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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 1/2016

01-02-2016 | ORIGINAL ARTICLE

Management of adrenal incidentaloma by laparoscopic transperitoneal anterior and submesocolic approach

Authors: Alessandro M. Paganini, Mario Guerrieri, Andrea Balla, Silvia Quaresima, Andrea M. Isidori, Franco Iafrate, Giancarlo D’Ambrosio, Giovanni Lezoche, Emanuele Lezoche

Published in: Langenbeck's Archives of Surgery | Issue 1/2016

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Abstract

Purpose

Laparoscopic adrenalectomy (LA) is becoming the main approach for incidentally discovered adrenal masses (adrenal incidentaloma (AI)). The aim of this study was to evaluate the results of LA with a transperitoneal anterior approach for right adrenal lesions and either a transperitoneal anterior or transperitoneal anterior submesocolic approach for the left-sided lesions.

Methods

The study is a retrospective analysis of prospectively collected data. From January 1994 to December 2012, 393 patients underwent LA, 117 of these for an AI. Sixty-seven (57.26 %) and 50 (42.73 %) patients underwent right and left adrenalectomy, respectively. The transperitoneal anterior approach was used in all 67 patients with right lesions (57.26 %) (group A) and in 13 patients with left-sided lesions (11.11 %) (group B). The transperitoneal anterior submesocolic approach was used in the remaining 37 left-sided lesions (31.62 %) (group C).

Results

Mean operative time in groups A, B, and C was 104.6 min (range 35–255), 148.9 min (range 80–210), and 82.7 min (range 45–230), respectively. One right and one left anterior LA (1.7 %) were converted to open surgery. There were one major and one minor complications (1.7 %). The mean lesion size was 4.73 cm (range 1–10 cm). Mean hospital stay was 3.6 days.

Conclusions

With adequate experience, LA with a transperitoneal anterior approach for AI is a safe and effective procedure. Early control of the adrenal vein with minimal gland manipulation and limited surgical dissection are its major advantages. In case of left LA, the submesocolic approach reduces the operative time significantly.
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Metadata
Title
Management of adrenal incidentaloma by laparoscopic transperitoneal anterior and submesocolic approach
Authors
Alessandro M. Paganini
Mario Guerrieri
Andrea Balla
Silvia Quaresima
Andrea M. Isidori
Franco Iafrate
Giancarlo D’Ambrosio
Giovanni Lezoche
Emanuele Lezoche
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 1/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-015-1367-y

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