Comparison of synchronous bilateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy: results of a multicenter study

Tuncel, Altuğ; Langenhuijsen, Johan F.; Erkan, Anil; Mikhaylikov, Taras; Arslan, Murat; Aslan, Yılmaz; Berker, Dilek; Özgök, Yaşar; Gallyamov, E. A.; Gözen, Ali Serdar

doi:10.1007/s00464-020-07474-y

Cited by 15 publications

(32 citation statements)

References 26 publications

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“…We believe that the classic retroperitoneoscopic approach has technical advantages in case of BA since it enables to avoid the reposition of the patient leading to shorter operative time with comparable outcomes to transperitoneal approach [48].…”

Section: Robot-assisted Bilateral Adrenalectomymentioning

confidence: 97%

“…Anyway, to date, consistent data of a potential superiority of the robotic over the laparoscopic technique are lacking. Bilateral laparoscopic adrenalectomy has proven to be feasible and safe by several studies [47,48] and to date, still being the gold standard approach. Overall, the same considerations made for unilateral RA are likely to be valid even for robotic BA.…”

Section: Robot-assisted Bilateral Adrenalectomymentioning

confidence: 99%

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Robot-assisted adrenalectomy: state of the art

Materazzi

Rossi

2020

Updates Surg

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Currently, laparoscopic adrenalectomy is worldwide considered the gold standard technique. Both transperitoneal and retroperitoneal approaches have proved their efficacy with excellent outcomes. Since the introduction of da Vinci System (Intuitive Surgical, Sunnyvale, CA), robotic surgery has made many steps forward gaining progressively more diffusion in the field of general and endocrine surgery. The robotic technique offers advantages to overcome some laparoscopic shortcomings (rigid instruments, loss of 3D vision, unstable camera). Indeed, the robotic system is provided of stereoscopic 3D-magnified vision, additional degree of freedom, tremor-filtering technology and a stable camera. Recently, several case series have demonstrated the feasibility and the safety of robot-assisted adrenalectomy in high-volume centers with outcomes comparable to laparoscopic adrenalectomy. Notwithstanding, the technical advantages of the robotic system have not yet demonstrated significant improvements in terms of outcomes to undermine laparoscopic adrenalectomy. Moreover, robotic adrenalectomy harbor inherits drawbacks, such as longer operative time and elevated costs, that limit its use. In particular, the high cost associated with the use of the robotic system is primarily related to the purchase and the maintenance of the unit, the high instruments cost and the longer operative time. Notably, these aspects make robotic adrenalectomy up to 2.3 times more costly than laparoscopic adrenalectomy. This literature review summarizes the current available studies and provides an overview about the robotic scenario including applicability, technical details and surgical outcomes.

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Section: Robot-assisted Bilateral Adrenalectomymentioning

confidence: 97%

Section: Robot-assisted Bilateral Adrenalectomymentioning

confidence: 99%

Robot-assisted adrenalectomy: state of the art

Materazzi

Rossi

2020

Updates Surg

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“…Several studies have compared the surgical outcomes of LTA and PRA. These reports demonstrated clinically equivalent out- www.e-enm.org 777 comes, with a smaller tumor size, less estimated blood loss (EBL), a shorter time to oral intake, and a shorter length of hospital stay in the PRA group (Table 1) [19,[21][22][23][24][25][26][27][28]. A recent metaanalysis reported significant differences in demographic characteristics and surgical outcomes between LTA and PRA groups.…”

Section: Comparison Of Surgical Outcomes Between Lta and Pramentioning

confidence: 99%

Minimally Invasive Adrenal Surgery

Kwak

Lee

2020

Endocrinol Metab

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Since the introduction of minimally invasive surgery, laparoscopic adrenalectomy has become the main treatment option for adrenal masses. Various studies have reported that laparoscopic adrenalectomy showed fewer postoperative complications and faster recovery than conventional open adrenalectomy. Laparoscopic adrenalectomy can be performed through either the transperitoneal approach or the retroperitoneoscopic approach, which are widely used in most adrenal surgical procedures. Furthermore, with the development of minimally invasive surgery, organ-sparing adrenalectomy has recently emerged as a way to conserve functional adrenal gland tissue. According to recent data, organ-sparing adrenalectomy shows promising surgical, functional, and oncological outcomes including less intraoperative blood loss, maintenance of adrenal function, and low recurrence. Partial adrenalectomy was initially proposed for bilateral adrenal tumors in patients with hereditary disease to avoid chronic adrenal insufficiency. However, it has also gained popularity for the treatment of unilateral adrenal disease involving a small adrenal tumor because even patients with a unilateral adrenal gland may develop adrenal insufficiency in stressful situations. Therefore, partial adrenalectomy has become increasingly common to avoid lifelong steroid replacement and recurrence in most cases, especially in bilateral adrenal disease. This review article evaluates the current evidence on minimally invasive adrenalectomy and organ-preserving partial adrenalectomy.

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“…Of which mainly concerns the risk of malignancy or the future recurrences from the remnant, potential for di culty of reoperation and complications, and likelihood of corticosteroid-independence to be balanced against the risks associated with chronically treated adrenal cortical insu ciency after CSA, and the inconsistent evidence of retrospective studies of small sample size. Recently, several international multicentre studies revealed the results showed that laparoscopic/open operative CSA (LCSA/OCSA) should be the successful surgical approach of choice for patients with hereditary bPHEO [1][2][3]12] . In particular, the bilateral LCSA (B-LCSA) approach should be considered a viable alternative option for these patients requiring surgical intervention [1][2][3][4][10][11][12][13][14] .However, simultaneous bilateral laparoscopic or open CSA (i.e., SB-LCSA or SB-OCSA) for bPHEO associated with MEN2, less practical experience has been reported so far [1-4,10−22] .…”

mentioning

confidence: 99%

“…Recently, several international multicentre studies revealed the results showed that laparoscopic/open operative CSA (LCSA/OCSA) should be the successful surgical approach of choice for patients with hereditary bPHEO [1][2][3]12] . In particular, the bilateral LCSA (B-LCSA) approach should be considered a viable alternative option for these patients requiring surgical intervention [1][2][3][4][10][11][12][13][14] .However, simultaneous bilateral laparoscopic or open CSA (i.e., SB-LCSA or SB-OCSA) for bPHEO associated with MEN2, less practical experience has been reported so far [1-4,10−22] . In the present study, 31 patients who had bPHEO originating from MEN2 in Ethnic Han Chinese, of whom 29 underwent a variety of bilateral CSA including synchronous/metachronous, LCSA/OCSA.…”

mentioning

confidence: 99%

Simultaneous Bilateral Laparoscopic Cortical-sparing Adrenalectomy for Bilateral Pheochromocytomas in Multiple Endocrine Neoplasia Type 2

Qi¹,

Qi²,

Fang³

et al. 2021

Preprint

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Background: laparoscopic or open cortical-sparing adrenalectomy (LCSA or OCSA; CSA) for treatment of bilateral pheochromocytomas (bPHEO) in multiple endocrine neoplasia type 2 (MEN2) offers a postoperative corticosteroid independence and is balanced against the risk of local recurrence. In this study, the optimal surgical approach and the value of the simultaneous bilateral LCSA/OCSA (SB-LCSA/ SB-OCSA) were further assessed.Methods: A total of 31 patients (54.8% women) were diagnosed with bPHEO in MEN2 at a median age at initial presentation of 38 years (range, 23–78). Twenty- seven patients (87.1%) presented with synchronous. With the exception two patients respectively presenting MEN2A died of MTC metastasis or MEN2B declined surgery, each of other 29 underwent initial CSA, and in 23 (79.3%), of whom 18 had SB-LCSA and 5 had SB-OCSA duration of the same anesthesia (synchronous surgery); whereas metachronous CSA was in 6 (20.7%), including 1 had metachronous bilateral LCSA, 2 had metachronous bilateral OCSA (metachronous surgery) and 3 had LCSA/OCSA (hybrid) surgery.Results: All 31 patients associated with RET-C634 mutations, as MEN2A (90.3%) and RET-M918T, as MEN2B (9.7%), respectively. No conversion and intraoperative or postoperative severe complications were necessary. There were less bleeding volume, and shorter hospitalizations between in SB-LCSA compared with those in SB-OCSA, as well as synchronous surgery versus metachronous (hybrid) surgery (all P < 0.05). An initial bilateral postoperative corticosteroid replacement was necessary in 14 patients (45.2%). During a median follow-up period of 7 years (range, 1.8–23), 3 of these patients (10.3%) showed a persistent/recurrent disease and needed reoperation.Conclusions: CSA for bPHEO in MEN2 has a relatively low recurrence and avoids lifelong corticosteroid replacement in well over half the patients. SB-LCSA for treatment of these synchronous bPHEO is safe and feasible, should be recommended as a prioritized surgical approach of choice.

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Comparison of synchronous bilateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy: results of a multicenter study

Cited by 15 publications

References 26 publications

Robot-assisted adrenalectomy: state of the art

Robot-assisted adrenalectomy: state of the art

Minimally Invasive Adrenal Surgery

Simultaneous Bilateral Laparoscopic Cortical-sparing Adrenalectomy for Bilateral Pheochromocytomas in Multiple Endocrine Neoplasia Type 2

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