Has experience changed the scenario in laparoscopic adrenalectomy?

Dalvi, Abhay; Thapar, Pinky M; Shah, Nalini; Menon, P. S. N.

doi:10.1007/s12262-009-0021-8

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…6,26 However, the need for blood transfusion was the same in both groups. Mellon et al, 19 showed blood loss as well as the need for blood transfusion were not statistically different between both groups. According to our results, there was no statistically difference as regard intra-and postoperative complications.…”

Section: Discussionmentioning

confidence: 90%

Laparoscopic Adrenalectomy versus Open Adrenalectomy for Benign Adrenal Tumours: Results from a Prospective Comparative Study

Nafei

Abdo

2016

Ain Shams Journal of Surgery

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Demographic data, operative findings, operative complications, postoperative complications, and duration of hospital stay were recorded and compared in both groups.Results: Two groups of patients (18 in each group) were allocated in this study. Both groups were statistically similar regarding age, gender, body mass index (BMI), and American Society of Anesthesiologists (ASA) score. Two patients in the laparoscopic group were converted to open resection. The mean operative time in the laparoscopic group was significantly higher. However, the mean operative blood loss, need for analgesics, time of passing flatus after surgery, the duration of hospital stay were significantly lower in the laparoscopic group. Postoperative complications, hemodynamic stability and need for blood transfusion showed no statistical difference in both groups.Conclusions: Laparoscopic adrenalectomy is a safe operative procedure offering faster recovery, and shorter hospital stay. Hence, we recommend laparoscopic adrenalectomy as the first line treatment for benign adrenal masses less than 6 cm in size.

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Section: Discussionmentioning

confidence: 90%

Laparoscopic Adrenalectomy versus Open Adrenalectomy for Benign Adrenal Tumours: Results from a Prospective Comparative Study

Nafei

Abdo

2016

Ain Shams Journal of Surgery

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“…According to our experience, the CO 2 insufflation pressure was usually between 12 cmH 2 O and 15 cmH 2 O. Studies have shown that these complications are mainly related to the different learning curves among surgeons [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of large adrenal tumors: impact of different laparoscopic approaches and resection methods on perioperative and long-term outcomes

et al. 2018

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BackgroundThe indication of retroperitoneal laparoscopic adrenalectomy (RLA) was extended with the retroperitoneal approach and has been wildly accepted and technologically matured. However, the management of large adrenal tumors via this approach still remains controversial. The aim of this study was to perform a comprehensive analysis on the minimally invasive surgical management of larger adrenal tumors.MethodsA total of 78 patients with large adrenal tumors (> 5 cm) and 97 patients with smaller adrenal tumors (< 5 cm) were enrolled in this study. The patient characteristics were preferentially analyzed. The intra-operative and postoperative indicators were compared between those who underwent RLA and those who underwent transperitoneal laparoscopic adrenalectomy (TLA); the intra-operative and postoperative indicators were also compared between the large tumor group and smaller tumor group of those who underwent RLA. Furthermore, the analyses of partial RLA were focused on the perioperative indicators and follow-up results.ResultsRLA was superior to TLA in terms of operation time (98.71 ± 32.30 min vs. 124.36 ± 34.62 min, respectively, P = 0.001), hospitalization duration (7.43 ± 2.82 days vs. 8.91 ± 3.40 days, respectively, P = 0.04), duration of drain (4.83 ± 0.37 days vs. 3.94 ± 2.21 days, respectively, P = 0.02), first oral intake (2.82 ± 0.71 days vs. 1.90 ± 0.83 days, respectively, P < 0.001) and time to ambulation (3.89 ± 1.64 days vs. 2.61 ± 1.42 days, respectively, P < 0.001). Further analyses of the RLA patients demonstrated that the larger tumor (> 5 cm) group showed superior results for the intraoperative indicators than the smaller tumor (< 5 cm) group (P < 0.05), while the results for the postoperative indicators between the two tumor size groups were similar (P > 0.05). Data confirmed that the partial resection method was superior to the total resection method from the perspective of the hormone supplement (0% vs. 48.15%, P = 0.002). The 2-year recurrence-free rates were 92.60 and 92.86% for the total and partial RLA resection methods, respectively (P = 0.97). The partial RLA resection method had a similar complete remission rate as the total RLA resection method (96.30% vs. 100%, respectively, P = 0.47).ConclusionBoth RLA and TLA seem to provide similar effects for the surgical management of large adrenal tumors. However, partial RLA resection should be considered for the management of benign tumors to reduce the hormone supplement.Electronic supplementary materialThe online version of this article (10.1186/s12894-018-0349-0) contains supplementary material, which is available to authorized users.

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“…Com relação às características do tumor, a cirurgia aberta tem preferência quando a lesão for especialmente grande (> 12 cm, dependendo da experiência do cirurgião) ou para o câncer adrenocortical localmente invasivo em que for necessário realizar linfadenectomia ou examinar órgãos adjacentes 1,3 . A primeira adrenalectomia videolaparoscópica foi relatada em 1992 por Gagner et al Desde então, vários estudos comparativos têm demonstrado as vantagens dessa técnica quando comparada com a cirurgia convencional por via aberta [4][5][6][7] . A adrenalectomia laparoscópica pode ser realizada utilizando um acesso transabdominal ou retroperitoneal; porém, o primeiro é preferível, principalmente para tumores grandes 1,8 .…”

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“…As complicações intraoperatórias mais descritas na literatura são: sangramento, lesões de outros órgãos e estruturas anatômicas, e pneumotórax. As pós-operatórias são: abscesso retroperitoneal, pneumonia e arritmias cardíacas 5,12,13 .…”

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Experiência De 20 Anos Em Adrenalectomia Videolaparoscópica

Gatelli¹,

Migliavacca²,

Guimarães³

et al. 2017

Clin. Biomed. Res.

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RESUMOIntrodução: As operações na glândula adrenal são realizadas para determinados cânceres, todas as massas biologicamente ativas, metástases, massas com mais de 4-5 cm encontradas incidentalmente e hiperplasia adrenal primária. Métodos:Estudo transversal e descritivo. Foram analisados os prontuários dos pacientes submetidos a adrenalectomia videolaparoscópica entre agosto de 1994 e novembro de 2014. Resultados:Foram realizadas 146 adrenalectomias videolaparoscópicas. Em 134 casos, foi realizada com sucesso, mas em 12 casos (8,2%), o procedimento foi convertido. Foram 97 pacientes do sexo feminino e 49 do sexo masculino, com idade variando de 9 a 81 anos (média de 46,7 anos). Foram removidas 56 adrenais direitas, 75 esquerdas e 15 bilaterais. O tamanho médio das adrenais foi de 5,7 cm, variando de 0,9 a 15 cm. A mediana do tempo de internação hospitalar pós-operatória foi de 4,5 dias. A mediana do tempo de cirurgia foi de 144 minutos. Houve complicações em 22,5% dos casos (maiores -casos em que houve conversão para cirurgia aberta, necessidade de reinternação hospitalar e óbito-e menores), sendo 10,9% complicações intraoperatórias e 11,6% pós-operatórias. Apenas sete (4,7%) pacientes foram considerados complicações maiores. Conclusão:A cirurgia realizada em nosso serviço está de acordo com o descrito na literatura, com taxas aceitáveis de complicações, com motivos de conversão compatíveis e com as indicações totalmente aceitáveis e condizentes. A adrenalectomia videolaparoscópica é a cirurgia de escolha para patologias cirúrgicas da glândula adrenal, exceto em casos de carcinoma adrenal localmente invasivo com comprometimento de outras estruturas. Palavras-chave: Glândulas suprarrenais; adrenalectomia; laparoscopia ABSTRACTIntroduction: Adrenal gland surgery is performed for some types of cancer, all biologically active masses, metastases, masses larger than 4-5 cm found incidentally, and primary adrenal hyperplasia.

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Has experience changed the scenario in laparoscopic adrenalectomy?

Abstract: Though technically difficult, with increasing experience and focused approach, laparoscopic skills in adrenalectomy improves. The spectrum of indications broadens, thus making laparoscopic interventions for vascular and large adrenal glands safe and patient friendly.

Cited by 5 publications

References 22 publications

Laparoscopic Adrenalectomy versus Open Adrenalectomy for Benign Adrenal Tumours: Results from a Prospective Comparative Study

Laparoscopic Adrenalectomy versus Open Adrenalectomy for Benign Adrenal Tumours: Results from a Prospective Comparative Study

Surgical management of large adrenal tumors: impact of different laparoscopic approaches and resection methods on perioperative and long-term outcomes

Experiência De 20 Anos Em Adrenalectomia Videolaparoscópica

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