Laparoscopic adrenalectomy in urological centres – the experience of the German Laparoscopic Working Group

Abstract

Study Type – Practice patterns (retrospective cohort) Level of Evidence 2b OBJECTIVE • To evaluate the safety and feasibility of laparoscopic adrenalectomy (LA) performed in several German centres with different laparoscopic experience, as LA has become the gold‐standard approach for benign surgical adrenal disorders; however, for solitary metastasis or primary adrenal cancer its precise role is uncertain. PATIENTS AND METHODS • The data of 363 patients who underwent a LA were prospectively collected in 23 centres. • All centres were stratified into three groups according to their experience: group A (<10 LAs/year), group B (10–20 LAs/year) and group C (>20 LAs/year). • In all, 15 centres used a transperitoneal approach, four a retroperitoneal approach and four both approaches. • Demographic data, perioperative and postoperative variables, including operating time, surgical approach, tumour size, estimated blood loss, complications, hospital stay and histological tumour staging, were collected and analysed. RESULTS • The transperitoneal approach was used in 281 cases (77.4%) and the retroperitoneal approach was used in 82 patients (22.6%). • In all, 263 of 363 lesions (72.5%) were benign and 100 (27.5%) were malignant. • The mean (sd) operating time was 127.22 (55.56) min and 130.16 (49.88) min after transperitoneal and retroperitoneal LA, respectively. • The mean complication rates for transperitoneal and retroperitoneal LA were 5% and 10.9%, respectively. CONCLUSION • LAs performed by urologists experienced in laparoscopy is safe for the removal of benign and malignant adrenal masses. LA for malignant adrenal tumours should be performed only in high‐volume centres by a surgeon performing at least >10 LAs/year.

Robotic Versus Laparoscopic Adrenalectomy: A Systematic Review and Meta-analysis

“…In a multicenter study, Greco et al demonstrated that laparoscopic surgery for malignant adrenal tumors should be performed only in high-volume centers with at least ≥10 adrenalectomies per year [26]. We did not specifically analyze and compare oncologic outcomes from the studies included in the present meta-analysis because only two of them partially reported on these outcomes.…”

Impact of Laparoscopic Adrenalectomy on Overall Survival in Patients with Nonmetastatic Adrenocortical Carcinoma

“…12,13 Laparoscopic adrenalectomy (LA) was initially described in 1992 and has become the gold standard for treatment of benign adrenal tumors. [14][15][16][17] In multiple retrospective studies, LA is associated with lower operative complication rates, shorter hospital stays, reduced 30-day morbidity, and lower overall costs. [18][19][20][21][22] However, the role of LA for treatment of patients with ACC remains controversial, particularly as it relates to its oncologic outcomes.…”

Comparison of Retroperitoneoscopic and Transperitoneal Laparoscopic Adrenalectomy for Right-Sided Benign Tumors: A Single-Institute Experience

“…If there is no evidence of metastasis, size alone does not predict malignancy in pheochromocytomas [21]. Greco et al [22] conducted a multicenter study and reported that the upper limit for adrenalectomy could be as high as 10-14 cm for very experienced surgeons. In our series, a pheochromocytoma measuring 9 cm in diameter was removed successfully using the retroperitoneal approach with a blood loss of 50 ml.…”