Laparoscopic vs. Open Adrenalectomy: Experience at King Faisal Specialist Hospital and Research Centre, Riyadh

Yousef, Hussam Bin; Zahrani, Ali Al; Ahmed, Mohammed; Arifi, Abdulla Al; Mahfouz, A. Al; Hussain, Raef; Al-Sobhi, Saif S.

doi:10.5144/0256-4947.2003.36

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…A recent review from the region showed that the total number of Robot-assisted surgery in the Middle East is still low and there are 19 da Vinci Surgical Systems installed in Saudi Arabia; 6 in Qatar; 3 in the United Arab Emirates; 2 in each of Kuwait and Lebanon; and only 1 in Egypt ( 18 ). Apart from the comparison of laparoscopic and open surgery in a small sample size, no published data is comparing the 3 surgical approaches for adrenal pathology from the Arab Middle East ( 19 ). The present study aims to describe the frequency, clinical presentation, and outcomes associated with the 3 surgical approaches in patients who underwent adrenalectomy (open, robotic, or laparoscopic) for adrenal pathology.…”

Section: Introductionmentioning

confidence: 99%

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

Al-Thani

Al-Sulaiti

et al. 2022

Front. Surg.

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BackgroundCurrently, adrenalectomies are trending toward minimally invasive approach including robotic and laparoscopic surgery. We aimed to describe the clinical presentation and outcomes associated with the 3 different surgical approaches in patients who underwent adrenalectomy for adrenal mass at a single tertiary center.MethodsA retrospective descriptive observational study was conducted to include all patients who underwent surgical interventions for adrenal gland mass between 2004 and 2019. Patients were categorized into three groups according to the interventional approach (open, robotic vs. laparoscopic adrenalectomy) and data were analyzed and compared.ResultsA total of 124 patients underwent adrenalectomies (61.3% robotic, 22.6% open, and 16.1% laparoscopic approach). Incidentally discovered adrenal mass was reported in 67% of patients, and hypertension was the most prevalent comorbidity (53%). The tendency for malignancy increased with increasing tumor size while the functioning tumors were more in the smaller tumor size. Larger tumors were more common in younger patients. The robotic approach showed shorter surgical intensive care and hospital length of stay. Patients in the open adrenalectomy group frequently presented with abdominal pain (p = 0.001), had more nonfunctional adrenal mass (p = 0.04), larger mean tumor size (p = 0.001), and were frequently operated on the right side (p = 0.03). There was no post-operative mortality; however, during follow-up, 8 patients died (3 open, 3 laparoscopic and, 2 robotic approach). The median follow-up was 746 days (range 7–5,840).ConclusionsThe study explored the three surgical adrenalectomy approaches in a dedicated center for patients with adrenal pathology. It showed that robotic adrenalectomy could be safe and effective surgical approach for patients with benign functioning adrenal tumors of a diameter <6 cm. However, the choice of a surgical approach varies according to the adrenal mass presentation, patient fitness for surgery, type and sizes of the tumor, surgeon's experience, and hospital resources. Open surgery is considered the first choice for larger, ruptured adrenal tumor or malignancy. However, the recent restructuring of the surgical department resulted in selection bias in favor of the robotic surgery. Further studies are required to address the risk factors, selection criteria for appropriate management, cost, and quality of life.

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Section: Introductionmentioning

confidence: 99%

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

Al-Thani

Al-Sulaiti

et al. 2022

Front. Surg.

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“…The indications for adrenalectomy were pheochromocytomas in five (23%) patients, Conn’s adenoma in 6 (28%) patients, Cushing’s disease in three (14%) patients, and ACC in only one (0.4%) patient. The study concluded that laparoscopic adrenalectomy is a safe procedure for most adrenal pathology [ 9 ]. Our understanding of the prevalence of adrenal tumors, incidence rate, types, treatment methods, and age group in Saudi Arabia is limited and insufficient.…”

Section: Introductionmentioning

confidence: 99%

A 10-Year Tertiary Care Center Experience With Adrenalectomies for Adrenal Tumors

Alghafees¹,

Musalli²,

Albaqami³

et al. 2022

Cureus

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“…The adrenal glands are ideal for the use of the technique, as they are small retroperitoneal organs that were traditionally approached through a relatively large abdominal, flank or thoracoabdominal incision. Laparoscopy enabled surgeons to use safe and effective procedures, and offers patients all the advantages of minimally invasive surgery, with decreased blood loss, less post operative pain, decreased hospital stay and faster recovery [3–6] . Laparoscopy has had an effect on adrenal surgery over the last two decades, with more adrenalectomies being performed, the lesion size as an indication for surgery decreased, and more incidentalomas and benign tumours being resected [7–10] .…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic adrenalectomy: An update

Alzahrani

2012

Arab Journal of Urology

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ObjectiveTo review the current role and outcome of laparoscopic adrenalectomy (LA) in the management of adrenal tumours.MethodsA Medline search using the keywords (adrenalectomy, laparoscopy, adrenal masses/tumours) was done for reports published between 1990 and 2011. Key articles were used to find more relevant references on the evaluation and laparoscopic management of adrenal masses.ResultsThe hormonal evaluation is not standardised, but initial screening tests are recommended and followed with confirmatory ones when positive, equivocal or the clinical presentation suggest adrenal hyperfunction. The imaging studies had, and continued to, advance, especially computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT. These advances have increased the accuracy of the diagnosis of adrenal masses, with a reported high sensitivity and specificity of 95–100%. The introduction of laparoscopy has resulted in more adrenal lesions being removed, especially incidental lesions smaller than the 5–6 cm that was previously the indication for surgical excision. The technique has developed and larger lesions of >6 cm are now considered for LA in the proper setting. The transperitoneal and retroperitoneal approaches are currently widely practised, with minor differences in the outcome. The reported outcome, although mostly retrospective, is excellent and with fewer complications. The role of LA for adrenal malignancy should be considered cautiously. Preoperative imaging signs of invasion into surrounding structures should be considered a contraindication for LA.ConclusionLA is the standard procedure for most adrenal lesions of appropriate size and no signs of surrounding tissue invasion, giving an excellent outcome.

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Laparoscopic vs. Open Adrenalectomy: Experience at King Faisal Specialist Hospital and Research Centre, Riyadh

Cited by 7 publications

References 14 publications

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

A Descriptive Comparative Analysis of the Surgical Management of Adrenal Tumors: The Open, Robotic, and Laparoscopic Approaches

A 10-Year Tertiary Care Center Experience With Adrenalectomies for Adrenal Tumors

Laparoscopic adrenalectomy: An update

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