Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy (original) (raw)
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World journal of surgery, 2007
Today, the posterior retroperitoneoscopic technique has become a standard procedure in adrenal surgery. The procedure allows direct access to the adrenal glands, but it seems to be difficult because of the uncommon anatomic view. This study compares the learning period of the new procedure of "posterior retroperitoneoscopic adrenalectomy" in the primary invention phase and the secondary introductory phase in a different hospital 10 years later. The analysis included 100 posterior retroperitoneoscopic adrenalectomies (PRA) and involved 50 procedures in each center. Group A consisted of 44 patients (14 males, 30 females; age: 48.7 +/- 14.5 years) undergoing surgery between 07/1994 and 8/1996 (24 right, 26 left; 8 Cushing adenomas, 14 Conn adenomas, 11 pheochromocytomas, 7 nonfunctioning adrenocortical adenomas, 10 ACTH-dependent adrenal hyperplasias). Group B consisted of 50 patients (12 males, 38 females; mean age 59.3 +/- 10.7 years) operated between 01/2004 and 01/2006 (2...
Posterior retroperitoneoscopic adrenalectomy—results of 560 procedures in 520 patients
Surgery, 2006
Background. The posterior retroperitoneoscopic adrenalectomy is less popular than the laparoscopic transabdominal method. Due to the direct approach to the adrenal glands, however, the posterior retroperitoneal access is easy to use and may offer advantages not available with other endoscopic procedures for adrenalectomy. Methods. Between July 1994 and March 2006, we performed 560 adrenalectomies (right side: n ϭ 258; left side: n ϭ 302) by the posterior retroperitoneoscopic approach in 520 patients (200 male, 320 female; age, 10 to 83 years). Of the 520 patients, 21 suffered from Cushing's disease, 499 patients had adrenal tumors (157 Conn's adenomas, 120 pheochromocytomas [13 bilateral], 110 Cushing's adenomas [6 bilateral], and 112 other tumors). Tumor size ranged from 0.5 to 10 cm (mean, 2.9 Ϯ 1.7 cm). The procedures were performed with the patients in the prone position usually with 3 trocars. Results. Mortality was zero. Conversions to open or laparoscopic lateral surgery were necessary in 9 patients (1.7%). Major complications occurred in 1.3% of patients, minor complications in 14.4%. Mean operating time was 67 Ϯ 40 min and declined significantly (P Ͻ .001) from the early procedures (106 Ϯ 46 min) to the later operations (40 Ϯ 15 min). Conclusions. The posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. In experienced hands, this method represents the ideal approach in adrenal surgery. , a prospective study was performed on 520 patients (200 male, 320 female; age, 49.2 Ϯ 15.0 years; range, 10 to 83 years) who underwent 560 posterior retroperitoneoscopic adrenalectomies (258 right, 302 left). In 499 patients (194 male, 305 female;
Retroperitoneal vs. transperitoneal laparoscopic adrenalectomy: a meta-analysis of the literature
European Surgery, 2018
Background Minimally invasive surgery is becoming the mainstay of surgical treatment. Two laparoscopic techniques have been developed in the management of adrenal disease-retroperitoneal and transperitoneal laparoscopic adrenalectomy. Methods A literature search has been carried out in PubMed, MEDLINE, EMBASE and Google Scholar academic search engines, using the MeSH terms "Adrenalectomy", "Randomised Controlled Trials", "Retroperitoneal", "Transperitoneal", "Laparoscopy". All randomized controlled trials published until January 2016 comparing retroperitoneal and transperitoneal laparoscopic adrenalectomy were identified. Data were collected on operative performance, operative time and post-operative management. Each outcome was calculated with 95% confidence intervals (CI). Results Three blinded prospective randomised controlled studies were used. When compared to transperitoneal laparoscopic adrenalectomy, retroperitoneal laparoscopic adrenalectomy has comparable blood loss (χ 2 = 11.24; P = 0.0008; CI-2.67, 6.73; I 2 = 91%), operative time (χ 2 = 5.77; P = 0.06; CI-0.41, 3.19; I 2 = 65%) and post-operative pain (χ 2 = 1.31; P = 0.25; CI-0.5, 1.33; I 2 = 24%). Retroperitoneal laparoscopic adrenalectomy is associated with a significantly shorter time to oral intake (χ 2 = 7.56; P = 0.006;
Purpose This study aims to compare posterior retroperitoneal laparoscopic adrenalectomy (PRLA) and laparoscopic transperitoneal adrenalectomy (LTA) in adults using pan-European data as conflicting results have been published regarding length of hospital stay, institutional volume, and morbidity. Methods This retrospective cohort study analyzed data from the surgical registry EUROCRINE®. All patients undergoing PRLA and TLA for adrenal tumours and registered between 2015 and 2020 were included and compared for morbidity, length of hospital stay, and conversion to open surgery. Results A total of 2,660 patients from 11 different countries and 69 different hospitals were analyzed and 1,696 LTA were compared to 964 PRLA. Length of hospital stay was shorter after RPLA, with less patients (N=434, 45.5%, vs N=1094, 65.0%, p<0.001) staying more than 2 days. In total, 96 patients (3.6%) developed a complication Clavien-Dindo grade 2 or higher. No statistical difference was found between b...
Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy
Surgery, 2013
Background. Laparoscopic adrenalectomies are being performed increasingly, either with transperitoneal or retroperitoneal approaches. Studies comparing the 2 approaches have not shown the superiority of either technique, but these studies are limited by small sample sizes and single-institution designs. To overcome these limitations, we performed a meta-analysis of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy. Methods. A systematic review of studies comparing lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy was conducted. Study endpoints included perioperative outcomes and measures of postoperative recovery. Meta-analysis was performed using a random effects model, pooling variables evaluated by more than 3 studies. Results. Twenty-one studies comparing a total of 1,205 lateral transperitoneal adrenalectomies and 688 retroperitoneal adrenalectomies were suitable for meta-analysis. Patients in the 2 groups were similar in term of age, sex, body mass index, lesion size and location, and rates of malignancy. There were no statistically significant differences between lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy in terms of operative time, blood loss, hospital stay, time to oral intake, overall and major morbidity, and mortality. Conclusion. Both lateral transperitoneal adrenalectomy and retroperitoneal adrenalectomy are associated with very low rates of perioperative complications. According to our meta-analysis, clinical outcomes after either technique are similar. For most adrenal lesions requiring operation, minimally invasive adrenalectomy can be performed safely and effectively with either transperitoneal or the retroperitoneal approach. Additional studies may be needed to analyze if any difference in long-term results exist. (Surgery 2013;153:111-9.)
Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy
British Journal of Surgery, 2012
Background: Laparoscopic adrenalectomy (LA) has replaced open adrenalectomy as the standard operation for non-malignant adrenal tumours. Retroperitoneoscopic adrenalectomy (RA) is an increasingly popular alternative minimally invasive approach. Advocates of each technique claim its superiority, but the issue has yet to be resolved and conclusions are complicated by the existence of a lateral (LRA) and true posterior (PRA) RA.
World Journal of Surgery, 1996
Posterior retroperitoneoscopic adrenalectomy is a new minimally invasive method. It represents an alternative to conventional open procedures and laparoscopic techniques. Between July 1994 and November 1995 a total of 30 retroperitoneoscopic adrenalectomies were performed on 27 patients. In 24 patients, unilateral tumors were seen (size 1-7 cm): seven Cushing adenomas, five Conn adenomas, seven pheochromocytomas, four hormonally inactive tumors, one cyst. Three patients suffered from Cushing syndrome with bilateral adrenal gland hyperplasias (two inoperable pituitary gland tumors, one bronchial carcinoid with ACTH secretion). The operations were carried out in prone position. After balloon dilatation of the retroperitoneum and creation of a pneumoperitoneum the preparation of the adrenal gland was performed via three trocar sites positioned below the 12th rib. Twenty-five adrenalectomies were completed endoscopically, and five times (among four patients) conversion to the conventional posterior technique was necessary. The average operating time of complete endoscopic adrenalectomies was 124 minutes (45-225 minutes); blood loss was 10 to 120 ml. With minimal need for postoperative analgesia (average dosage 7.9 mg of piritramide), mobilization and adequate food uptake were possible on the day of operation. The posterior retroperitoneoscopic adrenalectomy is a relatively fast, safe method, with the advantages of the posterior open approach and minimally invasive surgery. It therefore represents an important addition to adrenal gland surgery.