Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy

Eren Berber, Gurkan Tellioglu, Adrian Harvey, Jamie Mitchell, Kresimira Milas, Allan Siperstein

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Background: For the past 14 years, we have been performing laparoscopic adrenalectomy via the lateral transabdominal as well as the posterior retroperitoneal approach. The aim of this study is to describe patient selection criteria for each approach with comparison of perioperative outcomes. Methods: In patients with smaller tumors, low body mass index (BMI), history of previous abdominal operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterior approach. Data regarding clinical pathology, tumor size, BMI, estimated blood loss (EBL), operating time (OT), morbidity, mortality, and duration of stay were analyzed retrospectively. Data are expressed as mean ± standard error of the mean (SEM). Results: One hundred seventy-two laparoscopic adrenalectomy procedures were performed in 159 patients between 1994 and 2008. The lateral approach was used in 69 patients (right side: 39%, left side: 55%, bilateral: 6%) and the posterior approach in 90 patients (right side: 42%, left side: 48%, bilateral: 10%). The incidence of prior abdominal surgery was greater in the posterior group (26% vs 19%, NS). The lateral approach was used in 9% (3/34) of aldosteronoma, 38% (9/24) of Cushing's disease/syndrome, 47% (18/38) of nonsecreting cortical adenoma, 66% (23/35) of pheochromocytoma, 41% (7/17) of malignant lesions, and 73% (8/11) of others. Thirty percent of the bilateral adrenalectomies were performed via lateral and 70% via posterior approach. Two patients in the posterior approach were converted to the laparoscopic lateral approach, and 2 patients in the lateral approach were converted to open. Overall, patient age and sex were similar between groups. BMI was higher in patients undergoing adrenalectomy via lateral vs posterior approach (32.4 vs 28.4; P = .005). Tumor size was larger than 6 cm in 11 (16%) and 1 (1%) of the patients in the lateral and posterior groups, respectively. On univariate analysis, mean OT for lateral and posterior approaches was similar for unilateral cases (157 ± 7 vs 138 ± 6 min, respectively; P = NS). This was also true on multivariate analysis when corrected for patient selection factors. EBL was 35 ± 7 mL for lateral versus 25 ± 6 mL for posterior approach (P = .05). The duration of stay in lateral and posterior approaches was 1 day in 56% vs 82%, 2 days in 29% vs 13%, and more than 2 days in 15% vs 5% of the patients, respectively. Two patients in the lateral group died postoperatively because of cardiac and pulmonary causes, and 2 patients in the posterior group developed temporary neuralgia. Conclusion: This series compares 2 different approaches for laparoscopic adrenalectomy. Our study shows that the lateral and posterior techniques have a similar peri-operative outcome when patients are selected for each option based on certain criteria.

Original languageEnglish (US)
Pages (from-to)621-626
Number of pages6
JournalSurgery
Volume146
Issue number4
DOIs
StatePublished - Oct 2009
Externally publishedYes

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Adrenalectomy
Patient Selection
Body Mass Index
Patient Rights
Pituitary ACTH Hypersecretion
Neoplasms
Clinical Pathology
Cushing Syndrome
Neuralgia
Pheochromocytoma
Adenoma
Multivariate Analysis
Pathology
Morbidity
Lung

ASJC Scopus subject areas

  • Surgery

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Berber, E., Tellioglu, G., Harvey, A., Mitchell, J., Milas, K., & Siperstein, A. (2009). Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery, 146(4), 621-626. https://doi.org/10.1016/j.surg.2009.06.057

Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. / Berber, Eren; Tellioglu, Gurkan; Harvey, Adrian; Mitchell, Jamie; Milas, Kresimira; Siperstein, Allan.

In: Surgery, Vol. 146, No. 4, 10.2009, p. 621-626.

Research output: Contribution to journalArticle

Berber, E, Tellioglu, G, Harvey, A, Mitchell, J, Milas, K & Siperstein, A 2009, 'Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy', Surgery, vol. 146, no. 4, pp. 621-626. https://doi.org/10.1016/j.surg.2009.06.057
Berber E, Tellioglu G, Harvey A, Mitchell J, Milas K, Siperstein A. Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery. 2009 Oct;146(4):621-626. https://doi.org/10.1016/j.surg.2009.06.057
Berber, Eren ; Tellioglu, Gurkan ; Harvey, Adrian ; Mitchell, Jamie ; Milas, Kresimira ; Siperstein, Allan. / Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. In: Surgery. 2009 ; Vol. 146, No. 4. pp. 621-626.
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abstract = "Background: For the past 14 years, we have been performing laparoscopic adrenalectomy via the lateral transabdominal as well as the posterior retroperitoneal approach. The aim of this study is to describe patient selection criteria for each approach with comparison of perioperative outcomes. Methods: In patients with smaller tumors, low body mass index (BMI), history of previous abdominal operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterior approach. Data regarding clinical pathology, tumor size, BMI, estimated blood loss (EBL), operating time (OT), morbidity, mortality, and duration of stay were analyzed retrospectively. Data are expressed as mean ± standard error of the mean (SEM). Results: One hundred seventy-two laparoscopic adrenalectomy procedures were performed in 159 patients between 1994 and 2008. The lateral approach was used in 69 patients (right side: 39{\%}, left side: 55{\%}, bilateral: 6{\%}) and the posterior approach in 90 patients (right side: 42{\%}, left side: 48{\%}, bilateral: 10{\%}). The incidence of prior abdominal surgery was greater in the posterior group (26{\%} vs 19{\%}, NS). The lateral approach was used in 9{\%} (3/34) of aldosteronoma, 38{\%} (9/24) of Cushing's disease/syndrome, 47{\%} (18/38) of nonsecreting cortical adenoma, 66{\%} (23/35) of pheochromocytoma, 41{\%} (7/17) of malignant lesions, and 73{\%} (8/11) of others. Thirty percent of the bilateral adrenalectomies were performed via lateral and 70{\%} via posterior approach. Two patients in the posterior approach were converted to the laparoscopic lateral approach, and 2 patients in the lateral approach were converted to open. Overall, patient age and sex were similar between groups. BMI was higher in patients undergoing adrenalectomy via lateral vs posterior approach (32.4 vs 28.4; P = .005). Tumor size was larger than 6 cm in 11 (16{\%}) and 1 (1{\%}) of the patients in the lateral and posterior groups, respectively. On univariate analysis, mean OT for lateral and posterior approaches was similar for unilateral cases (157 ± 7 vs 138 ± 6 min, respectively; P = NS). This was also true on multivariate analysis when corrected for patient selection factors. EBL was 35 ± 7 mL for lateral versus 25 ± 6 mL for posterior approach (P = .05). The duration of stay in lateral and posterior approaches was 1 day in 56{\%} vs 82{\%}, 2 days in 29{\%} vs 13{\%}, and more than 2 days in 15{\%} vs 5{\%} of the patients, respectively. Two patients in the lateral group died postoperatively because of cardiac and pulmonary causes, and 2 patients in the posterior group developed temporary neuralgia. Conclusion: This series compares 2 different approaches for laparoscopic adrenalectomy. Our study shows that the lateral and posterior techniques have a similar peri-operative outcome when patients are selected for each option based on certain criteria.",
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AU - Tellioglu, Gurkan

AU - Harvey, Adrian

AU - Mitchell, Jamie

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AU - Siperstein, Allan

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N2 - Background: For the past 14 years, we have been performing laparoscopic adrenalectomy via the lateral transabdominal as well as the posterior retroperitoneal approach. The aim of this study is to describe patient selection criteria for each approach with comparison of perioperative outcomes. Methods: In patients with smaller tumors, low body mass index (BMI), history of previous abdominal operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterior approach. Data regarding clinical pathology, tumor size, BMI, estimated blood loss (EBL), operating time (OT), morbidity, mortality, and duration of stay were analyzed retrospectively. Data are expressed as mean ± standard error of the mean (SEM). Results: One hundred seventy-two laparoscopic adrenalectomy procedures were performed in 159 patients between 1994 and 2008. The lateral approach was used in 69 patients (right side: 39%, left side: 55%, bilateral: 6%) and the posterior approach in 90 patients (right side: 42%, left side: 48%, bilateral: 10%). The incidence of prior abdominal surgery was greater in the posterior group (26% vs 19%, NS). The lateral approach was used in 9% (3/34) of aldosteronoma, 38% (9/24) of Cushing's disease/syndrome, 47% (18/38) of nonsecreting cortical adenoma, 66% (23/35) of pheochromocytoma, 41% (7/17) of malignant lesions, and 73% (8/11) of others. Thirty percent of the bilateral adrenalectomies were performed via lateral and 70% via posterior approach. Two patients in the posterior approach were converted to the laparoscopic lateral approach, and 2 patients in the lateral approach were converted to open. Overall, patient age and sex were similar between groups. BMI was higher in patients undergoing adrenalectomy via lateral vs posterior approach (32.4 vs 28.4; P = .005). Tumor size was larger than 6 cm in 11 (16%) and 1 (1%) of the patients in the lateral and posterior groups, respectively. On univariate analysis, mean OT for lateral and posterior approaches was similar for unilateral cases (157 ± 7 vs 138 ± 6 min, respectively; P = NS). This was also true on multivariate analysis when corrected for patient selection factors. EBL was 35 ± 7 mL for lateral versus 25 ± 6 mL for posterior approach (P = .05). The duration of stay in lateral and posterior approaches was 1 day in 56% vs 82%, 2 days in 29% vs 13%, and more than 2 days in 15% vs 5% of the patients, respectively. Two patients in the lateral group died postoperatively because of cardiac and pulmonary causes, and 2 patients in the posterior group developed temporary neuralgia. Conclusion: This series compares 2 different approaches for laparoscopic adrenalectomy. Our study shows that the lateral and posterior techniques have a similar peri-operative outcome when patients are selected for each option based on certain criteria.

AB - Background: For the past 14 years, we have been performing laparoscopic adrenalectomy via the lateral transabdominal as well as the posterior retroperitoneal approach. The aim of this study is to describe patient selection criteria for each approach with comparison of perioperative outcomes. Methods: In patients with smaller tumors, low body mass index (BMI), history of previous abdominal operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterior approach. Data regarding clinical pathology, tumor size, BMI, estimated blood loss (EBL), operating time (OT), morbidity, mortality, and duration of stay were analyzed retrospectively. Data are expressed as mean ± standard error of the mean (SEM). Results: One hundred seventy-two laparoscopic adrenalectomy procedures were performed in 159 patients between 1994 and 2008. The lateral approach was used in 69 patients (right side: 39%, left side: 55%, bilateral: 6%) and the posterior approach in 90 patients (right side: 42%, left side: 48%, bilateral: 10%). The incidence of prior abdominal surgery was greater in the posterior group (26% vs 19%, NS). The lateral approach was used in 9% (3/34) of aldosteronoma, 38% (9/24) of Cushing's disease/syndrome, 47% (18/38) of nonsecreting cortical adenoma, 66% (23/35) of pheochromocytoma, 41% (7/17) of malignant lesions, and 73% (8/11) of others. Thirty percent of the bilateral adrenalectomies were performed via lateral and 70% via posterior approach. Two patients in the posterior approach were converted to the laparoscopic lateral approach, and 2 patients in the lateral approach were converted to open. Overall, patient age and sex were similar between groups. BMI was higher in patients undergoing adrenalectomy via lateral vs posterior approach (32.4 vs 28.4; P = .005). Tumor size was larger than 6 cm in 11 (16%) and 1 (1%) of the patients in the lateral and posterior groups, respectively. On univariate analysis, mean OT for lateral and posterior approaches was similar for unilateral cases (157 ± 7 vs 138 ± 6 min, respectively; P = NS). This was also true on multivariate analysis when corrected for patient selection factors. EBL was 35 ± 7 mL for lateral versus 25 ± 6 mL for posterior approach (P = .05). The duration of stay in lateral and posterior approaches was 1 day in 56% vs 82%, 2 days in 29% vs 13%, and more than 2 days in 15% vs 5% of the patients, respectively. Two patients in the lateral group died postoperatively because of cardiac and pulmonary causes, and 2 patients in the posterior group developed temporary neuralgia. Conclusion: This series compares 2 different approaches for laparoscopic adrenalectomy. Our study shows that the lateral and posterior techniques have a similar peri-operative outcome when patients are selected for each option based on certain criteria.

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