Top

World Journal of Surgery

Published in:

01-07-2016 | Original Scientific Report

Improving Minimally Invasive Adrenalectomy: Selection of Optimal Approach and Comparison of Outcomes

Authors: Terry C. Lairmore, Jessica Folek, Cara M. Govednik, Samuel K. Snyder

Published in: World Journal of Surgery | Issue 7/2016

Abstract

Introduction

Minimally invasive adrenalectomy is commonly performed by either a transperitoneal laparoscopic (TLA) or posterior retroperitoneoscopic (PRA) approach. Our group described the technique for robot-assisted PRA (RAPRA) in 2010. Few studies are available that directly compare outcomes between the available operative approaches. We reviewed our results for minimally invasive adrenalectomy using the three different approaches over a 10-year period.

Methods

Between January 2005 and April 2015, 160 minimally invasive adrenalectomies were performed. Clinicopathologic data were prospectively collected and retrospectively analyzed. The primary endpoints evaluated were operative time, blood loss, length of stay (LOS), and morbidity.

Results

The study included 67 TLA, 76 PRA, and 17 RAPRA procedures. Tumor size for PRA/RAPRA was smaller than for patients undergoing TLA (2.38 vs 3.6 cm, p ≤ 0.0001). Procedure time was shorter for PRA versus TLA (133.3 vs 152.8 min, p = 0.0381), as was LOS (1.85 vs 2.82 days, p = 0.0145). Procedure time was longer in RAPRA versus TLA/PRA (177 vs 153/133 min, p = 0.008), but LOS was significantly decreased (1.53 vs 2.82/1.85 days, p = 0.004).

Conclusions

Minimally invasive adrenalectomy is associated with expected excellent outcomes regardless of approach. In our series, the posterior approach is associated with decreased operative time and LOS. Robotic technology provides potential advantages for the surgeon at the expense of more complex setup requirements and costs. Further study is required to demonstrate clear benefit of one surgical approach. Utilization of the entire spectrum of available operative techniques can allow for selection of the optimal approach based on individual patient factors.

Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033CrossRefPubMed

Higashihara E, Tanaka Y, Horie S et al (1992) A case report of laparoscopic adrenalectomy. Nihon Hinyokika Gakkai Zasshi 83(7):1130–1133PubMed

Jacobs JK, Goldstein RE, Geer RJ (1997) Laparoscopic adrenalectomy. A new standard of care. Ann Surg 225(5):495–501 (discussion 501–2) CrossRefPubMedPubMedCentral

Korman JE, Ho T, Hiatt JR, Phillips EH (1997) Comparison of laparoscopic and open adrenalectomy. Am Surg 63(10):908–912PubMed

Linos DA, Stylopoulos N, Boukis M et al (1997) Anterior, posterior, or laparoscopic approach for the management of adrenal diseases? Am J Surg 173(2):120–125CrossRefPubMed

Thompson GB, Grant CS, van Heerden JA et al (1997) Laparoscopic versus open posterior adrenalectomy: a case-control study of 100 patients. Surgery 122(6):1132–1136CrossRefPubMed

Vargas HI, Kavoussi LR, Bartlett DL et al (1997) Laparoscopic adrenalectomy: a new standard of care. Urology 49(5):673–678CrossRefPubMed

Ishikawa T, Sowa M, Nagayama M et al (1997) Laparoscopic adrenalectomy: comparison with the conventional approach. Surg Laparosc Endosc 7(4):275–280CrossRefPubMed

Winfield HN, Hamilton BD, Bravo EL, Novick AC (1998) Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy. J Urol 160(2):325–329CrossRefPubMed

10.

Dudley NE, Harrison BJ (1999) Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy. Br J Surg 86(5):656–660CrossRefPubMed

11.

MacGillivray DC, Shichman SJ, Ferrer FA, Malchoff CD (1996) A comparison of open vs laparoscopic adrenalectomy. Surg Endosc 10(10):987–990CrossRefPubMed

12.

Brunt LM, Doherty GM, Norton JA et al (1996) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183(1):1–10PubMed

13.

Gonzalez R, Smith CD, McClusky DA 3rd et al (2004) Laparoscopic approach reduces likelihood of perioperative complications in patients undergoing adrenalectomy. Am Surg 70(8):668–674PubMed

14.

Hazzan D, Shiloni E, Golijanin D et al (2001) Laparoscopic vs open adrenalectomy for benign adrenal neoplasm. Surg Endosc 15(11):1356–1358CrossRefPubMed

15.

Walz MK, Alesina PF, Wenger FA et al (2006) Posterior retroperitoneoscopic adrenalectomy–results of 560 procedures in 520 patients. Surgery 140(6):943–948 (discussion 948–50) CrossRefPubMed

16.

Walz MK, Peitgen K, Walz MV et al (2001) Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years. World J Surg 25(6):728–734. doi:10.1007/s00268-001-0023-6 CrossRefPubMed

17.

Walz MK, Peitgen K, Hoermann R et al (1996) Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg 20(7):769–774. doi:10.1007/s002689900117 CrossRefPubMed

18.

Horgan S, Vanuno D (2001) Robots in laparoscopic surgery. J Laparoendosc Adv Surg Tech A 11(6):415–419CrossRefPubMed

19.

Brunaud L, Ayav A, Zarnegar R et al (2008) Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies. Surgery 144(6):995–1001 (discussion 1001) CrossRefPubMed

20.

Ludwig AT, Wagner KR, Lowry PS et al (2010) Robot-assisted posterior retroperitoneoscopic adrenalectomy. J Endourol 24(8):1307–1314CrossRefPubMed

21.

Berber E, Mitchell J, Milas M, Siperstein A (2010) Robotic posterior retroperitoneal adrenalectomy: operative technique. Arch Surg 145(8):781–784CrossRefPubMed

22.

Dickson PV, Alex GC, Grubbs EG et al (2013) Robotic-assisted retroperitoneoscopic adrenalectomy: making a good procedure even better. Am Surg 79(1):84–89PubMed

23.

Brunt LM, Moley JF, Doherty GM et al (2001) Outcomes analysis in patients undergoing laparoscopic adrenalectomy for hormonally active adrenal tumors. Surgery 130(4):629–634 (discussion 634–5) CrossRefPubMed

24.

Hamid KS, Snyder SK, Lairmore TC (2009) Minimally invasive adrenalectomy: retroperitoneoscopic versus transperitoneal approach. World J Surg 33(suppl 1):S235–S236

25.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed

26.

Chai YJ, Kwon H, Yu HW et al (2014) Systematic review of surgical approaches for adrenal tumors: lateral transperitoneal versus posterior retroperitoneal and laparoscopic versus robotic adrenalectomy. Int J Endocrinol 2014:918346CrossRefPubMedPubMedCentral

27.

Constantinides VA, Christakis I, Touska P, Palazzo FF (2012) Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg 99(12):1639–1648CrossRefPubMed

28.

Nigri G, Rosman AS, Petrucciani N et al (2013) Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 153(1):111–119CrossRefPubMed

29.

Chen W, Li F, Chen D et al (2013) Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutaneous Tech 23(2):121–127CrossRef

30.

Brandao LF, Autorino R, Laydner H et al (2014) Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol 65(6):1154–1161CrossRefPubMed

31.

Barczynski M, Konturek A, Nowak W (2014) Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg 260(5):740–747 (discussion 747–8) CrossRefPubMed

32.

Mohammadi-Fallah MR, Mehdizadeh A, Badalzadeh A et al (2013) Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study. J Laparoendosc Adv Surg Tech A 23(4):362–366CrossRefPubMed

33.

Broome JT, Solorzano CC (2013) Impact of surgical mentorship on retroperitoneoscopic adrenalectomy with comparison to transperitoneal laparoscopic adrenalectomy. Am Surg 79(2):162–166PubMed

34.

Constantinides VA, Christakis I, Touska P et al (2013) Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience. Surg Endosc 27(11):4147–4152CrossRefPubMed

Title: Improving Minimally Invasive Adrenalectomy: Selection of Optimal Approach and Comparison of Outcomes
Authors: Terry C. Lairmore
Jessica Folek
Cara M. Govednik
Samuel K. Snyder
Publication date: 01-07-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-016-3471-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Improving Minimally Invasive Adrenalectomy: Selection of Optimal Approach and Comparison of Outcomes

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2016

Port Site Recurrences Following Laparoscopic Liver Resection for Hepatocellular Carcinoma

External Validation of Risk Stratification Models Predicting the Immediate Mortality After Open Repair of Ruptured AAA

Usefulness of Inflammation-Based Prognostic Score in Patients Undergoing Lung Metastasectomy for Colorectal Carcinoma

The Damage Pattern to the Gastrointestinal Tract Depends on the Nature of the Ingested Caustic Agent

Managing Soft Tissue Sarcomas in a Developing Health System

Isolated Resection of Segment VIII: A Technique for Drainage Through the Couinaud Space to Prevent Postoperative Collections