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Surgical Endoscopy

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01-02-2021 | Adrenalectomy

Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing

Authors: Luca Cardinali, Edlira Skrami, Elisa Catani, Flavia Carle, Monica Ortenzi, Andrea Balla, Mario Guerrieri

Published in: Surgical Endoscopy | Issue 2/2021

Abstract

Background

Laparoscopic adrenalectomy is the standard surgical approach to adrenal lesions. Adrenal vessel sealing is the critical surgical phase of laparoscopic adrenalectomy. This study aimed at comparing perioperative outcomes of laparoscopic transperitoneal adrenalectomy by means of radiofrequency energy-based device (LARFD) to those performed with traditional clipping device (LACD), while focusing on the different adrenal vessel control techniques.

Methods

Patients who underwent adrenalectomy for adrenal disease between January 1994 and April 2019 at the Surgical Clinic, Polytechnic University of Marche were included in the study. Overall, 414 patients met inclusion criteria for study eligibility: 211 and 203 patients underwent LARFD and LACD, respectively. Multiple models of quantile regression, logistic regression and Poisson finite mixture regression were used to assess the relationship between operative time, conversion to open procedure, length of stay (LoS), surgical procedure and patient characteristics, respectively.

Results

LARFD reduced operative time of about 12 min compared to LACD. Additional operative time-related factors were surgery side, surgery approach, conversion to open procedure and trocar number. The probability of conversion to open procedure decreased by about 76% for each added trocar, whereas it increased by about 49% for each added centimeter of adrenal lesion and by about 25% for each added year of surgery. Two patient clusters were identified based on the LoS: long-stay and short-stay. In the long-stay cluster, LoS decreased of about 30% in LARFD group and it was significantly associated with conversion to open procedure and postoperative complications, whereas in short-stay cluster only postoperative complications had a significant effect on LoS.

Conclusion

Laparoscopic transperitoneal adrenalectomy performed by means of radiofrequency energy-based device for the sealing of adrenal vessels is an effective procedure reducing operative time with potentially improved postoperative outcomes.

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Title: Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing
Authors: Luca Cardinali
Edlira Skrami
Elisa Catani
Flavia Carle
Monica Ortenzi
Andrea Balla
Mario Guerrieri
Publication date: 01-02-2021
Publisher: Springer US
Keywords: Adrenalectomy
Adrenalectomy
Published in: Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-07432-8

At a glance: The STEP trials

Springer Medicine

Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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