Risk factors for open conversion of lateral transperitoneal laparoscopic adrenalectomy: retrospective cohort study of the Spanish Adrenal Surgery Group (SASG)

Vidal, Òscar; Saavedra-Pérez, David; Martos, Juan M.; Quintana, Aitor de la; Rodrı́guez, José Ignacio; Villar, Jesús; Moral, Antonio; Durán, Manuel; Valentini, Mauro; Fernández‐Cruz, Laureano

doi:10.1007/s00464-019-07264-1

Cited by 20 publications

(27 citation statements)

References 30 publications

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“…More than 75% of laparoscopic adrenalectomies are done using a lateral transperitoneal technique. The main advantage of the flank approach is that it allows the adrenal glands to be exposed by the gravity [8,14].…”

Section: Discussionmentioning

confidence: 99%

“…The rate of conversion to open surgery in laparoscopic adrenalectomy is 1-22% [8,18,23]. Conversion is usually due to bleeding, firm adhesions, obesity, large masses, inexperienced surgeons, or malignant processes [3,8,21].…”

Section: Discussionmentioning

confidence: 99%

“…In adrenalectomy in particular, obesity is associated with longer operative times, longer total times in the operating room, wound infections, septic complications, and longer hospital stays [14,15,23,24]. Although high BMI is a risk factor for conversion to open surgery, laparoscopic adrenalectomy can be safely performed in obese patients, maintaining the advantages of minimally invasive surgery [8,23,25]. Metabolic syndrome (obesity, diabetes, and arterial hypertension) has been associated with higher rates of complications, blood transfusion, and longer hospital stay after laparoscopic adrenalectomy [2].…”

Section: Discussionmentioning

confidence: 99%

“…Patient comorbidities (ASA III + IV, previous abdominal surgery, obesity, and diabetes), adrenal pathology (pheochromocytoma), tumor size (≥6 cm), and surgeons' inexperience are associated with increased operative time, conversions, complications, and length of stay [5,6,8,19,24,26]. Our study included many patients with ASA III + IV (98/160, 61.2%), previous abdominal surgery (80/160, 50%), obesity (90/160, 56.2%), diabetes (30/160, 18.8%), pheochromocytoma (39/160, 24.4%), and tumors ≥6 cm (53/160, 33.1%).…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, laparoscopy has become the standard technique for treating adrenal tumors [4][5][6]. In Spain, adrenalectomy is performed in high-volume (>10 per year) centers with an endocrine surgery unit [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Outcomes between Obese and Nonobese Patients in Laparoscopic Adrenalectomy: A Cohort Study

et al. 2021

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Introduction: Obesity is usually considered a risk factor for surgical complications. Laparoscopic adrenalectomy has replaced open adrenalectomy as the standard operation for adrenal tumors. Objective: To compare the safety of laparoscopic adrenalectomy to treat adrenal tumors in obese versus nonobese patients. Methods: This observational cohort study analyzed consecutive patients who underwent laparoscopic adrenalectomy with a lateral transperitoneal approach at a single center (2003–2020). Data and outcomes of obese (body mass index ≥30 kg/m2) and nonobese patients were compared. To analyze the association between operative time and other variables, we used simple and multivariate linear regression. Results: N = 160 (90 obese/70 nonobese) patients underwent laparoscopic adrenalectomy. Cushing syndrome and pheochromocytoma were the most frequent indications. Obese patients were older (58 vs. 52 years, p < 0.001). A greater proportion of obese patients were ASA grade III + IV (71.1 vs. 48.6%, p = 0.004). Obesity was associated with a longer operative time (72.5 vs. 60 min, p < 0.001) and greater blood loss (40 vs. 20 mL, p = 0.022). There were no differences in conversion, morbidity, or hospital stay. After adjustment for confounding factors, operative time was positively correlated with BMI ≥30 kg/m2, learning curve, estimated blood loss, 2D laparoscopy, and specimen size. Conclusion: Lateral transperitoneal laparoscopic adrenalectomy is safe in patients with a BMI 30–35 kg/m2, so these patients also benefit from this minimally invasive surgery.

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Section: Discussionmentioning

confidence: 99%