No Outcome Differences between a Laparoscopic and Retroperitoneoscopic Approach in Synchronous Bilateral Adrenal Surgery

Miccoli, Paolo; Materazzi, Gabriele; Brauckhoff, Michael; Ambrosini, Carlo Enrico; Miccoli, Mario; Dralle, Henning

doi:10.1007/s00268-011-1294-1

Cited by 22 publications

(16 citation statements)

References 27 publications

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“…Although retroperitoneal LA was introduced after lateral approach, both the techniques provide favorable outcomes, either in pheochromocytoma or in bilateral adrenalectomy [16,17]. However, the growing population of obese patients seems to bring more technical challenges to surgeons.…”

Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Hang

Ho³

et al. 2015

Urol Int

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Introduction: Obesity is usually considered a risk factor for postoperative complications; however, previous studies conclude contradictory results in retroperitoneal laparoscopic adrenalectomy (LA). We aim to evaluate the impact of obesity on the perioperative outcomes of LA. Methods: A retrospective cohort study from a single center including 353 patients from 2011 to 2013 was conducted. Perioperative outcomes of patients from different groups were compared according to their body mass index (BMI). Results: All the patients were divided into 3 groups: normal (n = 149), overweight (n = 141) and obese (n = 63). Operative time (OT) for patients belonging to the obese group was significantly longer than that in the normal and overweight group, and the results of estimated blood loss, postoperative length of stay in hospital and postoperative complications were all similar. In the multivariate logistic regression analysis, OT was an independent risk factor for postoperative complications (odds ratio 1.020; 95% confidence interval 1.001-1.039; p = 0.037), while other factors including BMI had negligible effect. Conclusions: Retroperitoneal LA offers similar perioperative outcomes for patients with different obesity statuses, which could be safe and feasible for obese patients.

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Section: Discussionmentioning

confidence: 99%

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Hang

Ho³

et al. 2015

Urol Int

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“…[21][22][23] Two case series compared SBA and found no significant advantages or disadvantages for either technique: Miccoli et al 21 compared the lateral transperitoneal and the retroperitoneal technique, while Raffaelli et al 22 compared transabdominal laparoscopic, simultaneous posterior retroperitoneoscopic and robot-assisted approach. It is likely therefore that the choice between laparoscopic lateral transabdominal versus posterior retroperitoneal approach will be based on individual surgeon's preference, 23 and the small number of cases will make it impossible to compare the two techniques through a randomized trial.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenalectomy: a review of 10 years’ experience

Maccora

Walls

Sadler

et al. 2017

annals

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INTRODUCTIONThe 2012 British Association of Endocrine and Thyroid Surgeons audit report showed that only 86 of 1359 patients who underwent adrenalectomy had a bilateral operation; thus the experience with this procedure remains limited. METHODS Retrospective review of patients undergoing bilateral adrenalectomy in a tertiary referral centre. RESULTS Between November 2005 and January 2016, bilateral adrenalectomy was performed in 23 patients (6 male, 17 female, age 43 ± 4 years) diagnosed with Cushing's disease (n = 13), hereditary phaeochromocytomas (n = 6), adrenocortical cancer (n = 2), colorectal metastatic disease (n = 1) and adrenocortical adenomas (n = 1).A laparoscopic transperitoneal approach was used in 17 patients, with one conversion to open. Three patients had open adrenalectomies for adrenocortical cancer and for simultaneous phaeochromocytomas and pancreatic neuroendocrine tumours in a patient with Von Hippel-Lindau syndrome. Three patients with Cushing's had a bilateral retroperitoneoscopic operation. The mean operating time was 195 ± 16 minutes for laparoscopic operations (n = 16), 243 ± 44 minutes for open adrenalectomies (n = 4) and 151 ± 12 minutes for retroperitoneal operations. It was significantly shorter for Cushing's disease than for phaeochromocytomas (162 ± 8 vs. 257 ± 39 minutes, P < 0.01).Median length of hospital stay was 5 days. Postoperative complications (Clavien-Dindo classification) included one chest infection (level 2), one postoperative haemorrhage and two chest drains for pneumothorax (level 3), two postoperative cardiac arrests (level 4) and one late cancer death from complications related to uncontrolled hypercortisolism (level 5). DISCUSSION Synchronous bilateral adrenalectomy remains an infrequent operation. The laparoscopic approach is feasible in the majority of patients. It is likely that the retroperitoneoscopic adrenalectomy will become the standard approach for bilateral operations.

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“…Wenn dann auch noch unterschiedliche Sozial systeme zugrunde liegen, werden verglei chende Angaben, z. B. zur Verweildauer, unsinnig [25].…”

Section: Vergleich Der Operationsmethodenunclassified

Minimal-invasive Nebennierenchirurgie

Walz

2012

Chirurg

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Currently adrenal gland surgery can be performed by a variety of laparoscopic and retroperitoneoscopic approaches. Of particular importance are the lateral laparoscopic and posterior retroperitoneoscopic approaches. Comparative studies of transperitoneal and retroperitoneal adrenalectomy demonstrate heterogeneous results. Nevertheless, retroperitoneal techniques may offer less postoperative pain and faster recovery. All these minimally invasive techniques are safe and reliable and have replaced open approaches in most cases.

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No Outcome Differences between a Laparoscopic and Retroperitoneoscopic Approach in Synchronous Bilateral Adrenal Surgery

Abstract: It is not possible to determine which of the two approaches is better; both are feasible, safe, and effective and patient outcomes are almost the same.

Cited by 22 publications

References 27 publications

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Bilateral adrenalectomy: a review of 10 years’ experience

Minimal-invasive Nebennierenchirurgie

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