Posterior Retroperitoneoscopy as a New Minimally Invasive Approach for Adrenalectomy: Results of 30 Adrenalectomies in 27 Patients

Walz, Martin K.; Peitgen, K.; Hoermann, Rudolf; Giebler, R.; Mann, Klaus; Eigler, F. W.

doi:10.1007/s002689900117

Cited by 255 publications

(179 citation statements)

References 24 publications

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“…The irritation of the subcostal nerve in our study was comparable to the subcostal nerve irritation described in the literature [8,13,18,19].…”

Section: Discussionsupporting

confidence: 73%

“…In the published literature the operation time seems to be shorter in the retroperitoneal approach compared to other techniques. Nevertheless, this result can only be reached by an experienced surgeon and after a certain learning curve [18]. Moreover, the published data about retroperitoneoscopic adrenalectomy show a shorter operation time for the dorsal approach [3,10,12,14,17,20].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the laparoscopic adrenalectomy is ideal as a minimal invasive operation technique [15]. Other documented advantages of the minimal invasive laparoscopic adrenalectomy (evidence level II) are the small loss of blood, less pain, low complication rate, short reconvalescence time, and certainly the cosmetic result [2,4,[6][7][8]11,18].…”

Section: Introductionmentioning

confidence: 99%

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Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Agha

Breitenbuch

Gahli

et al. 2007

Journal of Surgical Oncology

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Background: For tumours of the adrenal gland different surgical retroperitoneal approaches have been established, including the lateral and the dorsal approach. It is still unclear if the lateral or the dorsal approach should be preferred. Patients and Methods: A retrospective comparison between 21 patients who underwent retroperitoneoscopic adrenalectomy in lateral position (LRA) and 24 patients who underwent a retroperitoneoscopic adrenalectomy in dorsal position (DRA). Results: There were no significant differences with regard to the age, sex, tumour localisation, and the size of the tumour. The body-mass-index as well as the operation time was significantly higher of patients who underwent surgery in lateral position. Complications were comparable in both groups. Conclusion: The dorsal and the lateral retroperitoneal approach are ideal approaches for patients having had an intraabdominal surgery before. Due to the missing intraabdominal pressure the lateral approach is advantageous for patients with high body-mass-index (>35) and is indicated for patients with a tumour >6 cm due to the small retroperitoneal space.

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“…The irritation of the subcostal nerve in our study was comparable to the subcostal nerve irritation described in the literature [8,13,18,19].…”

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Agha

Breitenbuch

Gahli

et al. 2007

Journal of Surgical Oncology

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“…The BAETS 2012 audit showed that only 86 of 1359 patients (6%) who underwent adrenalectomy had a bilateral operation. 4 Laparoscopic unilateral adrenalectomy was initially reported in 1992 5 and within the last two decades has become the standard of care for benign adrenal tumours. It has been widely adopted because of its decreased morbidity and perioperative complications compared with the open approach.…”

Section: Introductionmentioning

confidence: 99%

Bilateral adrenalectomy: a review of 10 years’ experience

Maccora

Walls

Sadler

et al. 2017

annals

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INTRODUCTIONThe 2012 British Association of Endocrine and Thyroid Surgeons audit report showed that only 86 of 1359 patients who underwent adrenalectomy had a bilateral operation; thus the experience with this procedure remains limited. METHODS Retrospective review of patients undergoing bilateral adrenalectomy in a tertiary referral centre. RESULTS Between November 2005 and January 2016, bilateral adrenalectomy was performed in 23 patients (6 male, 17 female, age 43 ± 4 years) diagnosed with Cushing's disease (n = 13), hereditary phaeochromocytomas (n = 6), adrenocortical cancer (n = 2), colorectal metastatic disease (n = 1) and adrenocortical adenomas (n = 1).A laparoscopic transperitoneal approach was used in 17 patients, with one conversion to open. Three patients had open adrenalectomies for adrenocortical cancer and for simultaneous phaeochromocytomas and pancreatic neuroendocrine tumours in a patient with Von Hippel-Lindau syndrome. Three patients with Cushing's had a bilateral retroperitoneoscopic operation. The mean operating time was 195 ± 16 minutes for laparoscopic operations (n = 16), 243 ± 44 minutes for open adrenalectomies (n = 4) and 151 ± 12 minutes for retroperitoneal operations. It was significantly shorter for Cushing's disease than for phaeochromocytomas (162 ± 8 vs. 257 ± 39 minutes, P < 0.01).Median length of hospital stay was 5 days. Postoperative complications (Clavien-Dindo classification) included one chest infection (level 2), one postoperative haemorrhage and two chest drains for pneumothorax (level 3), two postoperative cardiac arrests (level 4) and one late cancer death from complications related to uncontrolled hypercortisolism (level 5). DISCUSSION Synchronous bilateral adrenalectomy remains an infrequent operation. The laparoscopic approach is feasible in the majority of patients. It is likely that the retroperitoneoscopic adrenalectomy will become the standard approach for bilateral operations.

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“…Retroperitoneoscopic adrenalectomy was developed in 1993 [159] and brought into clinical practice by Martin Walz [160]. This approach has gained popularity because it offers advantages, including direct access to the gland and the option of bilateral adrenalectomy without a requirement for repositioning if a prone approach is used.…”

Section: Surgerymentioning

confidence: 99%

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

et al. 2013

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Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare catecholamine-secreting tumors derived from chromaffin cells originating in the neural crest. These tumors represent a significant diagnostic and therapeutic challenge because the diagnosis of malignancy is frequently made in retrospect by the development of metastatic or recurrent disease. Complete surgical resection offers the only potential for cure; however, recurrence can occur even after apparently successful resection of the primary tumor. The prognosis for malignant disease is poor because traditional treatment modalities have been limited. The last decade has witnessed exciting discoveries in the study of PCCs and PGLs; advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors, and increasing knowledge of genotype-phenotype interactions has facilitated more accurate determination of malignant potential. Elucidating the molecular mechanisms responsible for malignant transformation in these tumors has opened avenues of investigation into targeted therapeutics that show promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for PCC. In this review, we discuss the currently available diagnostic and therapeutic options for patients with malignant PCCs and PGLs and detail the molecular rationale and clinical evidence for novel and emerging diagnostic and therapeutic strategies. TheOncologist2013; 18:391-407 Implications for Practice: Malignant pheochromocytoma and paraganglioma represent a significant management challenge.The diagnosis of malignancy is frequently made in retrospect and traditional treatment modalities have been limited. Recent exciting advances in molecular genetics have uncovered hereditary and germline mutations of at least 10 genes that contribute to the development of these tumors. Increasing knowledge of genotype-phenotype interactions facilitates more accurate determination of malignant potential and has prompted investigation into targeted therapeutics with promising results. There have also been significant advances in functional and radiological imaging and in the surgical approach to adrenalectomy, which remains the mainstay of treatment for pheochromocytoma. Due to the rarity of this tumor, large-scale clinical studies that would progress clinical practice are rare, and the requirement for international collaboration is crucial. The need for large-scale international multicenter studies to effectively exploit the molecular and genetic knowledge gained in this area is highlighted in this review.

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Posterior Retroperitoneoscopy as a New Minimally Invasive Approach for Adrenalectomy: Results of 30 Adrenalectomies in 27 Patients

Cited by 255 publications

References 24 publications

Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Retroperitoneoscopic adrenalectomy: Lateral versus dorsal approach

Bilateral adrenalectomy: a review of 10 years’ experience

Molecular and Therapeutic Advances in the Diagnosis and Management of Malignant Pheochromocytomas and Paragangliomas

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