Applicability and outcome of laparoscopic adrenalectomy for large tumours

Alila, Mohammed; Hamdane, Amine; Atiq, Sara El; Mohammed, Bounoual; Mouaqit, Ouadii; Khalid, Mazaz; Khalid, Ait Taleb; Ousadden, Abdelmalek

doi:10.11604/pamj.2018.31.23.15153

Cited by 8 publications

(9 citation statements)

References 13 publications

(28 reference statements)

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“…15,[21][22][23][24] Previous reports suggested that the cutoff for performing a minimal invasive approach is <6 cm due to the increased risk of malignancy. 4,13,[25][26][27] More recent reports on the feasibility and safety of performing larger size masses up to 12 cm, [27][28][29][30][31] especially in the era of robotic surgery, with growing evidence to support its safety. 27,32,33 Unfortunately, the tumor size is not available through the VASQIP data, which represents a limitation of this study, and may lead to selection bias.…”

Section: Discussionmentioning

confidence: 99%

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Shahait

Saleh

Weaver

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Since the introduction of laparoscopic adrenalectomy (LA) in 1992, it has become the standard of care for most adrenal benign pathologies. This study compares the outcomes and trends of open (OA) versus LA in veterans for benign pathologies.Methods: Veterans Affairs Surgical Quality Improvement Program was queried for adrenalectomies performed for benign pathologies during the period 2000-2019. Data collection included demographics, comorbidities, operative details, and postoperative outcomes.Results: A total of 1683 patients were included (91.4% males, mean age 59.6, mean body mass index 31.2, and 87.2% with American Society of Anesthesiologists class ≥ III). Overall, the mean operative time (OT) was 3.2 hours, the majority performed by general surgeons (71.4%), and the mean length of stay (LOS) was 4.1 days. There were 12 (0.7%) 30-day mortalities, and 162 patients (8.8%) developed ≥ 1 complication. LA was performed in 70.9% ( 1306), with the conversion rate of 0.85% (10). When compared with OA, patients with the laparoscopic approach were functionally independent, shorter OT, less intraoperative blood transfusion, shorter LOS, and lower mortality and morbidity. Dependent functional status, congestive heart failure, American Society of Anesthesiologists class ≥ III, and smoking were independent predictors of mortality, whereas intraoperative transfusions, chronic obstructive pulmonary disease, and dependent functional status were predictors of morbidity. Trend analysis showed an 8-fold increase in the use of LA. However, trend analysis for morbidity and mortality rates showed no significant change for both approaches. Conclusion:LA is being well adopted in the veterans affairs system with an 8-fold increase over 20 years, with lower morbidity and mortality compared with the open approach for benign adrenal pathologies.

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Section: Discussionmentioning

confidence: 99%

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Shahait

Saleh

Weaver

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…In their retrospective analysis, Mohammed et al proved that there is no priority of the open approach in adrenal tumors that are 5 cm or larger concerning complication rate, length of stay, mortality, or oncologic outcomes. Accordingly, they recommended laparoscopic adrenalectomy for all adrenal tumors regardless of their size [15]. Robotic-assisted resection was also recommended in more difficult cases or larger tumors, as it may provide the needed dexterity for handling such tumors [16].…”

Section: Discussionmentioning

confidence: 99%

A 15-cm Adrenal Incidentaloma Suggested on Upper Endoscopy and Resected Laparoscopically

Saleh¹,

Bazzi²,

Shamma³

et al. 2022

Cureus

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Incidentalomas are asymptomatic adrenal tumors that are discovered on investigations performed for other reasons. Classically, these tumors are found on computed tomography of the abdomen. This article describes an incidentaloma that was discovered on upper gastrointestinal endoscopy performed before a bariatric operation and caused an extrinsic compression of the first and second parts of the duodenum. Further investigations showed a 15-cm non-functional adrenal tumor. The patient was treated successfully with laparoscopic adrenalectomy. The histological examination showed a benign adrenocortical adenoma with myelolipomatous changes. The article highlights the fact that incidentalomas may not only be discovered on imaging modalities but may also show up in other diagnostic methods such as endoscopy.

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“…Traditionally, rigth-sided, large-sized or hormonal active tumors are believed to be more challenging but some recent publications claim otherwise. [6,10,11] More interestingly, Limberg et al [12] reported that laparoscopic adrenalectomy is as safe and feasible as laparoscopic cholecystectomy procedure and emphasized that physicians should not hesitate to refer their patients to surgery. Herewith, on the basis of our experience in minimally invasive surgery, we aimed to demonstrate the applicability of the procedure by representing our 5-year results.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Although many studies comparing transabdominal and retroperitoneal approaches have shown different advantages, transabdominal approach is mostly preferred because it provides a large area in the abdomen, allows excision of medium size (<6 cm) masses and is easy to teach [1,3] but there is still a debate about laparoscopic approach for large (>6 cm) or malignant masses. [4][5][6] The laparoscopic approach to adrenal masses has now become the standard procedure, and with the widespread use of laparoscopy, its use has increased rapidly. However, it is emphasized that it should still be performed in experienced centers because of its surgical risks.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic adrenalectomy by transabdominal lateral approach. Should we be afraid of getting started? First 5 years of experience

Çolakoğlu¹

2019

Laparosc Endosc Surg Sci

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Introduction: A laparoscopic approach has become the standard procedure for removing adrenal masses. However, the need for experience with the technique continues to be emphasized. The aim of this study was to retrospectively review the first 5 years of data of patients who had an adrenal mass and underwent laparoscopic surgery with a transabdominal lateral approach. Materials and Methods: All of the patients at a single institution who were operated on for an adrenal mass using a laparoscopic transabdominal lateral approach between January 2014 and January 2019 were included. The demographic data, any history of other abdominal surgery, American Society of Anesthesiologists score, preoperative diagnosis, hormonal characteristics of the tumor, intraoperative parameters, intraand postoperative complications, and the histological diagnosis were analyzed. Results: A total of 42 laparoscopic adrenalectomy procedures were performed. The mean age of the patients was 50.64±13.22 years. The lesion was located on the right side in 52.3% of the patients. Nine patients (21.4%) had previously undergone abdominal surgery for various reasons. The majority of the adrenal masses were a secretory adenoma or hyperplasia of the gland. Four patients were operated on for metastasis of other malignancies and others were non-secreting tumors. The mean size of the adrenal lesions was 29.4±12.7 mm. The mean operative time was 140.45 minutes and the mean blood loss was 62.9 mL. Intraoperative complications occurred in 3 cases (7.1%). Complications were observed postoperatively in 9 patients (21.4%). The mean length of hospitalization was 3.8±2.1 days. Conclusion: A laparoscopic adrenalectomy proved to be a safe and feasible method, even in cases in which it was the operator's first experience with the procedure. The results of a first application were similar to those reported in the literature. However, we strongly believe that other prior laparoscopic experience is required to achieve these results.

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Applicability and outcome of laparoscopic adrenalectomy for large tumours

Cited by 8 publications

References 13 publications

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

Two Decades’ Outcomes and Trends of Adrenalectomy for Benign Pathologies in Veterans

A 15-cm Adrenal Incidentaloma Suggested on Upper Endoscopy and Resected Laparoscopically

Laparoscopic adrenalectomy by transabdominal lateral approach. Should we be afraid of getting started? First 5 years of experience

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