Experience of retroperitoneoscopic adrenalectomy in 195 patients with primary aldosteronism

Abstract

Objectives: Laparoscopic adrenalectomy has become an effective option for aldosteronoma. We evaluated the retroperitoneal approach with regard to safety, efficacy, invasiveness and cost-benefit ratio in patients with primary aldosteronism. Methods: Between July 1999 and June 2005, we carried out a total of 195 retroperitoneoscopic adrenalectomies (RA) in one hospital, including 108 on the left and 87 on the right, in 78 men and 113 women aged 20-78 years (mean age 48.2 years) with aldosteronoma. Average adrenal tumor size was 16 mm (range 10-32 mm). The 195 operations were divided into 10 groups of 20 operations each, and the mean duration and estimated blood loss for each group were compared. Results: The mean operating time and intraoperative blood loss in RA were 93.2 Ϯ 37.4 (45-210) min and 68.5 Ϯ 53.2 (5-210) mL, respectively. Compared to group 1 (cases 1-20), a statistically significant decrease in operative time and estimated blood loss were seen in and after group 4 (Ն case 61, 94.5 Ϯ 30.3 vs 139.2 Ϯ 44.7 min, P < 0.01), and in and after group 5 (Ն case 81, 67.5 Ϯ 50.5 vs 120.5 Ϯ 60.9 mL, P < 0.01), respectively. No differences were found in duration of surgery and estimated blood loss between left and right sided tumors (P > 0.05). The mean postoperative hospital stay was 4.5 Ϯ 1.2 days. Postoperative complications, including hematoma and wound infection, occurred in 4.1% of patients. Conclusions: Retroperitoneoscopic adrenalectomy for aldosteronoma is a safe, effective, and minimally invasive approach with an advantageous cost-benefit ratio. With accumulated experience, it can expedite the learning curve for RA.

Evaluating the learning curve for retroperitoneoscopic adrenalectomy in a high-volume center for laparoscopic adrenal surgery

“…Operating times of RPA decreased significantly in time, completely stabilizing after 70 procedures, which is comparable to results in the literature [12–14]. To our knowledge, this study is one of the largest cohorts in which the learning curve of RPA is evaluated.…”

“…In comparison, operating times that were described for the invention phase were much longer (170 min directly after the introduction, reducing to 110 min after 20 patients, and 95 min after 40 patients) [15]. Lin et al [14] showed a similar learning curve of 60 patients, when looking at blood loss and operating times, for lateral retroperitoneoscopic adrenalectomies. Cabalag et al [12] showed a short learning curve of 10 patients in RPA (110–60 min) after an intensive training course with an expert, also pointing to a short learning curve when properly trained.…”

Laparoscopic Adrenalectomy in a Patient with Situs Inversus

“…9,10 Many report that laparoscopic surgery is advantageous as compared with conventional laparotomy, due to lower invasiveness, shortened hospitalization period, and fewer safety problems. 11,12 While laparoscopic surgery allows detailed observation in a magnified visual field, it is difficult to maintain spatial orientations or determine positional relationships between structures, because of the lack of landmarks such as organs in the narrow visible field. 12 …”

Updates in endourology

“…In a series of 195 patients by Lin et al [14] for primary aldosteronism, they concluded that retroperitoneoscopic adrenalectomy for aldosteronoma is a safe, effective, and minimally invasive approach with an advantageous cost-benefit ratio. Laparoscopic surgery is increasingly being performed for female stress incontinence in association with pelvic floor repair to treat genital prolapse and associated symptoms.…”