Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience

Coste, T; Caïazzo, Robert; Torres, F.; Vantyghem, Marie-Christine; Carnaille, B.; Pattou, François; Cao, Christine Do; Douillard, Claire

doi:10.1007/s00464-016-4830-0

Cited by 49 publications

(59 citation statements)

References 39 publications

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“…In our study we registered pre-operative data like ASA score, radiological features and hormonal tests. In literature age and ASA score were direct related to increased of length of hospital stay and postoperative complications [24]. Radiological features and tumor size appeared as a very important predictive parameter of outcome.…”

Section: Discussionmentioning

confidence: 95%

“…According to Dindo-Clavien scale rate we considered medical or surgical complications with grade ≥ 2 for statistical analysis with no significant correlation between mean tumor size, histological type and postoperative outcome (p value > 0.05). Coste T. et al [24] reported that postoperative medical complications were mainly respiratory diseases and various infections.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

et al. 2019

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Background: laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (< 5-6 cm), instead there are still open questions in literature regarding the correct management of larger lesions (> 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. Methods: at the University Hospital Policlinico "P. Giaccone" of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications. Results: Mean size of adrenal neoplasm was 7,5 cm (range 1.5 to 18 cm). The mean operative time was 145 min (range 75-240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p < 0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95 ml (range 50-350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7 days (range 3-6 days). Conclusions: Laparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

et al. 2019

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“…The surgical approach to adrenal gland includes laparotomy, combined thoraco-abdominal access, retroperitoneal posterior access, laparoscopy, and robotic surgery [ 86 ]. Since the first successfully laparoscopic adrenalectomy (LA) performed by Gagner in 1991 [ 28 ], the lateral trans-abdominal approach has become the most common therapeutic strategy for adrenal neoplasm [ 28 – 34 ]. LA is associated with lower postoperative pain, reduced ileus, shorter hospitalization, earlier return to work, and a better cosmetic result, guarantying a lower morbidity (5–20%) and mortality rate (below 0.5%) compared to open adrenalectomy [ 25 , 31 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since the first successfully laparoscopic adrenalectomy (LA) performed by Gagner in 1991 [ 28 ], the lateral trans-abdominal approach has become the most common therapeutic strategy for adrenal neoplasm [ 28 – 34 ]. LA is associated with lower postoperative pain, reduced ileus, shorter hospitalization, earlier return to work, and a better cosmetic result, guarantying a lower morbidity (5–20%) and mortality rate (below 0.5%) compared to open adrenalectomy [ 25 , 31 , 34 ]. In contrast, open adrenalectomy is associated with higher mortality (2–4%) and morbidity rates (bleeding, pulmonary and cardiac complications, pulmonary thromboembolism, and wound infections) and is reserved worldwide only for large tumors (diameter >6 cm) and primary malignancies, based on the radicality of resection, minor tumor local recurrence, and major survival [ 27 , 87 , 88 ].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical approaches to adrenal gland include laparotomy, combined thoraco-abdominal access, retroperitoneal posterior access, laparoscopy, and robotic surgery [ 27 ]. Since the first successfully laparoscopic adrenalectomy (LA) performed by Gagner in 1991 [ 28 ], the lateral trans-abdominal approach has become the most common therapeutic strategy for adrenal neoplasms [ 29 – 34 ]. To the best of our knowledge, this is the first case report of laparoscopic lateral trans-abdominal adrenalectomy for a large AOC (12 cm) ( Supplementary Video 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Trans-Abdominal Right Adrenalectomy for a Large Primitive Adrenal Oncocytic Carcinoma: A Case Report and Review of Literature

et al. 2018

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Patient: Male, 48Final Diagnosis: Adrenal oncocytic carcinomaSymptoms: AsymptomaticMedication: —Clinical Procedure: Transabdominal laparoscopic right adrenalectomySpecialty: SurgeryObjective:Rare diseaseBackground:Adrenocortical oncocytic neoplasms (AONs) are extremely rare tumors. AONs are classified as: oncocytoma (AO), oncocytic neoplasm of uncertain malignant potential (AONUMP), and oncocytic carcinoma (AOC). Among the 162 reported cases of AONs in the literature, 30 cases were classified as malignant. Adrenalectomy is the treatment of choice for AON.Case Report:We report the case of a 48-year-old man with a primitive 12-cm mass affecting the right adrenal gland, detected by ultrasonography during follow-up for alcoholic liver cirrhosis. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a mass of the right adrenal gland compressing the inferior vena cava (IVC) and dislocating the right lobe of the liver, with no invasion of kidney, liver, or IVC. Preoperative blood tests showed mild transaminase increase. Laparoscopic right adrenalectomy with lateral transperitoneal approach was performed. The postoperative course was uneventful. The lesion was diagnosed as a primitive adrenal oncocytic carcinoma (AOC). No recurrence was evidenced during 24-month follow-up.Conclusions:Although AONs are very rare, they must be considered in the differential diagnosis of adrenal masses due to their prognostic difference compared to non-oncocytic tumors. AOCs are a rare presentation of AONs. Only 30 cases are described in the literature. Laparotomic adrenalectomy is the treatment of choice for AOC. We report the first case of laparoscopic lateral trans-abdominal adrenalectomy for a voluminous AOC (120×95×110 mm) and we review the literature regarding AOCs. Laparoscopy in experienced hands is safe and effective for the treatment of AONs. Despite the rarity of AOC, a case series should be performed to confirm the results of our case report.

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Risk Factors Associated With Perioperative Complications and Prolonged Length of Stay After Laparoscopic Adrenalectomy

et al. 2018

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Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience

Abstract: Lesion diameter over 45 mm is the determinant parameter for guidance of patients to surgeons with more extensive experience.

Cited by 49 publications

References 39 publications

Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes

Laparoscopic Trans-Abdominal Right Adrenalectomy for a Large Primitive Adrenal Oncocytic Carcinoma: A Case Report and Review of Literature

Risk Factors Associated With Perioperative Complications and Prolonged Length of Stay After Laparoscopic Adrenalectomy

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