Background Retroperitoneal laparoscopic adrenalectomy is gaining traction as a minimally invasive technique. One of the purported relative contraindications is BMI given the smaller working space. We hypothesize that other anthropometric measurements may be better predictors of operative time. Methods An IRB‐approved, single‐institution, retrospective study of 83 patients who underwent laparoscopic retroperitoneal adrenalectomy evaluated the association of anthropometric measurements taken from cross‐sectional imaging and the primary outcome of operative time. Descriptive statistics were performed with Wilcoxon rank‐sum test for continuous variables (median; IQR) and Chi‐square (n; %) for categorical variables. A linear random effects model was used to model operative time. Results The majority of the patients were white (40; 48.2%) women (46; 55.4%) with a median age of 54 with interquartile range (IQR) of 43–63 and a median BMI of 27.8 (IQR 21.2–38.6). On univariable analysis, factors that led to longer operative time included right‐sided operation (p = 0.04), male gender (p < 0.01), clinical diagnosis (p < 0.01), waist area (p < 0.01), waist/hip ratio (p < 0.01), periadrenal volume (p < 0.01), posterior adiposity index (PAI) (p < 0.01) and BMI (p < 0.01). Only side, order of operation, and periadrenal fat volume (p < 0.01, p = 0.02 and p < 0.01, respectively) remained independent predictors of increased operative time on multivariable analysis. Conclusion This study demonstrates that anthropometric measurements, specifically periadrenal fat volume, and side of operation, are better predictors for increased operative time in laparoscopic retroperitoneal adrenalectomies than BMI. This information can help facilitate appropriate patient selection for this operative approach.

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Hürthle cell predominant thyroid nodules often confound the diagnostic utility of fine needle aspiration biopsy (FNAB) with cytology often interpreted as a Hürthle cell lesion with an indeterminate risk of malignancy, Bethesda category (BC) III or IV. Molecular diagnostics for Hürthle cell predominant nodules has also been disappointing in further defining the risk of malignancy. We present a case of a slowly enlarging nodule within a goiter initially reported as benign on FNAB, BC II but on subsequent FNAB suspicious for a Hürthle cell neoplasm, BC IV. The patient had initially requested a diagnostic lobectomy for a definitive diagnosis despite a higher risk of malignancy based on the size of the nodule > 4 cm alone. To better tailor this patient's treatment plan, a newer expanded gene mutation panel, ThyroSeq® v3 that includes copy number alterations (CNAs) and was recently found to have greater positive predictive value (PPV) for identifying Hürthle cell carcinoma (HCC), was performed on the FNAB material. Molecular profiling with ThyroSeq® v3 was able to predict a greater risk of carcinoma, making a more convincing argument in favor of total thyroidectomy. Surgical pathology confirmed a Hürthle cell carcinoma with 5 foci of angioinvasion and foci of capsular invasion.

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