Modified three-level techniques of retroperitoneal laparoscopic procedures to treat adrenal lesions for patients with BMI ≥ 25 Kg/m²

Abstract

Objective: To evaluate the modified Zhang's 'three-level' technique of retroperitoneal laparoscopic adrenalectomy (RLA) to treat adrenal lesions for patients with BMI of 25-30 Kg/m 2 . Methods: A retrospective analysis was performed in all patients with BMI of 25-30 Kg/m 2 in our hospital from January 2014 to December 2019. Those who underwent laparoscopic adrenal surgery were divided into two groups on the basis of the technique used: the Zhang's technique (the ZT group) and the modified technique (the MT group). Results: Herein, 170 operations were included (ZT, 91 patients; MT, 79 patients). RLA was successfully performed in all of them. Compared with the ZT group patients, the MT group patients showed shorter operation time ( p = 0.007), lesser intraoperative blood loss ( p = 0.023), shorter operation time, earlier postoperative diet recovery ( p < 0.001), shorter postoperative drainage time ( p < 0.001) and shorter postoperative hospitalization period ( p = 0.001). It was also worth noting that the unplanned total adrenalectomy rate was significantly less in the MT group than in the ZT group (0% vs. 10.8%, p = 0.020). There was no significant difference in the complications between the two groups (3.3% vs. 2.5%, p = 0.567). Conclusions: We found that MT was a beneficial retroperitoneal laparoscopic treatment for adrenal lesions in patients who had a BMI of 25-30 Kg/m 2 . It may provide a reference for the treatment of adrenal surgical diseases in such patients.

The Modified Retroperitoneal Laparoscopic Adrenalectomy effectively resolves adhesive periadrenal fat and achieves superior outcomes

“…The surgical procedures have been described in a previous report. [12] We con rm that all methods were performed in accordance with the relevant guidelines and regulations. This study was approved by the Ethics Committee of Fujian Provincial Hospital, Fujian Province, People's Republic of China (approval K2023-05-008).…”

“…[11] Compared to modi ed three-layered retroperitoneal laparoscopic adrenalectomy (MTRLA), unexpected TA rates were signi cantly higher in patients with high body mass index (BMI). [12] And higher BMI indicates a higher mayo adhesive probability (MAP) score. [13] A higher MAP score was associated with the operative time in LA [14,15] , as well as estimated blood loss and drainage tube removal time.…”

Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study

“…A limitation of this study is that it was a retrospective study conducted at our institution. Although previous studies have shown the advantages of the MT procedure ( 16 ), other surgeons with comparable experience may perceive the difference to be insignificant because of the significant differences in sample sizes between the two groups. Stratified analyses for patients with different MAP scores have not been conducted at this time ( 14 ) and adrenal lesion locations, which is our next step.…”

“…The detailed steps have been described in the previous article ( 16 ).The surgical video still was demonstrated in Figure 2 , and the complete procedure video ( 17 ) can be accessed by scanning Figure 2D . The schematic diagram of modified and three-level technique of retroperitoneal laparoscopic adrenalectomy was shown on Figure 3 .…”

“…also mentioned, for obese and cushing patients, perirenal fat in the upper pole of the kidney should be excised first ( 12 ). To address the challenge of upper pole renal fat interference in surgical procedures for overweight and obese patients, we implemented modified three-level retroperitoneal laparoscopic techniques in patients with a BMI ≥ 25 Kg/m2, resulting in significant enhancements ( 16 ). We further generalize this technology to encompass the entire population.…”