Videoscopic adrenalectomy - when does retroperitoneal seem better?

Myśliwiec, Piotr; Marek-Safiejko, Magda; Łukaszewicz, Jerzy; Safiejko, Kamil; Kozłowski, Robert; Wojskowicz, Piotr; Dadan, Jacek

doi:10.5114/wiitm.2014.41636

Cited by 14 publications

(20 citation statements)

References 32 publications

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“…It is due to the broader knowledge of the anatomy of the peritoneal cavity, skills gained in other laparoscopic procedures, as well as a larger operative field. However, according to numerous reports, PRA is easier to perform and is associated with less pain in the postoperative period [16,22,25]. The above observations are confirmed by our median operative time for PRA, 91.8 ± 30.8 min and its downward tendency.…”

Section: Discussionsupporting

confidence: 76%

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A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

Marek-Safiejko¹,

Safiejko²,

Łukaszewicz³

et al. 2016

Adv Clin Exp Med

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diovascular and respiratory diseases, or those with obesity [1]. However, novel methods may prolong operative time when employed by trainee surgeons.During surgical procedures, the proper exposure of paired adrenal glands is challenging due to their small size, fragility and localization in the retroperitoneal area (deep inside the adipose tissue). Classical interventions require extensive incisions through integuments that are disproportionately large compared to the size of the glands [3].Surgery has recently made immense progress towards the minimization of invasiveness. Surgical trauma and the rate of complications have been limited significantly. As a result, decreased postoperative pain, shorter hospital stay, faster recovery, reduced mortality, improved cosmetic effect and decreased hospital costs have been observed [1,2]. Various studies conducted worldwide confirm the safety and efficacy of interventions that employ novel methods also in patients diagnosed with car- AbstractBackground. Laparoscopic adrenalectomy is the gold standard for the surgical treatment of benign adrenal masses. It is most commonly performed using the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA). The choice of the method depends on contraindications for a particular approach in an individual case and surgical experience. The objective of the article is to compare two approaches, LTA and PRA, in view of our own experience and literature review. Objectives. The objective of the article is to compare two approaches, LTA and PRA, in view of our own experience and literature. Material and Methods. The assessment involved morphological characteristics of tumors, indications for PRA and LTA, operative time, perioperative blood loss and postoperative complications. Results. Seventy-seven of the examined 104 laparoscopic adrenalectomies were performed retroperitoneally; 27 -transperitoneally. The mean size of tumors in PRA was 4.6 cm and in LTA 6.2 cm. The mean total operative time was 91.8 min in the case of PRA and 153.1 min in LTA. No differences in the amount of blood loss between the two approaches were recorded. The average hospitalization post PRA lasted 2.03 days and post LTA 2.67 days. Conclusions. Laparoscopic adrenalectomy proves to be an effective and safe surgical technique both in the case of LTA and PRA. The technique to be used should be suited to surgical team's experience, patient's general condition and tumor size and location. In our experience, the most advantageous approach in the case of tumors of less than 7 cm is PRA (Adv Clin Exp Med 2016, 25, 5, 829-835).

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Section: Discussionsupporting

confidence: 76%

“…Opponents of the method indicate gas embolism and the release of catecholamines as possible risks of the increase in the CO 2 pressure [21]. However, this has not been confirmed in practice [16,22].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

Marek-Safiejko¹,

Safiejko²,

Łukaszewicz³

et al. 2016

Adv Clin Exp Med

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“…The number of non-severe complications of laparoscopic adrenalectomy, reaching 10%, is acceptable. Conversions to the open method are done in 5% of all cases [13][14][15]. Similar results were found in the presented study as well as in patients with malignancies and in patients with benign tumours not hormonally active.…”

Section: Rycina 2 Nowotwór Nadnerczy -Rezonans Magnetycznysupporting

confidence: 75%

The usefulness of laparoscopic adrenalectomy in the treatment of adrenal neoplasms — a single-centre experience

Pogorzelski

Toutounchi

Krajewska

et al. 2017

Endokrynologia Polska

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Introduction: Adrenal neoplasms comprise about 10% of all tumours affecting this organ and constitute a significant, at first diagnostic and subsequently therapeutic, problem, especially since a relatively high proportion of neoplastic lesions are asymptomatic. The number of diagnosed metastases to adrenal glands is increasing. Surgical treatment involves both open surgery as well as laparoscopy. Material and methods: There were 245 adrenalectomies performed at our centre due to various indications over the past four years. In 27 (11.5%) cases neoplasms were diagnosed in the final histopahtological examination. In 11 (40.7%) cases primary adrenal cortex tumours were diagnosed, metastases from other solid organ tumours were identified in another 12 (44.4%) patients, and rarer neoplasms were diagnosed in the remaning 4 (14.8%) subjects. Cases of malignant pheochromocytoma were not included in this report.

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“…There are authors who prefer retroperitoneal access in the case of smaller tumors. 25 Recent meta-analyses showed no statistical differences between laparoscopic and retroperitoneoscopic access regarding perioperative outcomes; however, postoperative recovery was slightly faster in the latter. 24,26 For instance, Zon ca et al suggested that retroperitoneoscopic access can also be used safely in morbidly obese patients, and indeed might be associated with more favorable postoperative course, shorter hospital stay, better cosmetic outcome and quicker recovery.…”

Section: Discussionmentioning

confidence: 98%

“…No doubt minimally invasive surgery is preferred in the treatment of most tumors. There are authors who prefer retroperitoneal access in the case of smaller tumors . Recent meta‐analyses showed no statistical differences between laparoscopic and retroperitoneoscopic access regarding perioperative outcomes; however, postoperative recovery was slightly faster in the latter .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short‐term outcomes

et al. 2016

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Objectives: To evaluate the impact of obesity and morbid obesity on short-term outcomes after laparoscopic adrenalectomy. Methods: The study included 520 consecutive patients undergoing laparoscopic adrenalectomy for adrenal tumor. The entire study group was divided depending on the body mass index: group 1 (normal weight), <25 kg/m . Additionally, group 4 (morbidly obese) was distinguished. Study end-points were: operative time, intraoperative blood loss, total length of hospital stay, morbidity rate and 30-day readmission rate. Results: The mean operative times were 88.8, 94.7, 93.5, and 99.9 min in groups 1, 2, 3 and 4, respectively (P = 0.1444). Complications were comparable between groups (12.8% vs 8.8% vs 8.2% vs 11.5%, P = 0.5295). The mean intraoperative blood loss was 66.8 versus 78.3 versus 60.7 versus 92.4, P = 0.1399. There were no differences in conversion rate between groups. Conclusions: Obesity has no influence on short-term outcomes of laparoscopic transperitoneal adrenalectomy. This procedure is feasible regardless of the body mass index. Therefore, it can be offered to all patient groups including those morbidly obese individuals in whose case preoperative weight loss seems unnecessary.

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Videoscopic adrenalectomy - when does retroperitoneal seem better?

Cited by 14 publications

References 32 publications

A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

The usefulness of laparoscopic adrenalectomy in the treatment of adrenal neoplasms — a single-centre experience

Laparoscopic transperitoneal adrenalectomy in morbidly obese patients is not associated with worse short‐term outcomes

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