scholarly journals Predicting surgical outcome in posterior retroperitoneoscopic adrenalectomy with the aid of a preoperative nomogram

2022 ◽  
Author(s):  
Allon van Uitert ◽  
Elle C. J. van de Wiel ◽  
Jordache Ramjith ◽  
Jaap Deinum ◽  
Henri J. L. M. Timmers ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Operative Time ◽  
Surrogate Endpoint ◽  
Variable Model ◽  
Working Space ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Improve Patient Selection ◽  
Surgical Complexity ◽  
Patient Variables ◽  
Posterior Retroperitoneoscopic Adrenalectomy

Abstract Background Posterior retroperitoneoscopic adrenalectomy (PRA) has several advantages over transperitoneal laparoscopic adrenalectomy (TLA) regarding operative time, blood loss, postoperative pain, and recovery. However, it can be a technically challenging procedure. To improve patient selection for PRA, we developed a preoperative nomogram to predict operative time. Methods All consecutive patients with tumors of ≤ 7 cm and a body mass index (BMI) of < 35 kg/m2 undergoing unilateral PRA between February 2011 and March 2020 were included in the study. The primary outcome was operative time as surrogate endpoint for surgical complexity. Using ten patient variables, an optimal prediction model was created, with a best subsets regression analysis to find the best one-variable up to the best seven-variable model. Results In total 215 patients were included, with a mean age of 52 years and mean tumor size of 2.4 cm. After best subsets regression analysis, a four-variable nomogram was selected and calibrated. This model included sex, pheochromocytoma, BMI, and perinephric fat, which were all individually significant predictors. This model showed an ideal balance between predictive power and applicability, with an R2 of 38.6. Conclusions A four-variable nomogram was developed to predict operative time in PRA, which can aid the surgeon to preoperatively identify suitable patients for PRA. If the nomogram predicts longer operative time and therefore a more complex operation, TLA should be considered as an alternative approach since it provides a larger working space. Also, the nomogram can be used for training purposes to select patients with favorable characteristics when learning this surgical approach.

scholarly journals Comparison of Posterior Retroperitoneoscopic Adrenalectomy Versus Lateral Transperitoneal Laparoscopic Adrenalectomy for Adrenal Tumors: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Chunyang Meng ◽  
Chunxiao Du ◽  
Lei Peng ◽  
Jinze Li ◽  
Jinming Li ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Conversion Rate ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Adrenal Tumors ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Estimated Blood Loss ◽  
Posterior Retroperitoneoscopic Adrenalectomy

ObjectiveTo discuss the differences in the effectiveness and security for adrenal tumors by posterior retroperitoneoscopic adrenalectomy (PRA) and lateral transperitoneal laparoscopic adrenalectomy (LTA).MethodsWe systematically searched PubMed, Embase, Scopus database and Cochrane Library, and the date was from above database establishment to November 2020. Stata 16 was used for calculation and statistical analyses.ResultsNine studies involving eight hundred patients were included. The following differences were observed in favor of PRA vs LTA: less operative time (MD: −22.5; 95% CI −32.57 to −12.45; P=0.000), Fewer estimated blood loss (MD: −15.17; 95% CI −26.63 to −3.72; P=0.009), lower intensity of postoperative pain (MD: −0.56; 95% CI, −1.05 to −0.07; P=0.026), shorter length of hospital stay (MD: −1.15; 95% CI −1.94 to −0.36; P=0.04). No differences were shown in conversion rate (OR 2.07; 95%CI 0.71 to 6.03; P=0.181) and complications (OR 0.85;95% CI 0.46 to 1.56; P=0.597).ConclusionsPosterior retroperitoneoscopic adrenalectomy was clinically superior to lateral transperitoneal laparoscopic adrenalectomy for adrenal tumors in operative time, estimated blood loss, length of hospital stay, and postoperative pain. Only in term of conversion rate and complications, both were similar

scholarly journals Impact of obesity on male urethral sling outcomes

2020 ◽  
Vol 12 ◽  
pp. 175628722092799
Author(s):  
M. Francesca Monn ◽  
Hannah V. Jarvis ◽  
Thomas A. Gardner ◽  
Matthew J. Mellon
Keyword(s):  
Operative Time ◽  
Cohort Analysis ◽  
Obese Patients ◽  
Retrospective Cohort Analysis ◽  
Surgical Complexity ◽  
History Of ◽  
Sling Placement ◽  
The Impact ◽  
Male Urethral Sling

Background: The impact of obesity on AdVance male urethral sling outcomes has been poorly evaluated. Anecdotally, male urethral sling placement can be more challenging due to body habitus in obese patients. The objective of this study was to evaluate the impact of obesity on surgical complexity using operative time as a surrogate and secondarily to evaluate the impact on postoperative pad use. Methods: A retrospective cohort analysis was performed using all men who underwent AdVance male urethral sling placement at a single institution between 2013 and 2019. Descriptive statistics comparing obese and non-obese patients were performed. Results: A total of 62 patients were identified with median (IQR) follow up of 14 (4–33) months. Of these, 40 were non-obese and 22 (35.5%) were obese. When excluding patients who underwent concurrent surgery, the mean operative times for the non-obese versus obese cohorts were 61.8 min versus 73.7 min ( p = 0.020). No Clavien 3–5 grade complications were noted. At follow up, 47.5% of the non-obese cohort and 63.6% of the obese cohort reported using one or more pads daily ( p = 0.290). Four of the five patients with a history of radiation were among the patients wearing pads following male urethral sling placement. Conclusion: Obese men undergoing AdVance male urethral sling placement required increased operative time, potentially related to operative complexity, and a higher proportion of obese compared with non-obese patients required postoperative pads for continued urinary incontinence. Further research is required to better delineate the full impact of obesity on male urethral sling outcomes.

Posterior Retroperitoneoscopic Adrenalectomy for Clinical and Subclinical Cushing’s Syndrome

2010 ◽  
Vol 34 (6) ◽  
pp. 1391-1397 ◽  
Author(s):  
Pier F. Alesina ◽  
Silvia Hommeltenberg ◽  
Beate Meier ◽  
Stephan Petersenn ◽  
Harald Lahner ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Subclinical Cushing’S Syndrome ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Posterior Retroperitoneoscopic Adrenalectomy

Posterior Retroperitoneoscopic Adrenalectomy

2012 ◽  
pp. 135-143 ◽  
Author(s):  
Rocco Bellantone ◽  
Marco Raffaelli ◽  
Carmela De Crea ◽  
Luigi Oragano ◽  
Celestino Pio Lombardi
Keyword(s):  
Retroperitoneoscopic Adrenalectomy ◽  
Posterior Retroperitoneoscopic Adrenalectomy

scholarly journals Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

2015 ◽  
Vol 9 (11-12) ◽  
pp. 859 ◽  
Author(s):  
Newaj Abdullah ◽  
Deepansh Dalela ◽  
Ravi Barod ◽  
Jeff Larson ◽  
Michael Johnson ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Independent Predictor ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Obese Patients ◽  
Estimated Blood Loss

<p><strong>Introduction: </strong>We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database.<strong> </strong></p><p><strong>Methods: </strong>We identified 1836 patients who underwent RPN from five academic centres from 2006-2014.  A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m<sup>2</sup>). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes.</p><p><strong>Results: </strong>A total of 806 (44%) patients were obese with median BMI of 33.8kg/m<sup>2</sup>. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p&lt;0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p = 0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p&lt;0.001), operative time (180 vs. 166 min, p&lt;0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001) and male sex was an independent predictor of these outcomes on regression analysis.</p><p><strong>Conclusion: </strong>In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss.  However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT.  Our results indicate that obesity alone should not preclude consideration for RPN.<strong></strong></p>

Lateral Transperitoneal Adrenalectomy Versus Posterior Retroperitoneoscopic Adrenalectomy for Benign Adrenal Gland Disease

2019 ◽  
Vol 269 (5) ◽  
pp. 842-848 ◽  
Author(s):  
Young Jun Chai ◽  
Hyeong Won Yu ◽  
Ra-Yeong Song ◽  
Su-jin Kim ◽  
June Young Choi ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Retroperitoneoscopic Adrenalectomy ◽  
Posterior Retroperitoneoscopic Adrenalectomy

scholarly journals Minimally Invasive Carpal Tunnel Release (CTR) Using the Wongsiri Technique with MiniSURE

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Sunton Wongsiri ◽  
Wongthawat Liawrungrueang
Keyword(s):  
Minimally Invasive ◽  
Return To Work ◽  
Carpal Tunnel ◽  
Endoscopic Surgery ◽  
Operative Time ◽  
Carpal Tunnel Release ◽  
Line Of Sight ◽  
Open Technique ◽  
Working Space ◽  
Carpal Tunnel Surgery

Introduction. The standard open technique for carpal tunnel surgery has wound problems and complications significantly more than minimally invasive surgery using the Wongsiri technique with MiniSURE Kit® (Surgical Innovation Healthcare Co., Ltd, Bangkok, Thailand) and in particular, the open technique surgery requires a longer time for return to work. CTR surgery with endoscopic devices improves the results with fewer wound problems when compared with the commonly used open technique; however, nerve complications and injury are more prevalent with endoscopic surgery than with the open technique. The Wongsiri technique produces good results with new medical devices such as the MiniSURE View, for improved vision and line-of-sight, and the MiniSURE Cut for improved and complete cutting via the supraretinacular technique that may reduce the nerve problems associated with endoscopic tooling in the carpal tunnel. Purpose. To evaluate the results of the operation and postoperative outcomes of the Wongsiri technique with a MiniSURE Kit®. Methods. 20 patients underwent carpal tunnel release using the Wongsiri technique and a MiniSURE Kit® with a five-step surgery: MIS starts when the surgeon makes a 1.5–1.8 cm incision, creates a working space, inserts the visual tube of MiniSURE View, inserts the freer, and then cuts the transverse carpal ligament by using the MiniSURE Cut. Results. All 20 successes of the Wongsiri technique and MiniSURE Kit® surgery occurred within 6.8 minutes operative time and a 12 mm wound size. A single outlier, in one case (6.7%), the patient experienced pillar pain which abated within one month. Patients can return to work in 7.3 days. Conclusions. The Wongsiri technique with the MiniSURE Kit® demonstrated good outcomes similar to the endoscope. By contrast with the endoscopic surgery, the Wongsiri technique with the MiniSURE Kit® reduced preop, operating, and postop time, many resources, and significant costs and resulted in no nerve problems or complications.

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