Laparoscopic and robot-assisted transperitoneal lateral adrenalectomy: a large clinical series from a single center

Niglio, Antonello; Grasso, Marica; Costigliola, Luciana; Zenone, P; Palma, Maurizio De

doi:10.1007/s13304-019-00675-8

Cited by 17 publications

(11 citation statements)

References 23 publications

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“…Most of adrenalectomy in this study was performed by surgeon under training. The operative time in this study was longer than previous reports [18,19], but was comparable to the reports of initial experience [20]. The surgeons sometimes had difficulty with separation between the liver and adrenal gland, and that motivated us to conduct this study.…”

Section: Discussionsupporting

confidence: 66%

Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy

et al. 2020

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This retrospective study aimed to identify predictive factors and imaging features of adrenohepatic adhesion found during laparoscopic right adrenalectomy. Materials and Methods: Altogether, 77 patients underwent laparoscopic right adrenalectomy between January 2005 and December 2018. Adrenohepatic adhesion was defined as strict adhesion that required either partial adrenalectomy with coagulation of residual tissue or partial hepatectomy to accomplish complete resection. We assessed their surgical video records to determine if adrenohepatic adhesion was present. Age, sex, body mass index, tumor size, tumor diagnosis and radiological findings (attachment between the liver and the adrenal gland, diameters of the right and left adrenal veins and its ratio) were evaluated as preoperative variables. Results: Adrenohepatic adhesion was present in 11 of the 77 patients (14.3%). Age, sex, and body mass index were not statistically significant factors. Tumor size was significantly small in adhesion group (14.2 mm vs. 25.9 mm, p=0.02). Attachment to the liver and adrenal gland was frequently seen regardless of the adhesion. The mean right/left adrenal veins diameters ratio was significantly lower in the adhesion group (0.8 vs. 1.1, p=0.01). Multivariate logistic regression analysis demonstrated the right/left adrenal veins diameters ratio was the only significant predictor of adhesion. The sensitivity, specificity, negative predictive value and positive predictive value were 0.82, 0.76, 0.43, and 0.95 respectively when the optimal cutoff value for the ratio was 0.9 (area under the curve, 0.75; 95% confidence interval, 0.60-0.90). Conclusions: The right/left adrenal veins diameters ratio was possible predictor of adrenohepatic adhesion.

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Section: Discussionsupporting

confidence: 66%

Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy

et al. 2020

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“…Since the first laparoscopic adrenalectomy was introduced in 1992 by Michel Gagner et al (8,19), this technique was developed and popularized rapidly due to its better cosmetic effect, lower complication rate, reduced postoperative analgesia assumption and early discharge; therefore, it becomes a gold standard treatment for benign or malignant adrenal tumors (6,7,20,21). However, there is still limited evidence proving the value of surgical drainage after LTLA.…”

Section: Discussionmentioning

confidence: 99%

Should surgical drainage after lateral transperitoneal laparoscopic adrenalectomy be routine?—A retrospective comparative study

Chai¹,

Pan²,

Liang³

et al. 2021

Gland Surg

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Background: Whether to use surgical drains after abdominal surgery or not has received much attention since a hundred years ago. Nowadays, lateral transperitoneal laparoscopic adrenalectomy (LTLA) is a widely used technique to treat adrenal tumors worldwide. However, the placement of drains after LTLA remains controversial. Methods: Data of 150 patients, who underwent LTLA between October 2014 and September 2020 by the same lead surgeon, were collected, including demographic, pathology, preoperative, operative variables and postoperative complications. The patients were divided into two groups, with and without drainage. The postoperative recovery of the two groups was compared. Results: Among 150 patients (65 men and 85 women, median age 48 years, median BMI 23.53), 89 patients had no drainage and 61 patients had drainage after surgery. Variables of the two groups were analyzed. Placement of drains correlated with long operative time (P<0.01). Patients with drain had longer hospital stays (P<0.001) and a higher incidence of postoperative complications (P=0.022). Other factors, including tumor size (P=0.61), tumor location (P=0.387), ASA score (P=0.687), pathology (P=0.55), VAS pain score (P=0.41), intraoperative blood loss (P=0.11), were not found to be significantly associated with drain placement. There was no conversion to open surgery in both groups. Moreover, no mortality was observed in either group.Conclusions: this study revealed that it is feasible and safe not to leave a drain in selective and uncomplicated patients and that surgical drainage should not be routine after LTLA.

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“…The selected studies included a total of 14,329 patients, of whom 6472 underwent robotic surgery and 7857 laparoscopic surgery. Fifty-one studies were retrospective [13,[25][26][27]32,33,37,[39][40][41][42][43][44][45][46][47][48][49][51][52][53][56][57][58][63][64][65][66][67][68][69]71,[73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90]92,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The results of the endocrine surgery studies are shown in Figure 9. Three studies [59,74,77] that addressed adrenalectomies for adrenal cancer were included in the analysis, involving 286 procedures, 155 laparoscopic and 131 robotic.…”

Section: Endocrine Surgerymentioning

confidence: 99%

The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis

Milone

Manigrasso

Anoldo

et al. 2022

JPM

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Abdominal adhesions are a risk factor for conversion to open surgery. An advantage of robotic surgery is the lower rate of unplanned conversions. A systematic review was conducted using the terms “laparoscopic” and “robotic”. Inclusion criteria were: comparative studies evaluating patients undergoing laparoscopic and robotic surgery; reporting data on conversion to open surgery for each group due to adhesions and studies including at least five patients in each group. The main outcomes were the conversion rates due to adhesions and surgeons’ expertise (novice vs. expert). The meta-analysis included 70 studies from different surgical specialities with 14,329 procedures (6472 robotic and 7857 laparoscopic). The robotic approach was associated with a reduced risk of conversion (OR 1.53, 95% CI 1.12–2.10, p = 0.007). The analysis of the procedures performed by “expert surgeons” showed a statistically significant difference in favour of robotic surgery (OR 1.48, 95% CI 1.03–2.12, p = 0.03). A reduced conversion rate due to adhesions with the robotic approach was observed in patients undergoing colorectal cancer surgery (OR 2.62, 95% CI 1.20–5.72, p = 0.02). The robotic approach could be a valid option in patients with abdominal adhesions, especially in the subgroup of those undergoing colorectal cancer resection performed by expert surgeons.

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Laparoscopic and robot-assisted transperitoneal lateral adrenalectomy: a large clinical series from a single center

Cited by 17 publications

References 23 publications

Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy

Predictive factors and radiological findings of adrenohepatic adhesion during laparoscopic adrenalectomy

Should surgical drainage after lateral transperitoneal laparoscopic adrenalectomy be routine?—A retrospective comparative study

The Role of Robotic Visceral Surgery in Patients with Adhesions: A Systematic Review and Meta-Analysis

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