Single-plane retroperitoneoscopic adrenalectomy: a new operative procedure for benign adrenal disease (original) (raw)
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Tailored Approach in Adrenal Surgery: Retroperitoneoscopic Partial Adrenalectomy
Frontiers in Endocrinology, 2022
The interest on partial adrenalectomy has steadily increased over the past twenty years. Adrenal pathologies are mostly benign, making an organ-preserving procedure attractive for many patients. The introduction of minimally invasive techniques played probably an important role in this process because they transformed a complex surgical procedure, related to the difficult access to the retroperitoneal space, into a simple operation improving the accessibility to this organ. In this review we summarize the role of partial retroperitoneoscopic adrenalectomy over the years and the current indications and technique.
2011
Minimally invasive adrenalectomy (MIA) is both feasible and safe with either transperitoneal or retroperitoneal entry. However, only a few studies have rigorously compared these two techniques. The aim of the current study is to compare transperitoneal and retroperitoneal adrenalectomy to detect significant differences in patient selection and perioperative outcomes. Between 1995 and 2009, 171 patients underwent MIA through transperitoneal (n 5 127) or retroperitoneal access (n 5 44). The respective cohorts were then examined retrospectively through matched and unmatched comparisons. Multivariate analyses of intraoperative blood loss, postoperative morbidity, and length of hospital stay were performed. Surgical indications were benign lesions (70.2%), malignant tumors (11.1%), and pheochromocytomas (18.7%). The postoperative morbidity rate was 15.8 per cent, but mortality was null. The rate of conversion to open surgery was 5.3 per cent. Blood loss and operative time were significantly lower with the transperitoneal approach, whereas time to oral intake was shorter for the retroperitoneal group. Tumor size less than 4.5 cm was associated with less blood loss, shorter hospital stay, and lower postoperative morbidity. Laparoscopic and retroperitoneal routes are both effective and safe for excising adrenal lesions. In the present study, however, laparoscopic adrenalectomy demonstrated shorter operative times with less blood loss. Regardless of this, we remain cautious in recommending one procedure preferentially. Other important measures of clinical outcome such as required pain control, ease of patient recovery, and cost considerations were not included in this analysis. Further randomized trials, with large patient numbers, are therefore desirable for defining an optimal surgical method.
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;
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...
Journal of Surgical Research, 2014
Background: Laparoscopic retroperitoneal (RP) adrenalectomy has gained popularity as the preferred approach over transabdominal (TA) method; however, surgeons have been reluctant to offer this operation to obese patients because of the concerns over inadequate working space and overall perceived higher rate of complications. The aim of the present study was to evaluate the feasibility and safety of RP adrenalectomy compared with TA adrenalectomy, specifically in morbidly obese patients. Methods: All laparoscopic adrenalectomies performed at our institution between 2004 and 2012 were reviewed retrospectively. Presenting features, operative characteristics, and postoperative outcomes were evaluated. Complications were graded using Clavien system. Continuous variables were compared using Student t-test. Categorical variables were compared using c 2 -test. Prediction models were constructed using linear or logistic regression as appropriate.
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;
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.)
Single access retroperitoneoscopic adrenalectomy (SARA)—one step beyond in endocrine surgery
Langenbeck's Archives of Surgery, 2008
Today, endoscopic adrenalectomy has become a gold standard in endocrine surgery. To minimize the morbidity and improve cosmesis, single access retroperitoneoscopic adrenalectomy (SARA) has been developed as an alternative to traditional multiport laparoscopy and single port access (SPA) surgery, potentially exploiting even more the already proven benefits of minimally invasive surgery. We applied the SARA technique to adrenalectomy using the posterior retroperitoneal approach. The aim is to highlight the current situation regarding the feasibility and safety of single access retroperitoneoscopic adrenalectomy and to present our initial experience. Between October 2010 and February 2011, a 74-year-old woman (body mass index (BMI)-31 kg/m 2) with pheochromocytoma (1.2 cm in size) and 3 women, aged 45, 46 and 66 years (BMI-27, 32, 33 kg/m 2), respectively, and all diagnosed with Conn's adenoma (from 1.2 cm to 2.0 cm in size), underwent single access retroperitoneoscopic adrenalectomies. Operations were performed using conventional laparoscopic (STORZ) equipment. No conversions to the open or conventional retroperitoneal approach were necessary. There were no perioperative or postoperative complications. Operating time ranged from 60 min to 80 min. All patients left the hospital 2 days after surgery. The single access retroperitoneoscopic technique has been successfully applied to adrenalectomy as an available alternative to multiport laparoendoscopic adrenalectomy and single port access surgery. Exposure, visualization and dissection are the same as in retroperitoneal endoscopic adrenalectomy. The SARA surgery offers patient benefits such as faster convalescence, decreased postoperative scarring, better cosmetic effect and financial benefit.
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...