Multidisciplinary collaborative approach for management of adrenal tumors: Outcomes of minimally invasive adrenalectomy at a single center

Introduction: Laparoscopy is currently the gold standard for the management of adrenal tumors as it is associated with less morbidity. Owing to technological advances, even large adrenal tumors are currently amenable to laparoscopic removal. In this work, we describe our multidisciplinary collaborative approach for management of adrenal tumors at a single center. Material and methods: Between January 2017 and January 2020, 18 patients with adrenal lesions were operated at our center. Five of these patients had incidentalomas. All patients were evaluated in coordination with endocrinologists and anesthetists. All patients underwent transperitoneal laparoscopic adrenalectomy. The surgical complications were classified as per Clavein-Dindo system. All patients with pheochromocytoma and Cushing syndrome were followed up by the endocrinologist for further evaluation and titration of glucocorticoids and antihypertensive medication. Results: Two out of the 18 patients had American Society of Anesthesiologists (ASA) physical status III. Out of the 18 patients, only one required conversion to open surgery. Five patients developed intraoperative hypertensive crisis while three patients developed hypotensive crisis. All patients were ambulated on the first postoperative day and were discharged on the third post operative day. None of the patients developed any major (Clavein-Dindo III–V) intra operative or post operative complications. Conclusion: Laparoscopic adrenalectomy is the procedure of choice for adrenal tumors. A multi-disciplinary approach involving the endocrinologist, anesthesiologist, and laparoscopic surgeon can help achieve favorable outcomes.

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Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

BMC Urology ◽

10.1186/s12894-020-00637-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Changwei Ji ◽

Qun Lu ◽

Wei Chen ◽

Feifei Zhang ◽

Hao Ji ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Laparoscopic Adrenalectomy ◽

Perioperative Outcomes ◽

Adrenal Tumors ◽

Transfusion Rate ◽

Robot Assisted ◽

Estimated Blood Loss ◽

Minimally Invasive Adrenalectomy

Abstract Background To compare the perioperative outcomes of transperitoneal laparoscopic (TLA), retroperitoneal laparoscopic (RLA), and robot-assisted transperitoneal laparoscopic (RATLA) adrenalectomy for adrenal tumors in our center. Methods Between April 2012 and February 2018, 241 minimally invasive adrenalectomies were performed. Cases were categorized based on the minimally invasive adrenalectomy technique. Demographic characteristics, perioperative information and pathological data were retrospectively collected and analyzed. Results This study included 37 TLA, 117 RLA, and 87 RATLA procedures. Any two groups had comparable age, ASA score, Charlson Comorbidity Index, and preoperative hemoglobin. The tumor size for RLA patients was 2.7 ± 1.1 cm, which was significantly smaller compared to patients who underwent TLA/RATLA (p = 0.000/0.000). Operative time was similar in any two groups, while estimated blood loss was lower for RATLA group (75.6 ± 95.6 ml) compared with the TLA group (131.1 ± 204.5 ml) (p = 0.041). Conversion to an open procedure occurred in only one (2.7%) patient in the TLA group for significant adhesion and hemorrhage. There were no significant differences between groups in terms of transfusion rate and complication rate. Length of stay was shorter for the RATLA group versus the TLA/RLA group (p = 0.000/0.029). In all groups, adrenocortical adenoma and pheochromocytoma were the most frequent histotypes. Conclusions Minimally invasive adrenalectomy is associated with expected excellent outcomes. In our study, the RATLA approach appears to provide the benefits of decreased estimated blood loss and length of stay. Robotic adrenalectomy appears to be a safe and effective alternative to conventional laparoscopic adrenalectomy.

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The clinical significance of left inferior phrenic vein in retroperitoneal laparoscopic adrenalectomy

10.21203/rs.3.rs-25361/v1 ◽

2020 ◽

Author(s):

Fang-Ming Wang ◽

Gui-Ming Zhang ◽

Yong Liu

Keyword(s):

Clinical Significance ◽

Laparoscopic Adrenalectomy ◽

Pathological Examination ◽

Adrenal Tumors ◽

Adrenal Cyst ◽

Conversion To Open Surgery ◽

Psoas Major Muscle ◽

The Mean ◽

Psoas Major ◽

Superior Margin

Abstract Background The clinical significance of left inferior phrenic vein (IPV) during left retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal tumors is unclear. We aimed to investigate the surgical feasibility and value of IPV as a landmark during RLA. Methods Between September 2016 and November 2018, 92 consecutive left RLAs were performed by the same surgeon. All the operations were performed through the approach of three relative avascular planes༎Then we searched for IPV between superior margin of renal artery and anterior aspect of psoas major muscle. The left IPV was used as an anatomical landmark to identify and ligate the central adrenal vein (CAV). Results All 92 operations were performed successfully with one conversion to open surgery. We identified the CAV following left IPV in all cases. The left IPV drained into the CAV in 100% of cases, and variant venous anatomy (2 CAVs) was encountered in 2 pheochromocytoma cases (2.17%). Peritoneum perforation occurred in one case in operation (1.09%). Postoperative complications (fever) occurred in 3 patients (3.26%). The mean operative time was 75.82 ± 21.55 minutes༎The average postoperative hospital stay was 3.57 ± 0.76 days༎Pathological examination revealed: cortical adenoma in 72 cases (78.26%), adrenal cyst in 11 cases (11.96%), pheochromocytoma in 6 cases (6.52%), cortical hyperplasia in 1 case (1.09%), medullary hyperplasia in 1 case (1.09%), and hemangioma in 1 case (1.09%). Conclusions Using left IPV as a landmark to search for and handle CAV has important clinical significance in left RLA.

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Laparoscopic Adrenalectomy for Potentially Malignant Adrenal Tumors Greater than 5 Centimeters

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2005-2420 ◽

2006 ◽

Vol 91 (8) ◽

pp. 3080-3083 ◽

Cited By ~ 61

Author(s):

Chun-Hou Liao ◽

Shih-Chieh Chueh ◽

Ming-Kuen Lai ◽

Po-Jen Hsiao ◽

Jun Chen

Keyword(s):

Tumor Size ◽

Laparoscopic Adrenalectomy ◽

Malignant Tumors ◽

Adrenal Tumors ◽

Benign Tumors ◽

Conversion To Open Surgery ◽

Open Conversion ◽

Potentially Malignant ◽

Adrenocortical Carcinomas

Abstract Purpose: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (>5 cm) adrenal tumors. Patients and Methods: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed. Results: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5–12 cm), operative time 207 min (115–315 min), and blood loss 75 ml (minimal–1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group. Conclusions: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.

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Comparison of Outcomes between Obese and Nonobese Patients in Laparoscopic Adrenalectomy: A Cohort Study

Digestive Surgery ◽

10.1159/000515589 ◽

2021 ◽

pp. 1-10

Author(s):

José Ignacio Rodríguez-Hermosa ◽

Pere Planellas-Giné ◽

Lídia Cornejo ◽

Jordi Gironès ◽

Mònica Recasens ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Laparoscopic Adrenalectomy ◽

Operative Time ◽

Cushing Syndrome ◽

Adrenal Tumors ◽

Obese Patients ◽

Estimated Blood Loss ◽

Observational Cohort ◽

Nonobese Patients

Introduction: Obesity is usually considered a risk factor for surgical complications. Laparoscopic adrenalectomy has replaced open adrenalectomy as the standard operation for adrenal tumors. Objective: To compare the safety of laparoscopic adrenalectomy to treat adrenal tumors in obese versus nonobese patients. Methods: This observational cohort study analyzed consecutive patients who underwent laparoscopic adrenalectomy with a lateral transperitoneal approach at a single center (2003–2020). Data and outcomes of obese (body mass index ≥30 kg/m2) and nonobese patients were compared. To analyze the association between operative time and other variables, we used simple and multivariate linear regression. Results: N = 160 (90 obese/70 nonobese) patients underwent laparoscopic adrenalectomy. Cushing syndrome and pheochromocytoma were the most frequent indications. Obese patients were older (58 vs. 52 years, p < 0.001). A greater proportion of obese patients were ASA grade III + IV (71.1 vs. 48.6%, p = 0.004). Obesity was associated with a longer operative time (72.5 vs. 60 min, p < 0.001) and greater blood loss (40 vs. 20 mL, p = 0.022). There were no differences in conversion, morbidity, or hospital stay. After adjustment for confounding factors, operative time was positively correlated with BMI ≥30 kg/m2, learning curve, estimated blood loss, 2D laparoscopy, and specimen size. Conclusion: Lateral transperitoneal laparoscopic adrenalectomy is safe in patients with a BMI 30–35 kg/m2, so these patients also benefit from this minimally invasive surgery.

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Comparison of Surgical Outcomes of Laparoscopic Adrenalectomy Between Patients With Nonfunctioning Adrenal Adenomas and Subclinical Cushing Syndrome: A Single-Center Experience

The Korean Journal of Urological Oncology ◽

10.22465/kjuo.2017.15.3.137 ◽

2017 ◽

Vol 15 (3) ◽

pp. 137-142

Author(s):

Minyong Kang ◽

Minki Baek ◽

Jonghoon Lee ◽

Byong Chang Jeong

Keyword(s):

Surgical Outcomes ◽

Laparoscopic Adrenalectomy ◽

Cushing Syndrome ◽

Single Center ◽

Single Center Experience ◽

Subclinical Cushing Syndrome ◽

Subclinical Cushing

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Epidemiology and Management of Children with Hypertensive Crisis: A Single-Center Experience

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1698759 ◽

2019 ◽

Vol 09 (01) ◽

pp. 045-050

Author(s):

Alicia May Lim ◽

Siew Le Chong ◽

Yong Hong Ng ◽

Yoke Hwee Chan ◽

Jan Hau Lee

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hypertensive Crisis ◽

Hypertensive Emergency ◽

Renal Pathology ◽

Pediatric Hospital ◽

Single Center ◽

Single Center Experience ◽

Effective Treatments

AbstractMost children who present with hypertensive crisis have a secondary cause for hypertension. This study describes the epidemiology and management of children with hypertensive crisis. A retrospective cohort study was done in a tertiary pediatric hospital from 2009 to 2015. Thirty-seven patients were treated for hypertensive crisis. Twelve (32.4%) patients were treated for hypertensive emergency. The majority of our patients (33 [89.1%]) had a secondary cause of hypertension. The most common identifiable cause of hypertension was a renal pathology (18/37 [48.6%]). Oral nifedipine (23 [62.1%]) was the most frequently used antihypertensive, followed by intravenous labetalol (8 [21.6%]). There were no mortalities or morbidities. Hypertensive crisis in children is likely secondary in nature. Oral nifedipine and intravenous labetalol are both effective treatments.

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