in four cases (10%). The left adrenal vein ended at the upper edge of the left renal vein either at the same level as the termination of the left GV in 14 cases (35%) or within the termination of the left GV in 26 cases (65%) by an average of 8 mm. The LAV was unique central vein in 22 cases (55%) and in 12 cases (30%), a major central adrenal vein with several small veins was found. CONCLUSIONS The LAV is usually unique but there are variations in number. There are also variations in the level of its termination in the left renal vein as well as its anastomosis. During surgery, in case of difficulty, the left GV and the adrenal-diaphragmatic venous trunk could be used as benchmarks.
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Affiliation(s)
- Ahmed Saadi
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia.
| | - Seif Mokadem
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Marouene Chakroun
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Hermi
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Hamza Boussaffa
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Haroun Ayed
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Allouche
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Department of Legal and Forensic Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Abderrazak Bouzouita
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Amine Derouiche
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Riadh Ben Slama
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
| | - Moncef Hamdoun
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Department of Legal and Forensic Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Chebil
- Faculty of Medecine Of Tunis, Charles Nicolle Hospital, Urology Department, University of Tunis El Manar, Tunis, Tunisia
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Alberici L, Ingaldi C, Ricci C, Selva S, Di Dalmazi G, Vicennati V, Pagotto U, Casadei R, Minni F. Minimally invasive adrenalectomy: a comprehensive systematic review and network meta-analysis of phase II/III randomized clinical controlled trials. Langenbecks Arch Surg 2022; 407:285-296. [PMID: 35022834 PMCID: PMC8847275 DOI: 10.1007/s00423-022-02431-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/02/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE The best approach for minimally invasive adrenalectomy is still under debate. METHODS A systematic search of randomized clinical trials was carried out. A frequentist random-effects network meta-analysis was made reporting the surface under the cumulative ranking (SUCRA). The primary endpoint regarded both in-hospital mortality and morbidity. The secondary endpoints were operative time (OP), blood loss (BL), length of stay (LOS), conversion, incisional hernia, and disease recurrence rate. RESULTS Eight studies were included, involving 359 patients clustered as follows: 175 (48.7%) in the TPLA arm; 55 (15.3%) in the RPLA arm; 10 (2.8%) in the Ro-TPLA arm; 25 (7%) in the TPAA arm; 20 (5.6%) in the SILS-LA arm; and 74 (20.6%) in the RPA arm. The RPLA had the highest probability of being the safest approach (SUCRA 69.6%), followed by RPA (SUCRA 63.0%). TPAA, Ro-TPLA, SILS-LA, and TPLA have similar probability of being safe (SUCRA values 45.2%, 43.4%, 43.0%, and 38.5%, respectively). Analysis of the secondary endpoints confirmed the superiority of RPA regarding OP, BL, LOS, and incisional hernia rate. CONCLUSIONS The best choice for patients with adrenal masses candidate for minimally invasive surgery seems to be RPA. An alternative could be RPLA. The remaining approaches could have some specific advantages but do not represent the first minimally invasive choice.
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Affiliation(s)
- Laura Alberici
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Carlo Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Claudio Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia.
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.
- Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum-Università Di Bologna, IRCCS, Policlinico S.Orsola-Malpighi, Via Massarenti n.9 40138, Bologna, Italy.
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Valentina Vicennati
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Uberto Pagotto
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
| | - Riccardo Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Minni
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, via Albertoni 15, Bologna, Italia
- Department of Internal Medicine and Surgery, DIMEC) Alma Mater Studiorum, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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16
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Buote NJ. Updates in Laparoscopy. Vet Clin North Am Small Anim Pract 2022; 52:513-529. [DOI: 10.1016/j.cvsm.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Alberici L, Paganini AM, Ricci C, Balla A, Ballarini Z, Ortenzi M, Casole G, Quaresima S, Di Dalmazi G, Ursi P, Alfano MS, Selva S, Casadei R, Ingaldi C, Lezoche G, Guerrieri M, Minni F, Tiberio GAM. Development and validation of a preoperative "difficulty score" for laparoscopic transabdominal adrenalectomy: a multicenter retrospective study. Surg Endosc 2021; 36:3549-3557. [PMID: 34402981 PMCID: PMC9001553 DOI: 10.1007/s00464-021-08678-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
Background A difficulty score for laparoscopic adrenalectomy (LA) is lacking in the literature. A retrospective cohort study was designed to develop a preoperative “difficulty score” for LA. Methods A multicenter study was conducted involving four Italian tertiary centers for adrenal disease. The population was randomly divided into two subsets: training group and validation one. A multicenter study was undertaken, including 964 patients. Patient, adrenal lesion, surgeon’s characteristics, and the type of procedure were studied as potential predictors of target events. The operative time (pOT), conversion rate (cLA), or both were used as indicators of the difficulty in three multivariate models. All models were developed in a training cohort (70% of the sample) and validated using 30% of patients. For all models, the ability to predict complicated postoperative course was reported describing the area under the curve (AUCs). Logistic regression, reporting odds ratio (OR) with p-value, was used. Results In model A, gender (OR 2.04, p = 0.001), BMI (OR 1.07, p = 0.002), previous surgery (OR 1.29, p = 0.048), site (OR 21.8, p < 0.001) and size of the lesion (OR 1.16, p = 0.002), cumulative sum of procedures (OR 0.99, p < 0.001), extended (OR 26.72, p < 0.001) or associated procedures (OR 4.32, p = 0.015) increased the pOT. In model B, ASA (OR 2.86, p = 0.001), lesion size (OR 1.20, p = 0.005), and extended resection (OR 8.85, p = 0.007) increased the cLA risk. Model C had similar results to model A. All scores obtained predicted the target events in validation cohort (OR 1.99, p < 0.001; OR 1.37, p = 0.007; OR 1.70, p < 0.001, score A, B, and C, respectively). The AUCs in predicting complications were 0.740, 0.686, and 0.763 for model A, B, and C, respectively. Conclusion A difficulty score based on both pOT and cLA (Model C) was developed using 70% of the sample. The score was validated using a second cohort. Finally, the score was tested, and its results are able to predict a complicated postoperative course. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08678-6.
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Affiliation(s)
- Laura Alberici
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alessandro M Paganini
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
- Policlinico S.Orsola-Malpighi, Alma Mater Studiorum-Università di Bologna, Via Massarenti n.9, 40138, Bologna, Italy.
| | - Andrea Balla
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Zeno Ballarini
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Monica Ortenzi
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Giovanni Casole
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Silvia Quaresima
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Guido Di Dalmazi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Endocrinology and Diabetes Prevention and Care, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Pietro Ursi
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Marie Sophie Alfano
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
| | - Saverio Selva
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Carlo Ingaldi
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Giovanni Lezoche
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Mario Guerrieri
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Francesco Minni
- Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Division of Pancreatic Surgery, IRCCS, Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Guido Alberto Massimo Tiberio
- Surgical Clinic, Department of Clinical and Experimental Sciences, The University of Brescia at ASST Spedali Civili di Brescia, Brescia, Italy
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Rodríguez-Hermosa JI, Planellas-Giné P, Cornejo L, Gironès J, Recasens M, Ortega FJ, Moreno-Navarrete JM, Latorre J, Fernandez-Real JM, Codina-Cazador A. Comparison of Outcomes between Obese and Nonobese Patients in Laparoscopic Adrenalectomy: A Cohort Study. Dig Surg 2021; 38:237-246. [PMID: 33906192 DOI: 10.1159/000515589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Obesity is usually considered a risk factor for surgical complications. Laparoscopic adrenalectomy has replaced open adrenalectomy as the standard operation for adrenal tumors. OBJECTIVE To compare the safety of laparoscopic adrenalectomy to treat adrenal tumors in obese versus nonobese patients. METHODS This observational cohort study analyzed consecutive patients who underwent laparoscopic adrenalectomy with a lateral transperitoneal approach at a single center (2003-2020). Data and outcomes of obese (body mass index ≥30 kg/m2) and nonobese patients were compared. To analyze the association between operative time and other variables, we used simple and multivariate linear regression. RESULTS N = 160 (90 obese/70 nonobese) patients underwent laparoscopic adrenalectomy. Cushing syndrome and pheochromocytoma were the most frequent indications. Obese patients were older (58 vs. 52 years, p < 0.001). A greater proportion of obese patients were ASA grade III + IV (71.1 vs. 48.6%, p = 0.004). Obesity was associated with a longer operative time (72.5 vs. 60 min, p < 0.001) and greater blood loss (40 vs. 20 mL, p = 0.022). There were no differences in conversion, morbidity, or hospital stay. After adjustment for confounding factors, operative time was positively correlated with BMI ≥30 kg/m2, learning curve, estimated blood loss, 2D laparoscopy, and specimen size. CONCLUSION Lateral transperitoneal laparoscopic adrenalectomy is safe in patients with a BMI 30-35 kg/m2, so these patients also benefit from this minimally invasive surgery.
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Affiliation(s)
- José Ignacio Rodríguez-Hermosa
- Department of Surgery, Department of Medical Sciences, Endocrine and Bariatric Surgery Units, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Pere Planellas-Giné
- Department of Surgery, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Lídia Cornejo
- Department of Surgery, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Jordi Gironès
- Department of Surgery, Department of Medical Sciences, Endocrine and Bariatric Surgery Units, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Mònica Recasens
- Department of Endocrinology, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Francisco José Ortega
- Department of Endocrinology, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - José María Moreno-Navarrete
- Department of Endocrinology, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Jèssica Latorre
- Department of Endocrinology, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - José Manuel Fernandez-Real
- Department of Endocrinology, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
| | - Antoni Codina-Cazador
- Department of Surgery, Department of Medical Sciences, Dr. Josep Trueta University Hospital, Girona Biomedical Research Institute (IDIBGI), Faculty of Medicine, University of Girona, Girona, Spain
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19
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Cancer risk in adrenalectomy: are adrenal lesions equal or more than 4 cm a contraindication for laparoscopy? Surg Endosc 2021; 36:1131-1142. [PMID: 33650006 PMCID: PMC8758647 DOI: 10.1007/s00464-021-08380-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/09/2021] [Indexed: 12/02/2022]
Abstract
Background Some authors consider adrenal lesions size of less than 4 cm as a positive cut-off limit to set the indications for minimally invasive surgery due to a lower risk of malignancy. Aim of this study is to report the risk of cancer for adrenal lesions measuring 4 cm or more in diameter, assessed as benign at preoperative workup (primary outcome), and to evaluate the feasibility and safety of laparoscopic adrenalectomy (LA) in these cases (secondary outcome). Methods From January 1994 to February 2019, 579 patients underwent adrenalectomy. Fifty patients with a preoperative diagnosis of primary adrenal cancer or metastases were excluded. The remaining 529 patients were included and divided in five subgroups based on adrenal lesion size at definitive histology: group A, 4–5.9 cm (137 patients); group B, 6–7.9 cm (64 patients); group C, 8–9.9 cm (13 patients); group D, ≥ 10 cm (11 patients); group E, < 4 cm (304 patients). Each group was further divided based on diagnosis of benign or malignant lesions at definitive histology. Results Four (2.9%) malignant lesions were observed in group A, 5 (7.8%) in group B, 2 (15.4%) in Groups C and D (18.2%) and 13 (4.3%) in Group E. Comparing the cancer risk among the groups, no statistically significant differences were observed. Operative time increased with increasing lesion size. However, no statistically significant differences were observed between benign and malignant lesions in each group comparing operative time, conversion and complication rates, postoperative hospital stay and mortality rate. Conclusions Adrenal lesions measuring 4 cm or more in diameter are not a contraindication for LA neither in terms of cancer risk nor of conversion and morbidity rates, even if the operative time increases with increasing adrenal lesion diameter. Further prospective studies with a larger number of patients are required to draw definitive conclusions.
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20
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Billmann F, Strobel O, Billeter A, Thomusch O, Keck T, Langan EA, Pfeiffer A, Nickel F, Müller-Stich BP. Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis. Surg Endosc 2021; 35:891-899. [PMID: 32095951 PMCID: PMC7819942 DOI: 10.1007/s00464-020-07463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insufflation pressures of or in excess of 25 mm Hg CO2 are routinely used during posterior retroperitoneoscopic adrenalectomy (PRA) in most centres. A critical analysis of the surgical literature provides limited evidence to support this strategy. OBJECTIVE To determine whether high pressure (≥ 25 mm Hg) compared with lower pressure (< 25 mm Hg) retroperitoneoscopy reduces operating time and complications. METHODS A multi-centre retrospective cohort study was performed using data collected over a period of almost one decade (1st November 2008 until 1st February 2018) from surgical centres in Germany. A total of 1032 patients with benign adrenal tumours were identified. We compared patients undergoing PRA with insufflation pressures of < 25 mm Hg (G20 group) versus ≥ 25 mm Hg (G25 group). A propensity score matching analysis was performed using BMI, tumour size and surgeon's experience as independent variables. The main outcomes were (1) the incidence of perioperative complications and (2) the length of operating time. RESULTS The baseline patient characteristics were similar in both groups, with the exception of tumour size, BMI and surgeon's experience in PRA. After propensity score matching, perioperative outcomes, especially perioperative complications (3.7% vs. 5.5% in G20 and G25, respectively; p = 0.335) and operation duration (47 min vs. 45 min in G20 and G25, respectively; p = 0.673), did not significantly differ between the groups. CONCLUSION Neither patient safety nor operative success was compromised when PRA was performed with insufflation pressures below 25 mm Hg. Prospective studies are required to determine whether an optimal insufflation pressure exists that maximizes patient safety and minimizes the risks of post-surgical complications. Nevertheless, our results call for a careful re-evaluation of the routine use of high insufflation pressures during PRA. In the absence of prospective data, commencing PRA with lower insufflation pressures, with the option of increasing insufflation pressures to counter intraoperative bleeding or exposition difficulties, may represent a reasonable strategy.
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Affiliation(s)
- Franck Billmann
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Oliver Strobel
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Adrian Billeter
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Oliver Thomusch
- Department of Surgery, University Hospital of Freiburg Im Breisgau, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany
| | - Tobias Keck
- Department of Surgery, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ewan Andrew Langan
- Department of Dermatology, University Hospital Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Dermatological Science, University of Manchester, Manchester, UK
| | - Aylin Pfeiffer
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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21
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Abstract
Since the introduction of minimally invasive surgery, laparoscopic adrenalectomy has become the main treatment option for adrenal masses. Various studies have reported that laparoscopic adrenalectomy showed fewer postoperative complications and faster recovery than conventional open adrenalectomy. Laparoscopic adrenalectomy can be performed through either the transperitoneal approach or the retroperitoneoscopic approach, which are widely used in most adrenal surgical procedures. Furthermore, with the development of minimally invasive surgery, organ-sparing adrenalectomy has recently emerged as a way to conserve functional adrenal gland tissue. According to recent data, organ-sparing adrenalectomy shows promising surgical, functional, and oncological outcomes including less intraoperative blood loss, maintenance of adrenal function, and low recurrence. Partial adrenalectomy was initially proposed for bilateral adrenal tumors in patients with hereditary disease to avoid chronic adrenal insufficiency. However, it has also gained popularity for the treatment of unilateral adrenal disease involving a small adrenal tumor because even patients with a unilateral adrenal gland may develop adrenal insufficiency in stressful situations. Therefore, partial adrenalectomy has become increasingly common to avoid lifelong steroid replacement and recurrence in most cases, especially in bilateral adrenal disease. This review article evaluates the current evidence on minimally invasive adrenalectomy and organ-preserving partial adrenalectomy.
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Affiliation(s)
- JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
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22
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Saadi A, Mokadem S, Chakroun M, Nouioui MA, Allouche M, Bouzouita A, Derouiche A, Ben Slama MR, Hamdoun M, Ayed H, Chebil M. A cadaveric anatomical study of the adrenals: Relationship with the posterior abdominal wall muscles revisited. Morphologie 2020; 105:210-216. [PMID: 33071051 DOI: 10.1016/j.morpho.2020.09.006] [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: 08/31/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
AIM OF THE STUDY The main difficulties during retroperitoneal laparoscopic adrenalectomies are due to its location. Our objective was to define the relationship of the adrenals with the diaphragm and the psoas muscle. METHODS Our work is an anatomical dissection of 80 fresh cadavers' adrenals. To study the right adrenal, we performed a right nephrectomy and adrenal remained attached to the Inferior vena cava by its main vein. On the left, the edges of the adrenal have been identified by needles and the adrenal was reclined to study its projection on the posterior muscular wall. RESULTS The right adrenal is located higher, 13mm [4-20mm] above the medial arcuate ligament (MAL) in 16 cases (40%). Its lower border was at the same level as the MAL in 18 cases (45%) and 11mm [10-17mm] below the MAL in 6 cases (15%). The posterior support of the right adrenal was the right crus of the diaphragm (Right-CD) in 34 cases (85%) and straddling the Right-CD and the psoas in 6 cases (15%). The study of the relationships of the left adrenal with the MAL showed that the lower edge of the gland was at its same level in 16 cases (40%) and below in 24 cases (60%) by 14mm [8-24mm]. The posterior support of the left adrenal was the left crus of the diaphragm (Left-CD) in 16 cases (40%) and straddling the Left-CD and the psoas in 24 cases (60%). CONCLUSIONS Our results showed that the right adrenal is higher. The MAL is an important posterior element to the adrenal gland that could serve as an anatomical landmark to identify the adrenal during laparoscopic adrenalectomy.
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Affiliation(s)
- A Saadi
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - S Mokadem
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Chakroun
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M A Nouioui
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Allouche
- Department of legal and forensic medicine, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - A Bouzouita
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - A Derouiche
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M R Ben Slama
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Hamdoun
- Department of legal and forensic medicine, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - H Ayed
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
| | - M Chebil
- Department of Urology, Charles Nicolle Hospital of Tunis, University Tunis El Manar Faculty of Medecine of Tunis, Tunis, Tunisia.
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23
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Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated Meta-Analysis. World J Surg 2020; 45:168-179. [PMID: 32856097 DOI: 10.1007/s00268-020-05759-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Two main minimal access adrenalectomy techniques are available: laparoscopic transperitoneal (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA). This study aims to compare these approaches in an updated meta-analysis of randomised controlled (RCT) and non-randomised comparative (NRT) trials. METHODS A systematic search of comparative LTA and PRA studies was performed. Standard demographic and surgical data were recorded. Outcome measures compared included: operative time, estimated blood loss (EBL), conversion to open, post-operative pain, time to oral intake and ambulation, early morbidity, hospital length of stay (HLOS) and mortality. Quality of RCTs and NRTs was assessed using Cochrane and ROBINS-I, respectively, and heterogeneity using the I2 test. Dichotomous and continuous variables were compared using odds ratios and mean/standard difference. Studies were then combined using the Mantel-Haenszel method. Meta-analysis was performed by fixed- and random-effect models. RESULTS Following exclusions, 12 studies were included in the analysis: 3 RCTs and 9 NRTs. These reported a total of 775 patients: 341 (44%) PRA and 434 (56%) LTA. Demographics were similar except for tumour size which was smaller (by 0.78 cm) in PRA (p = 0.003). Significant differences in outcome were seen in EBL (18 mls less in PRA, p = 0.006), time to oral intake (3.4 h sooner in PRA p = 0.009) and HLOS (shorter in PRA by 0.84 day, p = 0.001). CONCLUSIONS This analysis demonstrates that while PRA tends to be performed for smaller tumours it allows for less EBL, earlier post-operative oral intake and shorter hospital stays. In appropriately selected patients, it represents an invaluable tool in the endocrine surgeon's armamentarium.
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Comparison between retroperitoneal and transperitoneal laparoscopic adrenalectomy: Are both equally safe? J Visc Surg 2020; 158:204-210. [PMID: 32773296 DOI: 10.1016/j.jviscsurg.2020.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVES Compare the rates of major intra- and postoperative complications, surgical conversion and mortality between transperitoneal versus retroperitoneal laparoscopic adrenalectomy. PATIENTS AND METHODS In a series of 344 consecutive unilateral laparoscopic adrenalectomies, performed from January 1997 to December 2017, we evaluated the rates of major intra- and postoperative complications (Clavien-Dindo≥III) and surgical conversion of the two approaches. RESULTS The retroperitoneal laparoscopic route was used in 259 patients (67.3%) and the transperitoneal laparoscopic route in 85 patients (22.1%). A total of 12 (3.5%) major postoperative complications occurred, with no statistically significant difference between the two approaches (P=0.7). In univariate analysis, the only predictor of major postoperative complication was Cushing's syndrome (P=0.03). The surgical conversion rate was higher in the transperitoneal route group (10/85 (11.8%) compared to 6/259 (2.3%), P=0.0003) in the retroperitoneal route group. One death occurred in each group. Independent predictors of surgical conversion in multivariate analysis included the transperitoneal laparoscopic approach (OR 1.7, 95% CI 1.3-1.9, P=0.02), advanced age (OR 1.2, 95% CI 1.1-1.6, P=0.04) and large tumor size (OR 1.3, 95% CI 1.1-1.7, P=0.01). CONCLUSION Both transperitoneal and retroperitoneal approaches for laparoscopic adrenalectomy are safe, with an equivalent rate of major complications and mortality. The surgical conversion rate was higher for the transperitoneal route. The retroperitoneal approach should be reserved for small adrenal lesions.
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Pujol R, De Fourmestraux C, Symoens A, Branchereau J, Tessier C. Retroperitoneoscopy in the horse: Anatomical study of the retroperitoneal perirenal space and description of a surgical approach. Equine Vet J 2020; 53:364-372. [PMID: 32473613 DOI: 10.1111/evj.13293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Surgical approaches to the kidneys and perirenal structures are uncommonly performed in horses and several complications have been described with the current procedures. OBJECTIVE To describe the anatomy of the retroperitoneal perirenal space and investigate a retroperitoneal minimally invasive approach to access the kidney and perirenal structures in horses. STUDY DESIGN Descriptive, cadaveric study. METHODS Anatomical description of the retroperitoneal space was performed on three equine cadavers and the surgical approach was developed based on these dissections. Ten cadaveric horses underwent a retroperitoneoscopy. Five horses were placed in a right lateral recumbency position to explore the left retroperitoneal space and five horses were placed in a standing position to explore both left and right sides. Anatomical landmarks, working space and access to the renal hilus and perirenal structures were evaluated. RESULTS Dissections revealed that kidneys are surrounded by a renal fascia which delimits two spaces: a perirenal space between the kidney and the renal fascia, and a pararenal space between the renal fascia and psoas muscles or peritoneum. The retroperitoneoscopic portal was placed at the level of the dorsal aspect of the tuber coxae, 3 cm caudal to the last rib for the left side and 2 cm caudal to the last rib for the right side. Retroperitoneal access and working space were successfully established in all horses. The standing position allowed an easier dissection than lateral recumbency. Division of the perirenal fat allowed access to the kidney and adrenal glands as well as individualisation of renal vessels and ureter in the renal hilus. MAIN LIMITATIONS Study of cadavers precluded appreciation of haemorrhage or use the pulsating vessels as landmarks. CONCLUSIONS This study provides a description of the retroperitoneal perirenal space and describes a new surgical approach to access kidneys and perirenal structures in horses.
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Affiliation(s)
- Raymond Pujol
- Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Claire De Fourmestraux
- Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Antoine Symoens
- Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Nephrologie (ITUN), CHU Nantes, Nantes, France.,CRTI Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, INSERM, Université de Nantes, Nantes, France
| | - Caroline Tessier
- Department of Surgery, Equine Clinic, ONIRIS, National College of Veterinary Medicine, Food Science and Engineering, Nantes, France
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26
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Rossi GP, Bisogni V, Bacca AV, Belfiore A, Cesari M, Concistrè A, Del Pinto R, Fabris B, Fallo F, Fava C, Ferri C, Giacchetti G, Grassi G, Letizia C, Maccario M, Mallamaci F, Maiolino G, Manfellotto D, Minuz P, Monticone S, Morganti A, Muiesan ML, Mulatero P, Negro A, Parati G, Pengo MF, Petramala L, Pizzolo F, Rizzoni D, Rossitto G, Veglio F, Seccia TM. The 2020 Italian Society of Arterial Hypertension (SIIA) practical guidelines for the management of primary aldosteronism. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2020; 5:100029. [PMID: 33447758 PMCID: PMC7803025 DOI: 10.1016/j.ijchy.2020.100029] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Background and aim Considering the amount of novel knowledge generated in the last five years, a team of experienced hypertensionlogists was assembled to furnish updated clinical practice guidelines for the management of primary aldosteronism. Methods To identify the most relevant studies, the authors utilized a systematic literature review in international databases by applying the PICO strategy, and then they were required to make use of only those meeting predefined quality criteria. For studies of diagnostic tests, only those that fulfilled the Standards for Reporting of Diagnostic Accuracy recommendations were considered. Results Each section was jointly prepared by at least two co-authors, who provided Class of Recommendation and Level of Evidence following the American Heart Association methodology. The guidelines were sponsored by the Italian Society of Arterial Hypertension and underwent two rounds of revision, eventually reexamined by an External Committee. They were presented and thoroughly discussed in two face-to-face meetings with all co-authors and then presented on occasion of the 36th Italian Society of Arterial Hypertension meeting in order to gather further feedbacks by all members. The text amended according to these feedbacks was subjected to a further peer review. Conclusions After this process, substantial updated information was generated, which could simplify the diagnosis of primary aldosteronism and assist practicing physicians in optimizing treatment and follow-up of patients with one of the most common curable causes of arterial hypertension.
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Affiliation(s)
- Gian Paolo Rossi
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- Corresponding author. DIMED –Clinica dell’Ipertensione Arteriosa, University Hospital, via Giustiniani, 2; 35126, Padova, Italy.
| | - Valeria Bisogni
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | | | - Anna Belfiore
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Bari, Italy
| | - Maurizio Cesari
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Antonio Concistrè
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Rita Del Pinto
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | - Bruno Fabris
- Department of Medical Sciences, Università degli Studi di Trieste, Cattinara Teaching Hospital, Trieste, Italy
| | - Francesco Fallo
- Department of Medicine, DIMED, Internal Medicine 3, University of Padua, Italy
| | - Cristiano Fava
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Claudio Ferri
- University of L'Aquila, Department of Life, Health and Environmental Sciences, San Salvatore Hospital, L'Aquila, Italy
| | | | | | - Claudio Letizia
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Mauro Maccario
- Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesca Mallamaci
- CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | - Giuseppe Maiolino
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
| | - Dario Manfellotto
- UO Medicina Interna, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Silvia Monticone
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Alberto Morganti
- Centro Fisiologia Clinica e Ipertensione, Ospedale Policlinico, Università Milano, Milan, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Paolo Mulatero
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Aurelio Negro
- Department of Medicine, Center for Hypertension, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Martino F. Pengo
- Department of Medicine and Surgery, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi Petramala
- Department of Translational and Precision Medicine, Unit of Secondary Arterial Hypertension, "Sapienza" University of Rome, Italy
| | - Francesca Pizzolo
- Department of Medicine, University of Verona, Policlinico "G.B. Rossi", Italy
| | - Damiano Rizzoni
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Giacomo Rossitto
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Franco Veglio
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Teresa Maria Seccia
- Clinica dell'Ipertensione Arteriosa, Department of Medicine - DIMED, University of Padua, Italy
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Grozdev K, Khayat N, Shumarova S, Ivanova G, Angelov K, Todorov G. Lateral retroperitoneoscopic adrenalectomy: advantages and drawbacks. Updates Surg 2020; 72:1151-1157. [PMID: 32162272 DOI: 10.1007/s13304-020-00741-6] [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: 04/15/2019] [Accepted: 03/04/2020] [Indexed: 11/25/2022]
Abstract
Lateral retroperitoneoscopic adrenalectomy (LRA) is performed mostly by urologists. It is gaining popularity among general surgeons because of the direct access to the adrenal gland. However, the management of large tumors remains controversial. We report our experience and discuss the advantages and the drawbacks of this approach. Between December 2011 and April 2015, 89 consecutive patients underwent LRA for adrenal tumors. Conversion to open surgery, operative time, blood loss, hospital stay, intra-operative complications, early and late postoperative complications, and mortality were analyzed. The entire group was divided into patients with large tumors (> 5 cm) and patients with small tumors (≤ 5 cm), which were further compared. The conversion rate was 1.1%. The mean operative time was 107.4 ± 27.95 min, the mean blood loss 33.15 ± 25.45 ml. The mean hospital stay was 4.7 ± 2.05 days. Most of the complications were minor. There was zero mortality. Concerning the size of the tumor, we found statistically significant difference in operative time (p = 0.001), hospital stay (p = 0.020), incidence of early postoperative complications (p = 0.049), and conversion rate to open surgery (p = 0.037). LRA is a feasible, effective and safe procedure that offers additional advantages over the standard transabdominal approach because of its direct access to the adrenal gland. However, malignancy, large tumor size, bilateral pathology, and concomitant intra-abdominal pathology may represent a potential setback for this approach.
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Affiliation(s)
- Konstantin Grozdev
- Department of Surgery, Medical University of Sofia, Alexandrovska University Hospital, 1, St. G. Sofiyski Str., 1431, Sofia, Bulgaria.
| | - Nabil Khayat
- Department of Surgery, Medical University of Sofia, Alexandrovska University Hospital, 1, St. G. Sofiyski Str., 1431, Sofia, Bulgaria
| | - Svetlana Shumarova
- Department of Surgery, Medical University of Sofia, Alexandrovska University Hospital, 1, St. G. Sofiyski Str., 1431, Sofia, Bulgaria
| | - Gergana Ivanova
- Department of Anesthesiology and Intensive Care, Medical University of Sofia, Alexandrovska University Hospital, Sofia, Bulgaria
| | - Kostadin Angelov
- Department of Surgery, Medical University of Sofia, Alexandrovska University Hospital, 1, St. G. Sofiyski Str., 1431, Sofia, Bulgaria
| | - Georgi Todorov
- Department of Surgery, Medical University of Sofia, Alexandrovska University Hospital, 1, St. G. Sofiyski Str., 1431, Sofia, Bulgaria
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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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Jiang YL, Qian LJ, Li Z, Wang KE, Zhou XL, Zhou J, Ye CH. Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis. BMC Surg 2020; 20:12. [PMID: 31931809 PMCID: PMC6958587 DOI: 10.1186/s12893-020-0676-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 01/06/2020] [Indexed: 01/12/2023] Open
Abstract
Background To compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma. Methods We searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data. Results Four retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups. Conclusion Retroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.
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Affiliation(s)
- Yu-Li Jiang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Lu-Jie Qian
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.,School of Medicine, Hang Zhou Normal University, Hangzhou, 310016, China
| | - Zhen Li
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Kang-Er Wang
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Xie-Lai Zhou
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Jin Zhou
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China
| | - Chun-Hua Ye
- Department of Urology, The Affiliated Hospital of Hang Zhou Normal University, Hangzhou, 310015, China.
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Marrero AP, Kazaure HS, Thomas SM, Stang MT, Scheri RP. Patient selection and outcomes of laparoscopic transabdominal versus posterior retroperitoneal adrenalectomy among surgeons in the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP). Surgery 2020; 167:250-256. [DOI: 10.1016/j.surg.2019.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
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Adapa S, Konala VM, Naramala S, Dhingra H, Tower SW, Sahasranam P, Zhou F, Omololu O, Gavini F, Martin RR. Hyperaldosteronism from a large adrenal adenoma in a patient with bilateral adrenal nodules. Clin Case Rep 2020; 8:55-60. [PMID: 31998486 PMCID: PMC6982498 DOI: 10.1002/ccr3.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/25/2019] [Accepted: 10/05/2019] [Indexed: 11/09/2022] Open
Abstract
Primary aldosteronism (PA) is a potentially reversible cause of uncontrolled hypertension. Early diagnosis and timely management of PA can prevent end-organ damage. Aldosteronoma Resolution Score (ARS) is a useful tool to predict cure rates and resolution of hypertension after adrenalectomy.
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Affiliation(s)
| | | | | | | | | | | | - Fan Zhou
- Saint Agnes Medical Center Fresno CA USA
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Effect of preoperative computed tomography parameters and obesity on surgical outcomes of laparoendoscopic single-site adrenalectomy. Surg Endosc 2019; 34:4781-4787. [PMID: 31792689 DOI: 10.1007/s00464-019-07254-3] [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: 05/10/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aims of the present study were to (1) analyse preoperative computed tomography (CT) parameters, (2) investigate whether obesity and CT parameters affect surgical outcomes in patients undergoing LESS lateral retroperitoneal adrenalectomy, and (3) further establish the optimal cutoff point of CT parameters for tolerable operating time. METHODS Between January 2010 and August 2016, patients who underwent LESS adrenalectomy through the retroperitoneal approach in our hospitals were included. Patients' demographic data, preoperatively measured CT parameters (the depth and horizontal width to the adrenal gland in the axial view of abdominal CT, the vertical height in the coronal view of CT, and the angle of the depth and horizontal width), and intraoperative (operative time and blood loss) and postoperative (hospital stay and complications) parameters were retrospectively reviewed. Linear regression was performed to determine factors that potentially affect surgical outcomes. RESULTS In 116 patients, depth was the only CT parameter associated with surgical outcomes. Large depth (P = 0.005; 95% CI 1.739-9.256) and high BMI (P = 0.012; 95% CI 0.357-2.851) were factors significantly associated with longer operative time. The area under the ROC curve for the depth was 0.69 (P = 0.002), and the cutoff point 10.48 cm may be the tolerable operating time. CONCLUSIONS Our results suggest a depth limit of 10.48 cm for the optimal prediction of operating time less than 90 min; although obese patients and deeper adrenal glands had longer operative time, LESS adrenalectomy could be performed in the obese patients without increased blood loss, prolonged hospital stay, or increased pain.
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Son H, Ko J, Jeong J, Lee S, Sihn D, Kweon OK, Kim WH. Cardiopulmonary changes induced by retroperitoneal insufflation in healthy dogs in sternal recumbency with the abdomen unsupported. J Vet Med Sci 2019; 82:94-100. [PMID: 31801923 PMCID: PMC6983665 DOI: 10.1292/jvms.19-0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study assessed the effects of retroperitoneal carbon dioxide (CO2) insufflation on cardiopulmonary variables and intra-abdominal pressure (IAP) in mechanically ventilated dogs in sternal recumbency with the abdomen unsupported, following placement of a positioning kit and towels under the pectoral and pelvic regions. General anesthesia was induced in eight healthy adult male Beagles. A Swan-Ganz catheter was placed in the pulmonary artery via the jugular vein for cardiac output measurements. A Foley urethral catheter was placed to monitor transvesical IAP. A 10 mm balloon blunt-tip trocar was inserted into the retroperitoneal space. With a fixed respiratory rate and tidal volume by mechanical ventilation, insufflation pressure was sequentially increased from 0 to 10 mmHg in 5 mmHg increments, followed by desufflation. All variables were measured before insufflation, 5 min after the establishment of each insufflation pressure, and after desufflation. At 10 mmHg, the IAP was nearly equal to insufflation pressure. Cardiopulmonary function was not compromised at any point, although the cardiac index (CI), heart rate, mean arterial pressure (MAP), and mean pulmonary arterial pressure increased within normal ranges. End-tidal CO2 concentration, arterial CO2 partial pressure, and oxygen delivery index (DO2I) increased, whereas pH decreased, at 10 mmHg. CI, MAP, and DO2I did not recover to baseline after decompression. Thus, retroperitoneal CO2 insufflation up to 10 mmHg is well tolerated by mechanically ventilated dogs positioned in sternal recumbency with the abdomen unsupported, although sympathetic changes may occur with an insufflation pressure increase.
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Affiliation(s)
- Hyunglak Son
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jonghyeok Ko
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Junemoe Jeong
- Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Sungin Lee
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Dongmin Sihn
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Oh-Kyeong Kweon
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Wan Hee Kim
- Department of Veterinary Clinical Science, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
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Shank J, Prescott JD, Mathur A. Surgical Approach to Endocrine Hypertension in Patients with Adrenal Disorders. Endocrinol Metab Clin North Am 2019; 48:875-885. [PMID: 31655782 DOI: 10.1016/j.ecl.2019.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Increased hormonal secretion of aldosterone, cortisol, or catecholamines from an adrenal gland can produce a variety of undesirable symptoms, including hypertension, which may be the initial presenting symptom. Consequences of secondary hypertension can result in potential cardiovascular and cerebrovascular complications at higher rates than in those with essential hypertension. Once a biochemical diagnosis is confirmed, targeted pharmacotherapy can be initiated to improve hypertension and may be corrected with surgical intervention. Adrenalectomy can be curative and can reverse the risk of cardiovascular sequelae once blood pressure control is achieved. This article discusses perioperative and operative considerations of adrenal causes of hypertension.
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Affiliation(s)
- Jessica Shank
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
| | - Jason D Prescott
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA
| | - Aarti Mathur
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA.
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The Modified Semi-lateral Transmesocolic Approach for Laparoscopic Left Adrenalectomy. World J Surg 2019; 43:1708-1711. [PMID: 30820736 DOI: 10.1007/s00268-019-04954-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND As the most appropriate laparoscopic approach for adrenalectomy is still a matter of debate, we present a modified technique of laparoscopic transmesocolic approach for left adrenalectomy. METHODS All demographics, intraoperative and postoperative data of patients who underwent laparoscopic transmesocolic left adrenalectomy from 2009 to 2015 in Avicenne Hospital were recorded. RESULTS Thirty-three consecutive patients underwent laparoscopic transmesocolic left adrenalectomy. We observed no conversion, negligible blood loss, no red cell transfusion or intraoperative complication. Mean operative time reached 96 min (range: 40-200 min). Postoperatively, the median length of hospital stay was 5 days (range: 3-8 days), mortality was nil, and six (19%) patients suffered from complication, including one major complication (Clavien-Dindo III-IV, an abdominal collection treated with radiologic drainage). R0 resection was achieved in all patients. CONCLUSION Laparoscopic left adrenalectomy using semi-lateral transperitoneal transmesocolic approach is feasible and safe with acceptable intraoperative and perioperative outcomes. This technique could be considered as a routine approach and should be compared in further studies.
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Balla A, Palmieri L, Meoli F, Corallino D, Ortenzi M, Ursi P, Guerrieri M, Quaresima S, Paganini AM. Are Adrenal Lesions of 6 cm or More in Diameter a Contraindication to Laparoscopic Adrenalectomy? A Case–Control Study. World J Surg 2019; 44:810-818. [DOI: 10.1007/s00268-019-05287-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
OBJECTIVES The aim of this study was to present up to date information concerning the diagnosis and treatment of primary aldosteronism (PA). PA is the most common cause of endocrine hypertension. It has been reported up to 24% of selective referred hypertensive patients. METHODS We did a search in Pub-Med and Google Scholar using the terms: PA, hyperaldosteronism, idiopathic adrenal hyperplasia, diagnosis of PA, mineralocorticoid receptor antagonists, adrenalectomy, and surgery. We also did cross-referencing search with the above terms. We had divided our study into five sections: Introduction, Diagnosis, Genetics, Treatment, and Conclusions. We present our results in a question and answer fashion in order to make reading more interesting. RESULTS PA should be searched in all high-risk populations. The gold standard for diagnosis PA is the plasma aldosterone/plasma renin ratio (ARR). If this test is positive, then we proceed with one of the four confirmatory tests. If positive, then we proceed with a localizing technique like adrenal vein sampling (AVS) and CT scan. If the lesion is unilateral, after proper preoperative preparation, we proceed, in adrenalectomy. If the lesion is bilateral or the patient refuses or is not fit for surgery, we treat them with mineralocorticoid receptor antagonists, usually spironolactone. CONCLUSIONS Primary aldosteronism is the most common and a treatable case of secondary hypertension. Only patients with unilateral adrenal diseases are eligible for surgery, while patients with bilateral and non-surgically correctable PA are usually treated by mineralocorticoid receptor antagonist (MRA). Thus, the distinction between unilateral and bilateral aldosterone hypersecretion is crucial.
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Patel N, Egan RJ, Carter BR, Scott-Coombes DM, Stechman MJ. Outcomes of surgery for benign and malignant adrenal disease from the British Association of Endocrine and Thyroid Surgeons' national registry. Br J Surg 2019; 106:1495-1503. [PMID: 31424578 DOI: 10.1002/bjs.11297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/17/2019] [Accepted: 06/02/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes between benign and malignant disease. METHODS Data on adrenalectomies were extracted from a national surgeon-reported registry. Preoperative diagnosis, surgical technique, length of hospital stay, morbidity and in-hospital mortality were examined. RESULTS Some 3994 adrenalectomies were registered among patients with a median age of 54 (i.q.r. 43-65) years (55·9 per cent female). Surgery was performed for benign disease in 81·5 per cent. Tumour size was significantly greater in malignant disease: 60 (i.q.r. 34-100) versus 40 (24-55) mm (P < 0·001). A minimally invasive approach was employed in 90·2 per cent of operations for benign disease and 48·2 per cent for cancer (P < 0·001). The conversion rate was 3·5-fold higher in malignant disease (17·3 versus 4·7 per cent; P < 0·001). The length of hospital stay was 3 (i.q.r. 2-5) days for benign disease and 5 (3-8) days for malignant disease (P < 0·050). In multivariable analysis, risk factors for morbidity were malignant disease (odds ratio (OR) 1·69, 1·22 to 2·36; P = 0·002), tumour size larger than 60 mm (OR 1·43, 1·04 to 1·98; P = 0·028) and conversion to open surgery (OR 3·48, 2·16 to 5·61; P < 0·001). The in-hospital mortality rate was below 0·5 per cent overall, but significantly higher in the setting of malignant disease (1·2 versus 0·2 per cent; P < 0·001). Malignant disease (OR 4·88, 1·17 to 20·34; P = 0·029) and tumour size (OR 7·47, 1·52 to 39·61; P = 0·014) were independently associated with mortality in multivariable analysis. CONCLUSION Adrenalectomy is a safe procedure but the higher incidence of open surgery for malignant disease appears to influence postoperative outcomes.
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Affiliation(s)
- N Patel
- Department of Endocrine and General Surgery, University Hospital of Wales, Cardiff, UK
| | - R J Egan
- Department of Endocrine and General Surgery, University Hospital of Wales, Cardiff, UK
| | - B R Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D M Scott-Coombes
- Department of Endocrine and General Surgery, University Hospital of Wales, Cardiff, UK
| | - M J Stechman
- Department of Endocrine and General Surgery, University Hospital of Wales, Cardiff, UK
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Srougi V, Barbosa JAB, Massaud I, Cavalcante IP, Tanno FY, Almeida MQ, Srougi M, Fragoso MC, Chambô JL. Predictors of complication after adrenalectomy. Int Braz J Urol 2019; 45:514-522. [PMID: 31038857 PMCID: PMC6786121 DOI: 10.1590/s1677-5538.ibju.2018.0482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/13/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose: To investigate risk factors for complications in patients undergoing adrenalectomy. Materials and Methods: A retrospective search of our institutional database was performed of patients who underwent adrenalectomy, between 2014 and 2018. Clinical parameters and adrenal disorder characteristics were assessed and correlated to intra and post-operative course. Complications were analyzed within 30-days after surgery. A logistic regression was performed in order to identify independent predictors of morbidity in patients after adrenalectomy. Results: The files of 154 patients were reviewed. Median age and Body Mass Index (BMI) were 52-years and 27.8kg/m2, respectively. Mean tumor size was 4.9±4cm. Median surgery duration and estimated blood loss were 140min and 50mL, respectively. There were six conversions to open surgery. Minor and major post-operative complications occurred in 17.5% and 8.4% of the patients. Intra-operative complications occurred in 26.6% of the patients. Four patients died. Mean hospitalization duration was 4-days (Interquartile Range: 3-8). Patients age (p=0.004), comorbidities (p=0.003) and pathological diagnosis (p=0.003) were independent predictors of post-operative complications. Tumor size (p<0.001) and BMI (p=0.009) were independent predictors of intra-operative complications. Pathological diagnosis (p<0.001) and Charlson score (p=0.013) were independent predictors of death. Conclusion: Diligent care is needed with older patients, with multiple comorbidities and harboring unfavorable adrenal disorders (adrenocortical carcinoma and pheocromocytoma), who have greater risk of post-operative complications. Patients with elevated BMI and larger tumors have higher risk of intra, but not of post-operative complications.
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Affiliation(s)
- Victor Srougi
- Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - João A B Barbosa
- Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Isaac Massaud
- Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Isadora P Cavalcante
- Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Fabio Y Tanno
- Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Madson Q Almeida
- Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Miguel Srougi
- Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Maria C Fragoso
- Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - José L Chambô
- Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
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Alesina PF. Retroperitoneal adrenalectomy-learning curve, practical tips and tricks, what limits its wider uptake. Gland Surg 2019; 8:S36-S40. [PMID: 31404183 DOI: 10.21037/gs.2019.03.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The minimally invasive retroperitoneal approach to the adrenal surgery has been described in the early 90s following the first description of laparoscopic adrenalectomy. Although the advantages of the technique compared to laparoscopic surgery have been demonstrated in many studies, it remained for a long period confined to few centers. The operation has been standardized over the years into a safe and reproducible procedure that finally gained worldwide acceptance in the last 10 years. The present paper summarizes the surgical steps of the procedure focusing on the recent technical developments. Retroperitoneoscopic adrenalectomy should be part of the surgical armamentarium of any center dedicated to endocrine surgery.
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Affiliation(s)
- Pier Francesco Alesina
- Department of Surgery and Center of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany
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Silvinato A, Bernardo WM, Branco AW. Total and partial laparoscopic adrenalectomy. Rev Assoc Med Bras (1992) 2019; 65:578-585. [PMID: 31166429 DOI: 10.1590/1806-9282.65.5.578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 01/07/2018] [Indexed: 11/22/2022] Open
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Kozłowski T, Choromanska B, Wojskowicz P, Astapczyk K, Łukaszewicz J, Rutkowski D, Dadan J, Rydzewska-Rosołowska A, Myśliwiec P. Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach - prospective randomized trial. Wideochir Inne Tech Maloinwazyjne 2019; 14:160-169. [PMID: 31118978 PMCID: PMC6528120 DOI: 10.5114/wiitm.2019.84694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Laparoscopic adrenalectomy has become the gold standard of surgical treatment for benign adrenal masses. Two alternative surgical approaches are currently advocated: the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA). Several randomized trials have compared LTA to PRA, but most of them included small numbers of patients or had stringent inclusion criteria. AIM To compare clinical results of LTA and PRA endoscopic adrenalectomies for tumors < 8 cm with wide inclusion criteria. MATERIAL AND METHODS We randomized 77 patients to either LTA (n = 33) or PRA (n = 44). The groups were comparable in terms of age, gender proportions, body mass index, tumor size, clinical and pathological diagnosis. We analyzed duration of surgery, intraoperative blood loss, postoperative pain, length of hospital stay and postoperative morbidity. RESULTS The follow-up concerned 98.8% of patients and was on average 28 (8-47) months long. There were no conversions. We identified significantly lower intensity of pain assessed 24 h after surgery in the PRA group (3.4 ±1), as compared to LTA (4.2 ±1), with lower prevalence of shoulder pain (2.3% vs. 30.3%, respectively). Postoperative hospital stay was shorter in the PRA (1.14 ±0.4) than in the LTA (1.36 ±0.5) group. Perioperative morbidity concerned 4 patients in each group with pain requiring oral analgesia > 7 days. CONCLUSIONS To our knowledge this is the largest prospective randomized study comparing LTA to PRA. We demonstrated safety, efficacy and very low morbidity of both techniques. The PRA proved superior to LTA in terms of lower intensity of postoperative pain and shorter hospital stay.
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Affiliation(s)
- Tomasz Kozłowski
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Barbara Choromanska
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Wojskowicz
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Kamil Astapczyk
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Jerzy Łukaszewicz
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Dominika Rutkowski
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Jacek Dadan
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Alicja Rydzewska-Rosołowska
- 2 Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
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Ortenzi M, Balla A, Ghiselli R, Vergari R, Silecchia G, Guerrieri E, Maria Paganini A, Guerrieri M. Minimally invasive approach to the adrenal gland in obese patients with Cushing's syndrome. MINIM INVASIV THER 2019; 28:285-291. [PMID: 30663461 DOI: 10.1080/13645706.2018.1536669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: The combination of Cushing's syndrome and obesity, one of the most common manifestations of the syndrome itself, may be associated with the worsening of post-operative outcomes in case of laparoscopic adrenalectomy. This study focused on the laparoscopic treatment of Cushing's syndrome with the purpose to identify any relevant difference between morbidly obese, mildly obese and non-obese patients.Material and methods: Patients were retrospectively divided into three groups according to their Body Mass Index (BMI). Demographic characteristics, operative and post-operative data were collected. Data about different hemostatic devices were also collected and compared. Differences were analyzed with the Fisher's exact test for categorical variables, and the Mann-Whitney test for continuous variables.Results: No differences were found in operative time (101.5 ± 50.9 min; p = .919), conversion rate (2.6%; p = .655) or length of stay (4.3 ± 2.9 days; p = .886). Complication rate was 3% (p = .32), without any mortality. 95% of patients showed a complete resolution of hypercotisolyism-related symptoms, and a mean BMI reduction of 5 ± 3.2 kg/m2 (follow up = 6.3 ± 4.2 years). Conclusions: Laparoscopic adrenalectomy is safe and feasible in obese patients affected with Cushing's disease and it can lead to the resolution of the related symptoms.
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Affiliation(s)
- Monica Ortenzi
- Clinica Chirurgica, Universita Politecnica delle Marche, Ancona, Italy
| | - Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Roberto Ghiselli
- Clinica Chirurgica, Universita Politecnica delle Marche, Ancona, Italy
| | - Roberto Vergari
- Clinica Chirurgica, Universita Politecnica delle Marche, Ancona, Italy
| | - Gianfranco Silecchia
- Department of Medical-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence, Sapienza University of Rome, Rome, Italy
| | | | - Alessandro Maria Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Mario Guerrieri
- Clinica Chirurgica, Universita Politecnica delle Marche, Ancona, Italy
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Arezzo A, Bullano A, Cochetti G, Cirocchi R, Randolph J, Mearini E, Evangelista A, Ciccone G, Bonjer HJ, Morino M. 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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Is laparoscopic left adrenalectomy with the anterior submesocolic approach for Conn’s or Cushing’s syndrome equally safe and effective as the lateral and anterior ones? Surg Endosc 2018; 33:3026-3033. [DOI: 10.1007/s00464-018-6601-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Christakis I, Ng CS, Chen C, Yiin YH, Grubbs EG, Perrier ND, Lee JE, Graham PH. Operation duration and adrenal gland size, but not BMI, are correlated with complication rate for posterior retroperitoneoscopic adrenalectomy for benign diseases. Surgery 2018; 165:637-643. [PMID: 30482519 DOI: 10.1016/j.surg.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/10/2018] [Accepted: 09/15/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND We sought to determine whether obesity is correlated with complications after posterior retroperitoneoscopic adrenalectomy for benign diseases and to develop surrogate markers of abdominal fat in preoperative computed tomography. METHODS We conducted a retrospective chart review of all patients who had undergone posterior retroperitoneoscopic adrenalectomy and preoperative computed tomography between January 1, 2008 and December 31, 2015. The cross-sectional components of fat assessed by computed tomography included total fat area, subcutaneous fat area, retroperitoneal fat area, and peritoneal fat area. The patients were grouped into 2 categories according to the absence or presence of a postoperative complication (the no-complications group and the complications group, respectively). RESULTS Of 116 study patients, 20 patients (17%) had a postoperative complication. Operations of greater duration and smaller adrenal gland size were significantly correlated with complications both in univariate and multivariate analyses. Body mass index, total fat area, subcutaneous fat area, retroperitoneal fat area, peritoneal fat area, and distance of skin to muscle (in axial and sagittal images) correlated with complications in univariate analysis but not in multivariate analysis. In the no-complications group, the removed adrenal gland was larger than that removed in the complications group (6 vs 4 cm, respectively, P = .001), whereas the complications group had a greater operative duration (139 vs 104 min, respectively, P = .001) and a greater duration of hospital stay (3 days vs 1 day, respectively, P = .001). CONCLUSION In this study, operations of greater duration and smaller adrenal gland size were better predictors of complications after posterior retroperitoneoscopic adrenalectomy for benign disease than measures of obesity, including body mass index.
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Affiliation(s)
- Ioannis Christakis
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chaan S Ng
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chao Chen
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yeh Hung Yiin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Retroperitoneal vs. transperitoneal laparoscopic adrenalectomy: a meta-analysis of the literature. Eur Surg 2018. [DOI: 10.1007/s10353-018-0546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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: 58] [Impact Index Per Article: 8.3] [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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Inaishi T, Kikumori T, Takeuchi D, Ishihara H, Miyajima N, Shibata M, Takano Y, Nakanishi K, Noda S, Kodera Y. Obesity does not affect peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:21-28. [PMID: 29581611 PMCID: PMC5857498 DOI: 10.18999/nagjms.80.1.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Laparoscopic adrenalectomy is the gold standard procedure for most adrenal tumors. Obesity is considered as a risk factor for surgical complications. This study aimed to evaluate whether obesity affects peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy using body mass index (BMI). This retrospective study included 98 patients who underwent transabdominal laparoscopic adrenalectomy between January 2011 and December 2016. We divided the patients into 2 groups: non-obese group (BMI < 25 kg/m2) and obese group (BMI ≥ 25 kg/m2). We assessed perioperative outcomes and postoperative complications between the groups. A total of 98 patients were analyzed (70 without obesity and 28 with obesity). There were no significant differences between the non-obese and obese groups regarding operative time (111 vs 107 min; p = 0.795), blood loss (3.5 vs 3.5 ml; p = 0.740), rate of placement of additional trocars (14.3% vs 17.9%; p = 0.657), rate of open conversion (2.6% vs 3.6%; p = 0.853), and postoperative length of hospital stay (6 vs 5 days; p = 0.237). Furthermore, obesity was not a significant risk factor for postoperative complications (postoperative bleeding, wound infection, and pneumonia). There are no significant differences in peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy in patients with obesity compared with those without obesity. Transabdominal laparoscopic adrenalectomy is feasible and safe for patients with obesity.
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Affiliation(s)
- Takahiro Inaishi
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyone Kikumori
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dai Takeuchi
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiromasa Ishihara
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Miyajima
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Shibata
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Takano
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Nakanishi
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumiyo Noda
- Department of Transplantation and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Goossen K, Tenckhoff S, Probst P, Grummich K, Mihaljevic AL, Büchler MW, Diener MK. Optimal literature search for systematic reviews in surgery. Langenbecks Arch Surg 2017; 403:119-129. [PMID: 29209758 DOI: 10.1007/s00423-017-1646-x] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/27/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of the present study was to determine empirically which electronic databases contribute best to a literature search in surgical systematic reviews. METHODS For ten published systematic reviews, the systematic literature searches were repeated in the databases MEDLINE, Web of Science, CENTRAL, and EMBASE. On the basis of these reviews, a gold standard set of eligible articles was created. Recall (%), precision (%), unique contribution (%), and numbers needed to read (NNR) were calculated for each database, as well as for searches of citing references and of the reference lists of related systematic reviews (hand search). RESULTS CENTRAL yielded the highest recall (88.4%) and precision (8.3%) for randomized controlled trials (RCT), MEDLINE for non-randomized studies (NRS; recall 92.6%, precision 5.2%). The most effective combination of two databases plus hand searching for RCT was MEDLINE/CENTRAL (98.6% recall, NNR 97). Adding EMBASE marginally increased the recall to 99.3%, but with an NNR of 152. For NRS, the most effective combination was MEDLINE/Web of Science (99.5% recall, NNR 60). CONCLUSIONS For surgical systematic reviews, the optimal literature search for RCT employs MEDLINE and CENTRAL. For surgical systematic reviews of NRS, Web of Science instead of CENTRAL should be searched. EMBASE does not contribute substantially to reviews with a surgical intervention.
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Affiliation(s)
- Käthe Goossen
- Study Center of the German Surgical Society (SDGC), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Solveig Tenckhoff
- Study Center of the German Surgical Society (SDGC), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Pascal Probst
- Study Center of the German Surgical Society (SDGC), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Kathrin Grummich
- Study Center of the German Surgical Society (SDGC), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Study Center of the German Surgical Society (SDGC), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus K Diener
- Study Center of the German Surgical Society (SDGC), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany. .,Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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