Systematic review and meta-analysis of retroperitoneoscopic <i>versus</i> laparoscopic adrenalectomy

Constantinides, Vasilis; Christakis, Ioannis; Touska, Philip; Palazzo, Fausto

doi:10.1002/bjs.8921

Cited by 132 publications

(98 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…LA with transperitoneal submesocolic and retropancreatic approach has proven to be safe and effective [11,19,24], and its results are in line with those reported in the most recent literature [48] …”

Section: Laparoscopic Surgerysupporting

confidence: 76%

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Balla¹,

Quaresima²,

Seitaj³

et al. 2017

Laparoscopic Surgery

View full text Add to dashboard Cite

Introduction: The safety and efficacy of laparoscopic transperitoneal lateral adrenalectomy and retroperitoneoscopic adrenalectomy have been reported. The aim is to report the authors' experience in laparoscopic left adrenalectomy with an alternative transperitoneal submesocolic and retropancreatic approach with patient supine. Research methods:The authors have performed laparoscopic transperitoneal submesocolic, retropancreatic adrenalectomy for both benign and malignant, functioning lesions >4cm in diameter or with smaller lesions but having an imaging pattern suspicious of malignancy or of sub-clinically secreting tumors. After opening the posterior peritoneum at the root of the transverse mesocolon and Gerota's fascia, the junction of the inferior adrenal vein with the left renal vein is identified. The adrenal vein is then prepared and divided, followed by mobilization and removal of the left adrenal gland.Conclusion: Early ligation of the adrenal vein is the most relevant technical feature of this procedure to avoid the release of catecholamines, hormones or neoplastic cells which could occur during manipulation of the gland prior to ligation of the main adrenal vein. Moreover, this approach makes it possible to perform associated procedures, including a bilateral adrenalectomy, without the need to reposition the patient on the operative table, but simply by positioning additional trocars.

show abstract

Section: Laparoscopic Surgerysupporting

confidence: 76%

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Balla¹,

Quaresima²,

Seitaj³

et al. 2017

Laparoscopic Surgery

View full text Add to dashboard Cite

show abstract

“…19 Although he remains the surgeon with by far the largest experience in adrenalectomy, even in his practice, bilateral cases remain a small minority, with only 19 of 560 patients presenting with bilateral disease. 20 Despite the disadvantage of having a limited working area, which makes this procedure technically more demanding, the retroperitoneal approach is now widely accepted as a fast and safe operation, with the additional benefit for bilateral operations of avoiding the need for repositioning during the procedure.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenalectomy: a review of 10 years’ experience

Maccora

Walls

Sadler

et al. 2017

annals

View full text Add to dashboard Cite

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.

show abstract

“…Retroperitoneal LA, first described by Mercan et al [3] and Taskin et al [4], has provided a safe and direct access to the adrenal gland without the retraction or mobilization of the adjacent organs. Overall, several reviews have pointed out that retroperitoneal LA has equivalent outcomes as that of the traditional lateral transabdominal approach for the resection of adrenal lesions [5,6]. …”

Section: Introductionmentioning

confidence: 99%

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Hang

Ho³

et al. 2015

Urol Int

View full text Add to dashboard Cite

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.

show abstract

Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy

Abstract: RA overall has equivalent outcomes to LA but may be associated with a shorter hospital stay.

Cited by 132 publications

References 45 publications

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Laparoscopic Left Adrenalectomy with Submesocolic and Retropancreatic Approach

Bilateral adrenalectomy: a review of 10 years’ experience

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

Contact Info

Product

Resources

About