Outcomes after laparoscopic adrenalectomy

The main risk factors for the occurrence of complications during laparoscopic adrenalectomy appear to be surgical inexperience, age, and body mass index of the patient, the dimension of the mass, and pheochromocytoma. Therefore, laparoscopic adrenalectomy, especially for tumors that are potentially more complicated, should only be undertaken in high-volume specialist centers by surgeons with the appropriate training and experience.

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“…In fact, the largest institutional studies have demonstrated a mortality and morbility rate of 6.7-6.8 and 0.27-0.5% respectively [5,6].…”

Section: Discussionmentioning

confidence: 99%

Complications in laparoscopic adrenalectomy: the value of experience

et al. 2011

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“…Contemporary imaging techniques with an increased detection of adrenal incidentalomas and new surgical techniques with reduction of morbidity and mortality with endoscopic methods [1, 2] have contributed to the increase in operations. In 1992, Gagner et al were among the first to describe laparoscopic adrenalectomy [3].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for complications after adrenalectomy: results from a comprehensive national database

Thompson

Nordenström

Almquist

et al. 2016

Langenbecks Arch Surg

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PurposeMost knowledge regarding outcome after adrenal surgery stems from retrospective studies reported by highly specialized centres. The aim of this study was to report a national experience of adrenalectomy with particular attention to predictive factors for postoperative complications, conversion from endoscopic to open surgery and length of hospital stay.MethodsAdrenalectomies reported in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009–2014 were included. Risk factors for complications, conversion and hospital stay >3 days were assessed using univariable and multivariable logistic regression analysis.ResultsThere were 659 operations. Endoscopic adrenalectomy was performed in 513 (77.8%) operations and almost half of these were robotic assisted. The median length of hospital stay was 3 (range 1–30) days. There was no 30-day mortality. In 43 (6.6%) patients, at least one complication was registered. The only factor associated with complications in multivariable analysis was conversion to open surgery odds ratio (OR) 3.61 (95% confidence interval 1.07 to 12.12). The risk for conversion was associated with tumour size OR 1.03 (1.00 to 1.06) and with malignancy on histopathology OR 8.33 (2.12 to 32.07). Length of hospital stay increased in patients with operation of bilateral tumours OR 3.13, left-sided tumours OR 1.98, hyper secretion of catecholamines OR 2.32, conversion to open surgery OR 42.05 and open surgery OR 115.18.ConclusionsThe present study shows that endoscopic surgery is widely used. Complications were associated with conversion and the risk for conversion was associated with tumour size and malignant tumour. Hospital stay was short.Electronic supplementary materialThe online version of this article (doi:10.1007/s00423-016-1535-8) contains supplementary material, which is available to authorized users.

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“…In the last decade, the number of adrenalectomies has increased considerably due to improved diagnostic methods and the introduction of the laparoscopic adrenalectomy technique, which has emerged as a safer surgical procedure and reduced the incidence of post-surgical complications (Kaye et al, 2010;Gupta et al, 2011). In 2006, more than 5000 patients were submitted to adrenalectomy in the United States only and around 40% of these surgeries were performed in men (Kaye et al, 2010;Gupta et al, 2011). Despite the efforts to keep the exogenous adrenal steroid administration at physiological levels, under-or over-dosing are frequent events in ADX patients and associated with a higher incidence of post-surgical side effects and co-morbidities (Kaye et al, 2010).…”

Section: (H) (I) (C) (F) (D) (G)mentioning

confidence: 99%

“…In the last decade, laparoscopic adrenalectomy has become a 'state of the art' technique for the surgical treatment of many conditions requiring the removal of adrenal glands in humans, such as pheochromocytoma and adrenal hyperplasia secondary to Cushing's disease, with more than 5000 surgeries performed in 2006 in the United States only (Gupta et al, 2011). Very little is known on the reproductive outcomes of this surgical procedure, which further requires steroid hormone replacement for a life-time.…”

Section: Introductionmentioning

confidence: 99%

Impact of adrenalectomy and dexamethasone treatment on testicular morphology and sperm parameters in rats: insights into the adrenal control of male reproduction

et al. 2014

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SUMMARYHere we investigated the hypothesis that normal levels of glucocorticoids, a class of adrenal steroid hormones, are required for normal testicular and epididymal functions. We examined the effects of the manipulation of glucocorticoid plasma levels by bilateral adrenalectomy (1, 2, 7 and 15 days) alone or in combination with daily treatment with the synthetic glucocorticoid dexamethasone (DEX; 5 lg/kg, i.p., 6 days) on the morphology of the testis and sperm parameters in rats. We showed that adrenalectomy led to a reduction in testicular sperm count and daily sperm production starting 2 days after surgery and a differential decrease in sperm count in the epididymis, according to the region and time post-adrenalectomy analysed. In parallel, testes from 7-day adrenalectomized (ADX) rats displayed a higher frequency of damaged seminiferous tubules and the presence of elongated spermatids retained in the basal epithelial compartment in stages IX-XVII, which is indicative of defective spermiation. The alkaline comet assay revealed a late effect of adrenalectomy on epididymal sperm DNA fragmentation, which was increased only 15 days after surgery. DEX treatment prevented the changes in testicular and epididymal sperm count observed in 7-day ADX rats, but failed to protect the testis from ADX-induced morphological abnormalities. Thus, our results indicated that glucocorticoids may be involved in events related to the maintenance of spermatogenesis and sperm maturation during adulthood. These findings provide new insights into the importance of adrenal steroids to male fertility.

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Outcomes after laparoscopic adrenalectomy

Abstract: The morbidity and mortality rates after LA are low. Dependent functional status and peripheral vascular disease predispose to postoperative morbidity. Dependent status, higher ASA class, and respiratory and neurologic comorbidities are associated with longer operative time and LOS.

Cited by 62 publications

References 36 publications

Complications in laparoscopic adrenalectomy: the value of experience

Complications in laparoscopic adrenalectomy: the value of experience

Risk factors for complications after adrenalectomy: results from a comprehensive national database

Impact of adrenalectomy and dexamethasone treatment on testicular morphology and sperm parameters in rats: insights into the adrenal control of male reproduction

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