Transperitoneal laparoscopic surgery in large adrenal masses.

Abstract

Introduction: The laparoscopic adrenalectomy (LA) has become the gold standard since the transperitoneal laparoscopic approach was first reported. Aim: To evaluate the applicability, safety and short-term results of laparoscopic surgery in adrenal masses over 6 cm. Material and methods: Demographic data, hormonal activities, imaging modalities, operative findings, operation time, conversion rates, complications, duration of hospital stay and histopathologic results of 128 patients who underwent laparoscopic adrenalectomy were evaluated retrospectively. Patients included in the learning curve (n = 23), robotic surgery cases (n = 15) and patients with suspected metastasis (n = 4) were excluded from the study. Six cm mass size was taken as a reference and two groups were formed (group 1: < 6 cm, group 2: ≥ 6 cm). The results of the two groups were compared. Results: There were 64 cases in group 1 and 22 cases in group 2. Functional mass ratio and mass sides were similar between the groups (p = 0.30 and p = 0.17, respectively). The mean mass size in group 1 was 36.4 ±11.2 mm and in group 2 82.4 ±15.5 mm. The conversion rate was similar between the two groups (p = 0.18). The duration of surgery was 135.5 ±8.29 min in group 1, 177.0 ±14.9 min in group 2 (p = 0.014). Morbidity and lengths of hospital stay were similar (p = 0.76, p = 0.34 respectively). Adrenocortical carcinoma was detected in three cases in group 1, which were completed laparoscopically, and in two cases in group 2, which were converted to open surgery (p = 0.46). Conclusions: Although open surgery is still recommended in the guidelines, studies are now being carried out to ensure that laparoscopy can be safely performed on masses over 6 cm. There was no difference between short-term follow-up and histopathologic results in our study.

Establishment and validation of a nomogram for predicting the surgical difficulty of lateral retroperitoneal laparoscopic adrenalectomy

“…Additionally, the limited retroperitoneal space can cause interference and collision of surgical instruments, increasing the difficulty of exposing and isolating the adrenal lesion ( 15 ). Hence, surgeons prefer the transperitoneal approach for large adrenal masses because there is more working space ( 17 ).…”

Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience

“…The definition of a large size adrenal tumour varies widely among different studies, ranging from ≥5 cm to ≥8 cm. [ 5 14 15 ] Based on the final pathology report, we defined LTs as the largest diameter of tumours ≥6 cm. Diagnostic modalities (i.e.…”

“…Multiple comparative studies have demonstrated that minimally invasive surgery is a safe and feasible method for large adrenal tumours compared with small ones. [ 4 8 9 14 15 17 ] LTs may be associated with increased intraoperative blood loss and conversion rate,[ 7 8 ] prolonged operative time[ 17 18 ] and longer hospital stay for transperitoneal LA. [ 7 19 ] In our study, although the operation time and bleeding amount were higher in LTs, the conversion rate, blood transfusion requirement, hospital stay and complication rates were similar between the groups.…”

Peri- and postoperative outcomes of laparoscopic adrenalectomy in nonobese versus obese patients: a systematic review and meta-analysis.

“…LA has been considered a substitute for traditional open surgery in the past decade by numerous studies [5][6][7][8]. Moreover, a study showed that laparoscopy was also safe and feasible for the treatment of large adrenal tumors [31]. However, the increase in the incidence rate of obesity, which is generally considered a major factor for increasing complications, particularly wound and septic complications [30], poses new challenges to LA.…”