Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults

Arezzo, Alberto; Bullano, Alberto; Cochetti, Giovanni; Cirocchi, Roberto; Randolph, Justus; Mearini, Ettore; Evangelista, Andrea; Ciccone, Giovannino; Bonjer, H. Jaap; Morino, Mario

doi:10.1002/14651858.cd011668.pub2

Cited by 48 publications

(48 citation statements)

References 66 publications

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“…The adrenal gland can be approached directly through the retroperitoneal approach without obscuring other visceral organs; however, the operation field may be limited for large adrenal tumors. Although our study did not compare both approaches, our findings are consistent with the meta-analysis including 5 trials with a total of 244 participants by Arrezo et al, which compared transperitoneal and retroperitoneal laparoscopic adrenalectomy in adults and concluded that retroperitoneal adrenalectomy had an earlier start of oral intake and ambulation [ 51 ].…”

Section: Discussionsupporting

confidence: 90%

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Kang

et al. 2021

Annals of Medicine &Amp; Surgery

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Background To investigate the outcomes of laparoendoscopic single-site adrenalectomy (LESS-A) compared to multi-port laparoendoscopic adrenalectomy (m-LA). Methods Studies comparing LESS-A with m-LA were identified from PubMed, Embase, and Cochrane Library before June 2020. Post-operative pain, resumption outcomes, and perioperative outcomes were analyzed. We conducted meta-analyses using the Mantel-Haenszel method with random-effects model. Subset analyses were conducted according to peritoneal and retroperitoneal approaches. A small study effect was illustrated using funnel plots and Egger's test. Results One randomized controlled trial (RCT) and nineteen retrospective cohort studies involving 1554 patients were included for analyzed. Pooled analysis showed that LESS-A had significantly lower postoperative pain scores (MD −0.77, 95%CI −1.45 to −0.10) and less pain medication used (RR 0.74, 95%CI 0.60 to 0.91) compared to m-LA. Besides, LESS-A had significantly shorter hospital stays (MD −0.75, 95%CI −1.18 to −0.33), shorter duration of oral intake resumption (MD −0.33, 95%CI −0.60 to −0.06), and better cosmetic satisfaction (SMD 1.15, 95%CI 0.21 to −2.09). As for perioperative outcomes, LESS-A led to significant longer operative time (MD 13.43, 95%CI 4.08 to 22.77). No significant differences were observed in terms of the remaining perioperative outcomes. Conclusions LESS-A is associated with less post-operative pain and quicker recovery duration. However, the longer operative time of LESS-A compared with m-LA is a drawback.

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Section: Discussionsupporting

confidence: 90%

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Kang

et al. 2021

Annals of Medicine &Amp; Surgery

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“…A Cochrane systematic review and meta-analysis has documented that the posterior approach may show a shorter time to oral fluid or food intake and time to ambulation than the transperitoneal approach [24], however, in the current study, postoperative follow-up posed no impact on bowel movements, and all patients tolerated oral fluid intake at the 6th hour postoperatively, and normal diet on the first postoperative day. Mobilization and respiratory therapy using the tri-flow instrument are also initiated on the first postoperative day.…”

Section: Discussioncontrasting

confidence: 59%

Feasibility of laparoscopic approach in malignant and benign adrenal lesions

2020

Ann Clin Anal Med

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Aim: The approach to adrenal lesions is still controversial, especially concerning the potentially malignant masses. This study aims to present the results of laparoscopic adrenalectomy of a tertiary referral center, and the laparoscopic management strategy of both benign and malignant lesions. Materials and Methods: This retrospective study conducted in a single tertiary referral center was designed to evaluate the laparoscopic management strategy of both benign and malignant adrenal lesions. The demographic and clinical data were retrieved by reviewing electronic medical files yielding to 43 patients. The surgical outcomes were evaluated based on the postoperative complications and length of hospital stay. All patients were operated employing minimally invasive surgery techniques precisely via the lateral transperitoneal approach. Results: Out of 43 patients, 35 had benign pathology, whereas eight had adrenocortical carcinoma (ACC). Regardless of the size of ACC, the National Comprehensive Cancer Network (NCCN), the American Association of Clinical Endocrinologists (AACE), and American Association of Endocrine Surgeons (AAES) recommend open surgery, however in selected cases of ACC, we do recommend the laparoscopic approach since the results are satisfactory and this recommendation is endorsed by the European Society of Endocrine Surgeons. The mean duration of hospital stay was 2.96±0.9 days. The mean operative time was 124.8±45 minutes. The operative time was not affected by tumor sidedness, however, those operated for malignancy had statistically significant longer operative time than the benign lesions. Discussion: Even though the posterior retroperitoneal approach is considered to be more comfortable for the patient, it is unfortunately restricted to selective non-obese cases with small, benign lesions, hence, benign and selected cases of malignant adrenal lesions could feasibly be treated through the transperitoneal approach.

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“…The advantages of the laparoscopic compared with the traditional approach are less pain, faster recovery and shorter hospitalization, and it is usually reserved for smaller myelolipomas (11,12). Robotic surgery is being increasingly used in different common surgical procedures, although its applicability in adrenal surgery remains debated upon (13,14). A magnified 3D view of the operative field, the absence of tremor, wristed instruments and improved ergonomics are considered invaluable advantages over the laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Robotic treatment of giant adrenal myelolipoma: A case report and review of the literature

Cochetti¹,

Paladini²,

Boni³

et al. 2019

mol clin onc

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Adrenal myelolipoma is a rare mesenchymal tumour with benign biological behaviour that is mainly composed of mature adipose and myeloid tissue. Both sexes are equally affected, most commonly between the fifth and seventh decades of life. The diagnosis of adrenal myelolipoma is mostly incidental. Although it may occasionally be associated with necrosis, rupture and haemorrhage, causing abdominal pain, this tumour is usually asymptomatic. Consequently, management is conservative, while surgical treatment is reserved for symptomatic cases, or for masses growing quickly or to a size >6 cm. Giant myelolipomas (sized >10 cm) are rare. Open radical adrenalectomy is the standard treatment for giant myelolipomas, while the minimally invasive approach has been used in only few cases. We herein report the case of a patient with a giant adrenal myelolipoma who underwent robotic partial adrenalectomy. To the best of our knowledge, this is the largest giant adrenal myelolipoma treated with robotic surgery reported in the literature to date. A 55-year-old male patient underwent an abdominal computed tomography scan during follow-up after radical prostatectomy for prostate cancer Gleason Score 6 (ISUP 1) due to biochemical recurrence. The examination revealed a right hypodense adrenal mass, sized 16×13 cm. Abdominal magnetic resonance imaging confirmed the presence of characteristics suggestive of a myelolipoma. The patient did not report any symptoms. Due to the benign characteristics of the mass, robotic partial adrenalectomy and enucleation of the mass were performed. The operative time and estimated blood loss were 205 min and 100 ml, respectively. No intra- or postoperative complications occurred. The patient was mobilized on the first postoperative day and the time to flatus was 36 h; the length of hospitalization was 4 days. Histological examination confirmed the diagnosis of adrenal myelolipoma, sized 18×11.5×6 cm. No tumour recurrence occurred over a follow-up period of 12 months. In conclusion, robotic surgery allows performing partial adrenalectomy with a lower risk of bleeding and with preservation of healthy adrenal tissue, which is of paramount importance for the patient as it reduces recovery time and the need for medical substitution therapy.

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Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults

Cited by 48 publications

References 66 publications

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Laparoendoscopic single-site adrenalectomy versus multi-port laparoendoscopic adrenalectomy: A systemic review and meta-analysis

Feasibility of laparoscopic approach in malignant and benign adrenal lesions

Robotic treatment of giant adrenal myelolipoma: A case report and review of the literature

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