Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study

Al-Jalabneh, Talal Mustafa; Al-Shawabkeh, Omar Ayed; Al-Gwairy, Ibrahim; Abu-Zeitoun, Omar; Al-Njadat, Ismaieel; Alsoudi, Majdi Abdelmahdi; Zarour, Ahmad

doi:10.5455/medarh.2021.75.41-44

Cited by 10 publications

(3 citation statements)

References 21 publications

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“…Therefore, RA may be good for pheochromocytomas as well as large malignant tumors. Finally, surgeons should remember that the choice of open adrenalectomy (OA) should be considered to accomplish complete resection in patients with tumors >10 cm, malignant tumors >6 cm, or invasion and/or vascular thrombi 29,30 …”

Section: Discussionmentioning

confidence: 99%

Perirenal fat thickness is a powerful predictor for surgical outcomes of transperitoneal laparoscopic adrenalectomy

Hayashida,

Sakaguchi,

Yasuoka

et al. 2023

Int J of Urology

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ObjectivesLaparoscopic adrenalectomy has been the gold standard surgical procedure. However, the adaptation criteria for malignant tumors and predictors of perioperative outcomes are not well defined. Therefore, this study tried to identify valid predictors for perioperative outcomes of laparoscopic adrenalectomy and consider the adaptation criteria.MethodsWe retrospectively reviewed the preoperative and perioperative data of 216 patients who underwent transperitoneal laparoscopic adrenalectomy in our hospital. Preoperative factors associated with perioperative outcomes were analyzed using multiple regression analysis.ResultsAmong 216 patients, 165 (76.4%), 26 (12.0%), and 25 (11.6%) were suspected of having benign tumors, pheochromocytoma, and malignant tumors, respectively. Median tumor size was 25.0 mm (interquartile range 18.0–35.0); median perirenal fat thickness was 9.2 mm (interquartile range 4.9–15.6) on preoperative computed tomography scans. The median operative time was 145.5 min (interquartile range 117.5–184.0) and the median estimated blood loss was 0.0 mL (interquartile range 0.0–27.3). Perirenal fat thickness (p < 0.001), tumor size (p < 0.001), and malignant tumors (p = 0.020) were associated with operative time, and perirenal fat thickness (p = 0.038) and malignant tumors (p = 0.002) were associated with estimated blood loss.ConclusionsPerirenal fat thickness, tumor size, and malignant tumors are valid predictors of the surgical outcomes of transperitoneal laparoscopic adrenalectomy. As only perirenal fat thickness is associated with both surgical outcomes except for malignant tumors, it is a powerful predictor. Transperitoneal laparoscopic adrenalectomy for large malignant adrenal tumors with thick perirenal fat should be performed with caution.

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Section: Discussionmentioning

confidence: 99%

Perirenal fat thickness is a powerful predictor for surgical outcomes of transperitoneal laparoscopic adrenalectomy

Hayashida,

Sakaguchi,

Yasuoka

et al. 2023

Int J of Urology

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“…Laparoscopic adrenalectomy (LA) is considered to be the gold standard surgery for treating most benign and malignant adrenal lesions ( 1 ). Compared with open surgery, LA is associated with lower complications, faster operation time and smoother recovery ( 2 ). Although several approaches have been reported for LA, transperitoneal and retroperitoneal are the most frequently used surgical approaches for the adrenal glands ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of a nomogram for predicting the surgical difficulty of lateral retroperitoneal laparoscopic adrenalectomy

Zhao¹,

Wu²,

Qiu³

et al. 2023

Transl Androl Urol

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Background: Lateral retroperitoneal laparoscopic adrenalectomy (LRLA) is widely performed for the resection of adrenal disorders, but when larger and more malignant lesions are involved, the difficulty of LRLA increases. We aimed to develop and evaluate a predictive model for the surgical difficulty of LRLA.Methods: A retrospective, observational, single-center study was performed involving all consecutive cases of unilateral RLA for adrenal disease from 2012.01 to 2021.12. Cases were randomly divided into training and validation cohorts (split ratio =7:3), then least absolute shrinkage and selection operator (LASSO) regression was applied to reduce data dimension and select predictors. Multivariate logistic regression followed to develop the prediction nomogram for the surgical difficulty of LRLA. Finally, receiver operating characteristic (ROC) curve, calibration curve plot and decision curve analysis (DCA) were used to evaluate the nomogram's discrimination, calibration, and clinical usefulness, respectively.Results: A total of 621 cases were enrolled with a median age of 53 years and a median tumor diameter of 1.7 cm. After LASSO regression analysis, surgeon's experience, tumor diameter, resection procedure, histological type, patient's sex and body mass index (BMI) were identified to establish the nomogram. The model displayed good discrimination with area under the curve (AUC) in both the training cohort (0.754, 95% CI: 0.701-0.806) and validation cohort (0.742, 95% CI: 0.646-0.838). Additionally, excellent calibration curves were revealed for surgical difficulty evaluation in both the training cohort (P=0.999) and validation cohort (P=0.444). DCA results indicated the prediction model was clinically useful.Conclusions: Our novel and effective predictive model can be used to assess the individual surgical difficulty of LRLA. By stratifying patients at risk of having a difficult LRLA for adrenal disease, the model could contribute to improvements in perioperative strategy and therapy.

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“…Laparoscopic surgery has developed into a mainstream surgical approach in the field of urology in recent years [ 1 , 2 ]. However, the special pathophysiological conditions of elderly patients and the effect of the pneumoperitoneum on respiratory circulation during surgery may trigger a strong stress response in the body [ 3 ], which are prone to adverse prognostic outcomes such as neurocognitive disorders and damages to vital organs after surgery [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial

Qi,

Fan,

Wang

et al. 2023

BMC Anesthesiol

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Background Based on electroencephalogram (EEG) analysis, index of consciousness (IoC) monitoring is a new technique for monitoring anesthesia depth. IoC is divided into IoC1 (depth of sedation) and IoC2 (depth of analgesia). The potential for concurrent monitoring of IoC1 and IoC2 to expedite postoperative convalescence remains to be elucidated. We investigated whether combined monitoring of IoC1 and IoC2 can effectively enhances postoperative recovery compared with bispectral index (BIS) in elderly patients undergoing laparoscopic urological surgery under general anesthesia. Methods In this prospective, controlled, double-blinded trail, 120 patients aged 65 years or older were arbitrarily assigned to either the IoC group or the control group (BIS monitoring). All patients underwent blood gas analysis at T1 (before anesthesia induction) and T2 (the end of operation). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were administered to all patients at T0 (1 day before surgery) and T4 (7 days after surgery). Serum concentrations of C-reactive protein (CRP) and glial fibrillary acid protein (GFAP) were assessed at T1, T2, and T3 (24 h after surgery). Postoperative complications and the duration of hospitalization were subjected to comparative evaluation. Results The incidence of postoperative cognitive dysfunction (POCD) was notably lower in the IoC group (10%) than in the control group (31.7%) (P = 0.003). Postoperative serum CRP and GFAP concentrations exhibited significant differences at time points T2 (CRP: P = 0.000; GFAP: P = 0.000) and T3 (CRP: P = 0.003; GFAP: P = 0.008). Postoperative blood glucose levels (P = 0.000) and the overall rate of complications (P = 0.037) were significantly lower in Group IoC than in Group control. Conclusion The employment of IoC monitoring for the management of elderly surgical patients can accelerate postoperative convalescence by mitigating intraoperative stress and reducing peripheral and central inflammatory injury. Trial registration Chinese Clinical Trial Registry Identifier: ChiCTR1900025241 (17/08/2019).

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Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study

Cited by 10 publications

References 21 publications

Perirenal fat thickness is a powerful predictor for surgical outcomes of transperitoneal laparoscopic adrenalectomy

Perirenal fat thickness is a powerful predictor for surgical outcomes of transperitoneal laparoscopic adrenalectomy

Establishment and validation of a nomogram for predicting the surgical difficulty of lateral retroperitoneal laparoscopic adrenalectomy

Index of consciousness monitoring during general anesthesia may effectively enhance rehabilitation in elderly patients undergoing laparoscopic urological surgery: a randomized controlled clinical trial

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