Laparoscopic Adrenalectomy Has the Same Operative Risk as Routine Laparoscopic Cholecystectomy

Limberg, Jessica; Ullmann, Timothy M.; Gray, Katherine D.; Stefanova, Dessislava; Zarnegar, Rasa; Li, Jing; Fahey, Thomas J.; Beninato, Toni

doi:10.1016/j.jss.2019.03.042

Cited by 14 publications

(9 citation statements)

References 20 publications

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“…Elfenbein and colleagues reported shorter OT and LOS for both groups (OA and LA) compared with our results, which could be potentially explained by being performed by more experienced surgeons in the private sector. These findings of comparable outcomes to private sector outcomes 6,[16][17][18] are well illustrated in our data despite the nature of the VA patients population having more comorbidities, as reported previously. 7,19,20 Adrenal mass size represents one of the major factors in the selection of the surgical approach, and a predictor of difficulty, conversion, and complications.…”

Section: Discussionsupporting

confidence: 90%

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Shahait

Saleh

Weaver

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies.Methods: Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes.Results: A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class ≥ III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥ 1 complication. LA was performed in 70.9% ( 1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥ III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. Conclusion:LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.

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Section: Discussionsupporting

confidence: 90%

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Shahait

Saleh

Weaver

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…In one study, the database of American College of Surgery National Surgical Quality Improvement Program was evaluated for the laparoscopic cholecystectomy and laparoscopic adrenalectomy applied between 2012 and 2015, and the operative risks were found same for both procedures. [22] Also, in patients with a history of previous abdominal surgery, laparoscopic adrenalectomy can be safely applied when compared to patients with no history of previous abdominal surgery. [23] Moreover, for successful laparoscopic adrenal surgery, surgical experience, number of patients operated in a hospital per year and multidisciplinary approach of the surgeon, endocrinologist and anesthesiologist for patient selection are crucial.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Approach To The Adrenal Masses: Single Center Experience Of 5 Years

Kostek¹

2020

Sisli Etfal

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S urgical approach to the adrenal masses is an important challenge for surgeons and decision making for operative strategy is critical for patient safety and prognosis. A surgeon should decide how to manage an adrenal mass considering the patient's general performance, size of the adrenal mass, presence of malignancy, previous operation history of the patient and his own surgical skills. [1] Although open adrenalectomy is a standard procedure, minimally invasive techniques become increasingly widespread, such as laparoscopic adrenalectomy, which has be-come a gold standard technique since its definition in 1992 by Gagner et al. [2][3][4] Robotic or laparoscopic techniques and transabdominal or posterior retroperitoneal approach can be applied to the patient considering the surgeon's experience and characteristics of adrenal masses. [5] Malignant adrenocortical tumors are the main cases for open surgery to avoid the dissemination of cancer. [1,6] Tumor size is important for decision making, but there is no consensus for open surgery indication. Laparoscopic adrenalectomy has superiority over open adrenalectomy con-Objectives: Currently, laparoscopic adrenalectomy is the gold standard technique for suitable patients with adrenal masses. In this study, we aimed to assess the postoperative results of patients who underwent laparoscopic adrenalectomy. Methods: Between January 2014 and October 2019, 76 cases were operated and retrospectively evaluated. Laparoscopic transabdominal adrenalectomy was applied to the patients. Demographic profiles, preoperative indications, intraoperative and postoperative complications, mortality and length of hospital stay were evaluated. Results: Seventy-six patients (30 male, 46 female) with a mean age of 47.2±11.7 (range 22-71) years underwent laparoscopic adrenalectomy. Thirty-nine of the patients had right; 33 of the patients had left adrenal masses. Three patients had bilateral adrenal cortical hyperplasia. One patient was operated for paraganglioma. Conversion to open adrenalectomy was observed in four patients (5.26%). Nine patients (11.8%) experienced intraoperative and postoperative complications. Intraoperative and postoperative complications were bleeding from spleen (2 cases) and upper pole of kidney (1 case), renal artery injury (1 case), bleeding from liver parenchyma (2 cases), ischemia of spleen and pancreas (1 case), small intestinal injury (1 case) and incisional hernia (1 case). The complication rate is acceptable and comparable with other studies in the literature. Conclusion: Laparoscopic adrenalectomy can be safely applied in suitable patients with acceptable complications and low conversion rates.

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“…Traditionally, rigth-sided, large-sized or hormonal active tumors are believed to be more challenging but some recent publications claim otherwise. [6,10,11] More interestingly, Limberg et al [12] reported that laparoscopic adrenalectomy is as safe and feasible as laparoscopic cholecystectomy procedure and emphasized that physicians should not hesitate to refer their patients to surgery. Herewith, on the basis of our experience in minimally invasive surgery, we aimed to demonstrate the applicability of the procedure by representing our 5-year results.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic adrenalectomy by transabdominal lateral approach. Should we be afraid of getting started? First 5 years of experience

Çolakoğlu¹

2019

Laparosc Endosc Surg Sci

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Introduction: A laparoscopic approach has become the standard procedure for removing adrenal masses. However, the need for experience with the technique continues to be emphasized. The aim of this study was to retrospectively review the first 5 years of data of patients who had an adrenal mass and underwent laparoscopic surgery with a transabdominal lateral approach. Materials and Methods: All of the patients at a single institution who were operated on for an adrenal mass using a laparoscopic transabdominal lateral approach between January 2014 and January 2019 were included. The demographic data, any history of other abdominal surgery, American Society of Anesthesiologists score, preoperative diagnosis, hormonal characteristics of the tumor, intraoperative parameters, intraand postoperative complications, and the histological diagnosis were analyzed. Results: A total of 42 laparoscopic adrenalectomy procedures were performed. The mean age of the patients was 50.64±13.22 years. The lesion was located on the right side in 52.3% of the patients. Nine patients (21.4%) had previously undergone abdominal surgery for various reasons. The majority of the adrenal masses were a secretory adenoma or hyperplasia of the gland. Four patients were operated on for metastasis of other malignancies and others were non-secreting tumors. The mean size of the adrenal lesions was 29.4±12.7 mm. The mean operative time was 140.45 minutes and the mean blood loss was 62.9 mL. Intraoperative complications occurred in 3 cases (7.1%). Complications were observed postoperatively in 9 patients (21.4%). The mean length of hospitalization was 3.8±2.1 days. Conclusion: A laparoscopic adrenalectomy proved to be a safe and feasible method, even in cases in which it was the operator's first experience with the procedure. The results of a first application were similar to those reported in the literature. However, we strongly believe that other prior laparoscopic experience is required to achieve these results.

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Laparoscopic Adrenalectomy Has the Same Operative Risk as Routine Laparoscopic Cholecystectomy

Cited by 14 publications

References 20 publications

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Laparoscopic Approach To The Adrenal Masses: Single Center Experience Of 5 Years

Laparoscopic adrenalectomy by transabdominal lateral approach. Should we be afraid of getting started? First 5 years of experience

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