Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project

Elfenbein, Dawn M.; Scarborough, John; Speicher, Paul J.; Scheri, Randall P.

doi:10.1016/j.jss.2013.04.014

Cited by 103 publications

(80 citation statements)

References 17 publications

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“…Numerous studies support the use of MIS adrenalectomy. A recent study from the National Surgical Quality Improvement Program (NSQIP) noted lower rates of 30-day complications and shorter hospitalisations for patients undergoing laparoscopic compared with open adrenalectomy [19]. Similarly, the present study showed complications in 13% of open adrenalectomies compared with 8% of MIS, and a 2 day shorter hospitalisation for MIS adrenalectomy.…”

Section: Discussionsupporting

confidence: 78%

Changing USA national trends for adrenalectomy: the influence of surgeon and technique

et al. 2014

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ObjectiveTo explain differences over time between operative approach and surgeon type for adrenal surgery in the USA. Patients and methodsA retrospective cohort analysis was performed on all patients undergoing adrenalectomy between 2002 and 2011 using the Nationwide Inpatient Sample. Patients undergoing concurrent nephrectomy were excluded. Surgeon specialty was only available for [2003][2004][2005][2006][2007][2008][2009]. Descriptive analyses and multivariable logistic regression models were used to assess variables associated with minimally invasive surgery (MIS) and urologist-performed procedures. ResultsIn all, 58 948 adrenalectomies were identified. A MIS approach was used in 20% of these operations. There was a 4% increase in MIS throughout the study period (P < 0.001). Cases performed at teaching hospitals were more likely to be MIS (odds ratio [OR] 1.47, P < 0.001). We were able to identify surgical specialty in 23 746 cases, of which 60% were performed by urologists. Cases performed in the Midwest compared with Northeast were at increased adjusted odds of being performed by urologists (OR 1.38, P = 0.11). Despite most cases being performed by urologists, adrenalectomy by urologists showed a 15% annual decrease over the analysed period (P < 0.001). ConclusionsThe use of a MIS technique to perform adrenalectomy is increasing at a slower rate compared with most other surgical extirpative procedures. Further investigation to explain the decreased performance of adrenalectomy by urologists is warranted.

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Section: Discussionsupporting

confidence: 78%

Changing USA national trends for adrenalectomy: the influence of surgeon and technique

et al. 2014

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“…Операцией выбора при обнаружении добро качественной аденомы, вызывающей субклинический автономный гиперкорти-цизм, является лапароскопическая адренал-эктомия в связи с низкой вероятностью раз-вития осложнений в сравнении с открытой адреналэктомией [65]. Относительными про-тивопоказаниями к проведению лапароско-пической операции являются морбидное ожирение, большая вероятность развития кровотечений, предшествующие абдоми-нальные операции (в последнем случае есть возможность использовать ретроперитоне-альный доступ при лапароскопической адре-налэктомии) [41].…”

Section: тактика ведения и лечения пациентов с субклиническим синдромunclassified

Subclinical Cushing's syndrome due to unilateral or bilateral adrenal incidentalomas. Problems of diagnostic and indication to surgical treatment. Review of literature

et al. 2015

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“…In the largest to date comparative study with 3,100 patients assessing laparoscopic versus open adrenalectomy, laparoscopic surgery was associated with reductions in postoperative morbidity and hospitalization. 105 Concomitant conditions as morbid obesity, bleeding disorders or previous abdominal procedures are considered as relative contraindications, depending on the laparoscopic experience of the surgeon.…”

Section: Surgical Managementmentioning

confidence: 99%

Subclinical Cushing’s syndrome: Current concepts and trends

Zografos¹,

Perysinakis²,

Vassilatou³

2014

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AbSTrAcTclinically inapparent adrenal masses which are incidentally detected have become a common problem in everyday practice. Approximately 5-20% of adrenal incidentalomas present subclinical cortisol hypersecretion which is characterized by subtle alterations of the hypothalamicpituitary-adrenal axis due to adrenal autonomy. This disorder has been described as subclinical cushing's syndrome, since there is no typical clinical phenotype. The diagnosis of subclinical cushing's syndrome is based on biochemical evaluation; however, there is still no consensus for the biochemical diagnostic criteria. An abnormal 1mg dexamethasone suppression test (DST) as initial screening test in combination with at least one other abnormal test of the hypothalamic-pituitary-adrenal axis has been advocated by most experts for the diagnosis of subclinical cushing's syndrome. DST is the main method of establishing the diagnosis, while there is inhomogeneity of the information that other tests provide. Arterial hypertension, diabetes mellitus type 2 or impaired glucose tolerance, central obesity, osteoporosis/vertebral fractures and dyslipidemia are considered as detrimental effects of chronic subtle cortisol excess, although there is no proven causal relationship between subclinical cortisol hypersecretion and these morbidities. Therapeutic strategies include careful observation along with medical treatment of morbidities potentially related to subtle cortisol hypersecretion versus laparoscopic adrenalectomy. The optimal management of patients with subclinical cushing's syndrome is not yet defined. The conservative approach is appropriate for the majority of these patients; however, the duration of follow-up and the frequency of periodical evaluation still remain open issues. Surgical resection may be beneficial for patients with hypertension, diabetes mellitus type 2 or abnormal glucose tolerance and obesity.

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Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project

Cited by 103 publications

References 17 publications

Changing USA national trends for adrenalectomy: the influence of surgeon and technique

Changing USA national trends for adrenalectomy: the influence of surgeon and technique

Subclinical Cushing's syndrome due to unilateral or bilateral adrenal incidentalomas. Problems of diagnostic and indication to surgical treatment. Review of literature

Subclinical Cushing’s syndrome: Current concepts and trends

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