scholarly journals Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhao Liu ◽  
Da-wei Li ◽  
Lei Yan ◽  
Zhong-Hua Xu ◽  
Gang-li Gu
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Retroperitoneal Approach ◽  
Perioperative Outcomes ◽  
Transperitoneal Approach ◽  
Operative Data

Abstract Background There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approach for left-sided and right-sided laparoscopic adrenalectomy respectively. Methods Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For left side, transperitoneal approach was used in 132 (103 with tumors < 5 cm and 29 with tumors ≥ 5 cm) and retroperitoneal approach in 110 (102 with tumors < 5 cm and 8 with tumors ≥ 5 cm). For right side, transperitoneal approach was used in 139 (121 with tumors < 5 cm and 18 with tumors ≥ 5 cm) and retroperitoneal approach in 113 (102 with tumors < 5 cm and 11 with tumors ≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumors < 5 cm and ≥ 5 cm respectively. Results For left-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumors ≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumors ≥ 5 cm, the peri-operative data was comparable. Conclusions Lateral transperitoneal and retroperitoneal approach are both effective for laparoscopic adrenalectomy. Lateral transperitoneal approach is faster with less blood loss for tumors < 5 cm.

Comparison of Retroperitoneoscopic and Transperitoneal Laparoscopic Adrenalectomy for Right-Sided Benign Tumors: A Single-Institute Experience

2015 ◽  
Vol 94 (2) ◽  
pp. 144-148 ◽  
Author(s):  
Po Hui Chiang ◽  
Cheng Jen Yu ◽  
Wei Ching Lee ◽  
Hung Jen Wang ◽  
Wu Chi Hsu
Keyword(s):  
Laparoscopic Adrenalectomy ◽  
Open Surgery ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Benign Tumors ◽  
Transperitoneal Approach ◽  
Conversion To Open Surgery ◽  
Significant Difference ◽  
Length Of Hospitalization

Introduction: There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for right-sided laparoscopic adrenalectomy. The aim of this study was to determine whether there is any difference between right-sided transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA). Material and Methods: Our surgery database was reviewed to identify patients who underwent right-sided laparoscopic adrenalectomy with a retroperitoneal or transperitoneal approach since 2000. Fifty-five patients were enrolled (31 RLA and 24 TLA). Patient characteristics, as well as operative and perioperative details, were compared between the two groups. Results: There was no difference in patient characteristics between the groups. There was a statistically significant difference (p = 0.02) in blood loss (31.7 ± 16.4 vs. 56.9 ± 65.5 ml) between RLA and TLA when the patient's BMI was >26. There was no significant difference in operative time, conversion to open surgery, length of hospitalization, or time to oral intake between the groups. Conclusions: Right-sided laparoscopic adrenalectomy can be performed safely and effectively via either RLA or TLA. Surgeons can adopt either approach with confidence depending on their preference if they are familiar with that approach.

scholarly journals The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wooseok Byon ◽  
Keehoon Hyun ◽  
Ji-Sup Yun ◽  
Yong Lai Park ◽  
Chan Heun Park
Keyword(s):  
Surgical Outcomes ◽  
Laparoscopic Adrenalectomy ◽  
Adrenal Glands ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Posterior Retroperitoneal Approach ◽  
Optimal Approach ◽  
The Right ◽  
Length Of Hospitalization

Introduction.Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands.Materials and Methods.From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port) were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA) and posterior retroperitoneal approach (PRA) were analyzed and compared.Results and Discussion.On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min;P=0.038), time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days;P=0.042), and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days;P≤0.001), whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min;P=0.002).Conclusions.We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

scholarly journals Mini-invasive robotic assisted pyelolithotomy: Comparison between the transperitoneal and retroperitoneal approach

2019 ◽  
Vol 91 (2) ◽  
Author(s):  
Daniele D'Agostino ◽  
Paolo Corsi ◽  
Marco Giampaoli ◽  
Federico Mineo Bianchi ◽  
Daniele Romagnoli ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Retroperitoneal Approach ◽  
Transperitoneal Approach ◽  
Robotic Assisted ◽  
Stone Free Rate ◽  
Free Rate

Objective: To compare the retroperitoneal with the transperitoneal approach in a series of patients underwent to robotic-assisted pyelolithotomy (RP). Materials and methods: From January 2015 to December 2018 we evaluated 20 patients subjected to robotic pyelolithotomy; 11 patients were treated with retroperitoneal approach (RRP) and 9 with transperitoneal approach (TRP). For each patient intra and perioperative data were recorded: operative time (OT), blood loss (BL), length of hospital stay (LOS), stone clearance, post-operative complications and time to remove the drain. The presence of stone fragments < 4 mm was considered as stone free rate. Results: The principal stone burden was greater in the TRP group than in the RRP group (48 ± 10 mm vs 32 ± 14 mm, p = 0.12). Preoperative hydronephrosis was present in 7 (64%) patients in RRP group and a mild hydronephrosis in 3 of TRP group (p = 0.04). The average operative time was higher in the RRP group than in the TRP group (203 ± 45 min vs 137 ± 31 min, p = 0.002). The average blood loss was 305 ± 175 ml in the RRP group versus 94 ± 104 ml in the TRP group (p = 0.005). The stone free rate was similar between the two groups, 36% (4 patients) in the RRP group and 44% (4 patients) in the TRP (p = 0.966). Conclusions: RP appears to be a safe and effective minimally invasive treatment for some patients with renal staghorn calculi or urinary tract malformations. The TRP may give lower operative time and better results in terms of blood loss and length of hospital stay.

Impact of Surgical Mentorship on Retroperitoneoscopic Adrenalectomy with Comparison to Transperitoneal Laparoscopic Adrenalectomy

2013 ◽  
Vol 79 (2) ◽  
pp. 162-166
Author(s):  
James T. Broome ◽  
Carmen C. Solorzano
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Retroperitoneoscopic Adrenalectomy ◽  
The Mean ◽  
The Impact

Retroperitoneoscopic adrenalectomy (RA) provides a direct approach to the adrenal gland. RA represents a complex approach with unique orientation that is less intuitive. The authors objectively evaluated the impact of mentorship on the performance of RA and also compared it with laparoscopic adrenalectomy (LA). After implementing the use of RA, a retrospective review of the operative experience of two high-volume endocrine surgeons was performed. Both surgeons participated in a hands-on RA mentorship. Clinical presentation and perioperative outcomes were compared. Subgroup analysis was used to compare RA pre- and postmentorship and with LA. Sixty-one LAs and 31 RAs were included in the analysis. The mean operative time was 115 for LA versus 90 minutes for RA ( P = 0.002). Blood loss was greater for LA versus RA (56 vs 22 mL; P = 0.001). Length of stay (LOS) for LA was 2.2 versus 1.5 days for RA ( P = 0.029). Ten patients were treated by RA in the prementorship era versus 21 in the postmentorship era. The mean operative time for the prementorship group was 118 minutes, which decreased to 77 minutes postmentorship ( P < 0.0001). LOS also decreased from 2.0 to 1.2 days ( P = 0.04) in the postmentorship era. RA demonstrates a shorter operative time, less blood loss, and decrease length of hospital stay as compared with standard LA. After proper mentorship and patient selection, RA may represent a superior option for removal of small, benign adrenal tumors.

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

BMC Urology ◽  
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.

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>

scholarly journals Comparison of open and minimally invasive surgery for intradural-extramedullary spine tumors

2015 ◽  
Vol 39 (2) ◽  
pp. E11 ◽  
Author(s):  
Albert P. Wong ◽  
Rishi R. Lall ◽  
Nader S. Dahdaleh ◽  
Cort D. Lawton ◽  
Zachary A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Operative Time ◽  
Open Group ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Open Resection ◽  
Spine Tumors ◽  
Intradural Extramedullary

OBJECT Patients with symptomatic intradural-extramedullary (ID-EM) tumors may be successfully treated with resection of the lesion and decompression of associated neural structures. Studies of patients undergoing open resection of these tumors have reported high rates of gross-total resection (GTR) with minimal long-term neurological deficit. Case reports and small case series have suggested that these patients may be successfully treated with minimally invasive surgery (MIS). These studies have been limited by small patient populations. Moreover, there are no studies directly comparing perioperative outcomes between patients treated with open resection and MIS. The objective of this study was to compare perioperative outcomes in patients with ID-EM tumors treated using open resection or MIS. METHODS A retrospective review was performed using data collected from 45 consecutive patients treated by open resection or MIS for ID-EM spine tumors. These patients were treated over a 9-year period between April 2003 and October 2012 at Northwestern University and the University of Chicago. Statistical analysis was performed to compare perioperative outcomes between the two groups. RESULTS Of the 45 patients in the study, 27 were treated with the MIS approach and 18 were treated with the open approach. Operative time was similar between the two groups: 256.3 minutes in the MIS group versus 241.1 minutes in the open group (p = 0.55). Estimated blood loss was significantly lower in the MIS group (133.7 ml) compared with the open group (558.8 ml) (p < 0.01). A GTR was achieved in 94.4% of the open cases and 92.6% of the MIS cases (p = 0.81). The mean hospital stay was significantly shorter in the MIS group (3.9 days) compared with the open group (6.1 days) (p < 0.01). There was no significant difference between the complication rates (p = 0.32) and reoperation rates (p = 0.33) between the two groups. Multivariate analysis demonstrated an increased rate of complications in cervical spine tumors (OR 15, p = 0.05). CONCLUSIONS Thoracolumbar ID-EM tumors may be safely and effectively treated with either the open approach or an MIS approach, with an equivalent rate of GTR, perioperative complication rate, and operative time. Patients treated with an MIS approach may benefit from a decrease in operative blood loss and shorter hospital stays.

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background: To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.Methods: From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results: There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19) and the LH group (n=13), patients in the OH group (n=25) had a significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 hours of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P＞0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P＜0.05). There was no significant difference in the operative time between the RH group and the OH group (P＞0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P＜0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P＜0.05).Conclusion: Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver hemangiomas of over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver hemangiomas.Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver hemangiomas were included into this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results There were no significant differences in age, sex, tumor location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver hemangioma volume, FLR/SLV, resected normal liver volume / resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19), and the LH group (n=13), patients in the OH group (n=25) had significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), time to get-out-of-bed (P < 0.05), a higher VAS score after 24 hours of surgery (P < 0.05) and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time of the RH group was significantly shorter than the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The intraoperative blood loss of the RH group was the least among the three groups (P<0.05) and the intraoperative blood loss of the LH group was less than the OH group (P<0.05).Discussion Robotic, laparoscopic, and open hemihepatectomy were safe and efficacious treatments for giant liver hemangiomas. Robotic and laparoscopic hemihepatectomy were significantly better than open hemihepatectomy in intraoperative blood loss, postoperative recovery and pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and shorter operative time.

scholarly journals Body Mass Index and Its Role in Total Laparoscopic Hysterectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shilpa Bhandari ◽  
Pallavi Agrawal ◽  
Aparna Singh
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Perioperative Outcomes ◽  
Obese Patients ◽  
Duration Of Surgery

Objective. To evaluate operative and perioperative outcomes in patients undergoing total laparoscopic hysterectomy according to their body mass index. Method. A retrospective study was performed for patients undergoing total laparoscopic hysterectomy at a tertiary care center for a period of 4 years. Patients were divided into two groups: obese (BMI > 30 Kg/m2) and nonobese (BMI < 30 Kg/m2). Duration of surgery, intraoperative blood loss, successful laparoscopic completion, and intraoperative complications were compared in two groups. Result. A total of 253 patients underwent total laparoscopic hysterectomy from January 2010 to December 2013. Out of them, 105 women (41.5%) had a BMI of more than 30 kg/m2. Overall, the mean blood loss was 85.79 ± 54.17 mL; the operative time was 54.17 ± 19.83 min. The surgery was completed laparoscopically in 244 (96.4%) women while laparotomy was done in 4 cases and vaginal suturing and closure of vault were done in 5 cases. Risk of vaginal assistance was higher in obese patients whereas out of the 4 conversions to laparotomy 3 had BMI < 30 kg/m2. The operative time was increased as the BMI of patient increased. Conclusions. Total laparoscopic hysterectomy is a safe and effective procedure for obese patients and can be performed with an efficacy similar to that in nonobese patients.

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