The safety and efficiency of retroperitoneal laparoscopic adrenalectomy via extra and intra perinephric fat approaches: a retrospective clinical study

Wang, Xuejian; Liu, Junqiang; Ji, Aozhang; Liu, Changli; Nahayo, Sony; Wang, Lina; Zhu, Xinqing; Fan, Wei-wei; Song, Xishuang; Wang, Jianbo; Yang, Deyong

doi:10.1186/s12893-019-0648-8

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…In addition, there was a signi cant difference in the average surgical time between the two groups of patients, with the EPFA group having a shorter surgical time, which is consistent with studies in other countries [18][19]. Compared with traditional three-layer adrenal surgery, IPFA is an improvement, which only requires the separation of a layer between the perirenal adipose sac and the anterior fascia to effectively expose the adrenal gland.…”

Section: 3estimated Blood Losssupporting

confidence: 84%

A comparative study of retroperitoneal laparoscopic adrenalectomy via intra and extra perinephric fat approaches

Tan,

Lin,

et al. 2024

Preprint

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Objective To investigate the safety and effectiveness of retroperitoneal adrenalectomy via extra and intra perinephric fat approaches to provide experience and basis for resection of adrenal tumors through the retroperitoneal cavity. Methods The clinical data of 284 patients undergoing retroperitoneal adrenalectomy in our hospital from December 2017 to March 2023 were collected. The basic characteristics of the two groups of patients and the changes in perioperative indicators were retrospectively analyzed. Results A total of 117 patients with intra perinephric fat approach (IPFA) were included,and 167 patients with extra perinephric fat approach (EPFA) were included. Estimated blood loss,operation time and hospitalization expenses were comparable between the two groups.The estimated blood loss in the IPFA group (123.59 ± 50.76ml) was higher than that in the EPFA group (99.10 ± 99.51ml) (p = 0.015),and the operative time in the IPFA group(105.25 ± 42.25min) was longer than that in the EPFA group(81.75 ± 30.45min) (p = 0.000).The hospitalization expenses of IPFA patients(36306.39 ± 7544.25RMB)was more expensive compared with patients receiving EPFA(32122.77 ± 7284.00RMB)(p = 0.000).There were no significant differences between the two groups in terms of tumor size,blood transfusion times and postoperative hospitalization time. Conclusion Retroperitoneal laparoscopic adrenalectomy is a safe and effective procedure that can be performed via extra and intra perinephric fat approaches. IPFA is more than EPFA in terms of estimated blood loss, and the operation time of EPFA is shorter than IPFA. The choice of surgical approach may depend primarily on the experience of the surgeon, the characteristics of adrenal tumor, and the nature of perirenal adipose tissue.

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Section: 3estimated Blood Losssupporting

confidence: 84%

A comparative study of retroperitoneal laparoscopic adrenalectomy via intra and extra perinephric fat approaches

Tan,

Lin,

et al. 2024

Preprint

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“…[22] The surgeon's experience, adrenal tumor characteristics, and nature of the perinephric fat were likely to be key factors in uencing the decision. [23] In the hands of appropriately selected patients, it serves as an indispensable tool in the armamentarium of endocrine surgeons. [21] The preferred choice in our unit is RLA, whereas TRA serves as an alternative based on individual patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

The Modified Retroperitoneal Laparoscopic Adrenalectomy effectively resolves adhesive periadrenal fat and achieves superior outcomes

Hu,

Li,

Cai

et al. 2024

Preprint

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Purpose: The Mayo adhesive probabilityscore affects adrenalectomy outcome. To determine whether modified three-layered retroperitoneal laparoscopic adrenalectomy overcomes periadrenal fat adhesion compared to classic three-layered retroperitoneal laparoscopic adrenalectomy to achieve better surgical outcomes. Materials and Methods: Patients who underwent retroperitoneal laparoscopic adrenalectomy were divided into two groups from January 2016 to December 2022. Baseline characteristics and perioperative data were analyzed, and statistical significance was defined as p<0.05. Linear regression analysis was used for data that met certain conditions, such as linearity, normality, and independence. Binary logistic regression analysis was employed for binary classification of the dependent variables. Results: A total of 731 patients underwent retroperitoneal laparoscopic adrenalectomy, and 651 patients had adequate data for the adhesive probability score assessment. Of these patients, 247 were in the modified group and 404 were in the classic group, and baseline characteristics were comparable between the two groups (p>0.05). The modified group exhibited superior outcomes in terms of the operating time, duration, postoperative hospital stay, estimated blood loss, and complications. Notably, there were 16 cases of unplanned adrenalectomy in the classic group, whereas no such cases occurred in the modified group. Further analysis revealed that periadrenal stranding may be the underlying cause of this discrepancy. Conclusions: The modified three-layered retroperitoneal laparoscopic adrenalectomy effectively overcame the impact of adhesive periadrenal fat compared with the classic approach. We recommend the use of modified three-layered retroperitoneal laparoscopic adrenalectomy for patients with adhesive periadrenal fat.

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“…The entire cohort underwent the en bloc route. Notably, another study showed serious saponification of perinephric fat and heavy adhesion to renal fascia led to the transformation of the split route to the en bloc in three cases, suggesting that the en bloc route would be preferred in the setting of adherent fat [ 24 ]. Taken together, these findings support the potential value and promising application of Mayo score as an omnidimensional measurement of periadrenal fat for operative planning, preoperative evaluation and consultation.…”

Section: Discussionmentioning

confidence: 99%

The Adhesive Perinephric Fat Score is Correlated with Outcomes of Retroperitoneal Laparoscopic Adrenalectomy for Benign Diseases

et al. 2022

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Background Retroperitoneal laparoscopic adrenalectomy (RLA) possessing unique superiority with minimal abdominal interference is complicated by the status of periadrenal fat, including its quantity and texture. We hypothesized that an adherent perinephric fat predictor, the Mayo Adhesive Probability score (Mayo score), is associated with the perioperative outcomes of RLA. Methods This retrospective study included consecutive patients who underwent RLA for the diagnosis of benign adrenal tumors at our institution between 2017 and 2020. Medical records were reviewed to evaluate the association between Mayo scores obtained from preoperative computed tomography imaging and surgical outcomes as well as complications. Factors independently related to perioperative results were analyzed using multivariable regression models. Results In total, 186 RLA were included. According to their Mayo scores, the patients were divided as follows: 0 (n = 51, 27.4%), 1 (n = 34, 18.3%), 2 (n = 45, 24.2%), 3 (n = 29, 15.6%), 4 (n = 16, 8.6%) and 5 (n = 11, 5.9%). Longer operative time (92.0 ± 25.0 vs. 114.7 ± 30.6 vs. 137.4 ± 27.1 min, P < 0.001), higher estimated blood loss (42.2 ± 28.1 vs. 70.5 ± 44.9 vs. 132.6 ± 63.4 mL, P < 0.001) and greater decline of hemoglobin (0.7 ± 0.4 vs. 1.0 ± 0.4 vs. 1.3 ± 0.6 g/dL, P < 0.001) were significantly associated with elevated Mayo score risks. No difference in complication rates was found. The score was identified as a unique, independent risk factor for perioperative outcomes on multivariable analysis. Conclusions The Mayo score is a vital outcome predictor of RLA. It may be utilized in the preoperative planning for patients undergoing RLA.

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The safety and efficiency of retroperitoneal laparoscopic adrenalectomy via extra and intra perinephric fat approaches: a retrospective clinical study

Cited by 3 publications

References 13 publications

A comparative study of retroperitoneal laparoscopic adrenalectomy via intra and extra perinephric fat approaches

A comparative study of retroperitoneal laparoscopic adrenalectomy via intra and extra perinephric fat approaches

The Modified Retroperitoneal Laparoscopic Adrenalectomy effectively resolves adhesive periadrenal fat and achieves superior outcomes

The Adhesive Perinephric Fat Score is Correlated with Outcomes of Retroperitoneal Laparoscopic Adrenalectomy for Benign Diseases

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