Óriás mellékvesetumorok eltávolítása laparoszkópos                     transperitonealis technikával három sikeres eset kapcsán

Abstract: With the development of laparoscopic adrenalectomy, indications for resection gradually span from small and benign to bigger and even malignant lesions. We studied the results of laparoscopic adrenalectomy for giant (>10 cm) adrenal tumors in three cases. Three patients (2 female, 1 male, mean age 49.33 years, BMI 31) underwent laparoscopic transperitoneal adrenalectomy due to giant (>10 cm) adrenal lesions with a limited size Pfannenstiel incision. Mean operative time was 126.66 minutes, with a mean intraoperative blood loss of 150 ml. Final histology confirmed adrenocortical carcinoma in two cases, and neurofibroma in one case. Mean hospital stay was 4 days, without perioperative complications. R0 resection was carried out in all cases. During a mean follow-up period of 24 months no local or distant metastasis occurred. Under appropriate conditions adrenalectomy performed by the laparoscopic transperitoneal technique for giant malignant tumors proved to be a safe method fulfilling oncological requirements. Orv Hetil. 2017; 158(45): 1802–1807.

Download Full-text

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.

Download Full-text

Laparoscopic Adrenalectomy for Adrenal Cancer—A Systematic Review

The American Surgeon ◽

10.1177/000313481608200517 ◽

2016 ◽

Vol 82 (5) ◽

pp. 420-426 ◽

Cited By ~ 6

Author(s):

Amanda E. Sautter ◽

Steven C. Cunningham ◽

Gopal C. Kowdley

Keyword(s):

Systematic Review ◽

Recurrence Rate ◽

Laparoscopic Adrenalectomy ◽

Malignant Tumors ◽

Cancer Recurrence ◽

Adrenal Tumors ◽

Scientific Rigor ◽

Pubmed Search ◽

Adrenal Masses

Laparoscopic adrenalectomy is increasingly employed for removal of adrenal masses. As adrenal tumors increase in size, however, their malignant potential likewise increases, raising concerns for the use of laparoscopy for removal of large adrenal malignancies. We present a systematic review of the use of laparoscopic adrenalectomy of large malignant tumors. A PubMed search was undertaken and two independent reviewers reviewed the manuscripts and a methodological index for nonrandomized studies score was determined. Manuscripts with scores greater than eight were included. The primary end points were rate of cancer recurrence, rate of conversion to open, complications, and surgical technique. Our initial search produced 412 manuscripts. After abstract review, 44 manuscripts were scored, of which 19 manuscripts were used. A total of 2183 tumors were removed, of which 517 were malignant. Average follow-up time was 38.7 months. The recurrence rate was 12.9 per cent. The rate of conversion was 3.6 per cent. The main techniques used were transabdominal and retroperitoneal. No significant differences in rate of recurrence or complications were seen when compared with open. Laparoscopic adrenalectomy may be performed for large and malignant tumors; however, most manuscripts on this subject lack significant scientific rigor and follow-up.

Download Full-text

Laparoscopic adrenalectomy - is it safe in hands of residents in training?

BMC Urology ◽

10.1186/s12894-019-0538-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Jadwiga Dworak ◽

Michał Wysocki ◽

Anna Rzepa ◽

Michał Natkaniec ◽

Michał Pędziwiatr ◽

...

Keyword(s):

General Surgery ◽

Laparoscopic Adrenalectomy ◽

Perioperative Complications ◽

High Volume ◽

Adrenal Tumors ◽

Safe Procedure ◽

The Difference ◽

Group 2 ◽

The One ◽

Laparoscopic Transperitoneal

Abstract Background Laparoscopic adrenalectomy (LA) has become the “gold standard” for treating most adrenal tumors in the past decade. However, it is still considered a relatively complicated procedure requiring experience from surgeon. The aim of the study was to evaluate the safety of laparoscopic adrenalectomy performed by residents who are undergoing training in general surgery. Methods A prospectively collected database containing all 300 transperitoneal laparoscopic adrenalectomies performed in II Department of General Surgery JU MC, Krakow between January 2013 and March 2018 was retrospectively reviewed. Patients were divided into two groups; patients operated on by residents (group 1, 54 operations) and by attending general surgeons (group 2, 246 operations). We compared the course of the operation and patient hospitalization in these two groups. If the operation was completed by a different person than the one who started the procedure, we refer to this as “operator conversion”. Results We found no differences in demographic factors or comorbidities between the two groups. The mean operative time was similar in the residents’ and the specialists’ groups (p = 0.5761). Median blood loss did not differ between the groups (p = 0.4325). The overall ratio of intraoperative adverse events was similar in both groups (p = 0.8643). The difference in the ratio of perioperative complications between the groups was not statistically significant (p = 0.6442). The average mean hospital stay after surgery was 2 days for both groups. We identified 25 cases (8.33%) of operator conversion; the difference in operator conversions between two groups was not statistically significant (p = 0.1741). Conclusions Laparoscopic transperitoneal adrenalectomy performed by a supervised resident is a safe procedure. The course of the operation and patient hospitalization did not differ importantly when comparing procedures performed by residents and attending surgeons. Liberal use of operator conversions from resident to attending surgeon and from a surgeon to a senior surgeon provides reasonable safety and prevents complications. In high-volume centers performing minimally invasive techniques, closed supervision allows residents to safely perform LA.

Download Full-text

Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study

BMC Surgery ◽

10.1186/s12893-020-00895-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sheng-Qiang Fu ◽

Chang-Shui Zhuang ◽

Xiao-Rong Yang ◽

Wen-Jie Xie ◽

Bin-Bin Gong ◽

...

Keyword(s):

Laparoscopic Adrenalectomy ◽

Operative Time ◽

Haemodynamic Instability ◽

Robot Assisted ◽

Improvement Rate ◽

Long Term Follow Up ◽

Tumour Characteristics ◽

Group 1

Abstract Background To evaluate the feasibility and safety of robot-assisted retroperitoneal laparoscopic adrenalectomy (RARLA) for large pheochromocytomas (PHEOs; size≥6 cm) compared with retroperitoneal laparoscopic adrenalectomy (RLA). Methods Fifty-one patients who underwent adrenalectomy for large PHEOs between March 2016 and January 2019 were enrolled and divided into two groups, including 32 RLA cases and 19 RARLA cases. We compared the perioperative efficacy and long-term follow-up results between the two groups. Results Preoperative data, including demographics, comorbidities and tumour characteristics, were similar between the groups. Intraoperatively, the RARLA group had a lower incidence of haemodynamic instability (26.3% vs. 56.2%, P = 0.038) and less intraoperative blood loss (100 ml vs. Two hundred milliliter, P = 0.042) than the RLA group. The groups showed no significant differences in operative time or transfusion rates. Postoperatively, the time to diet resumption, time to ambulation, time to drainage removal and postoperative hospital stay were shorter in the RARLA group than in the RLA group (1 d vs. 2 d, P = 0.027; 1 d vs. 2 d, P = 0.034; 3 d vs. 5 d, P = 0.002; 5 d vs. 6 d, P = 0.02, respectively). The groups exhibited no significant differences in the duration of anaesthetic use, complications, or long-term follow-up results for the blood pressure (BP) improvement rate. Conclusions Compared with RLA, RARLA is a safe, feasible and even optimized procedure for large PHEOs.

Download Full-text

LAPAROSCOPIC ADRENALECTOMY IN SURGICAL TREATMENT OF ADRENANOCORTICAL CARCINOMA

Vestnik of Russian military medical Academy ◽

10.17816/brmma13050 ◽

2019 ◽

Vol 21 (1) ◽

pp. 75-78

Author(s):

A V Krivosheev ◽

T A Britvin ◽

M E Beloshitsky

Keyword(s):

Surgical Treatment ◽

Laparoscopic Adrenalectomy ◽

Distant Metastases ◽

Long Term Results ◽

R0 Resection ◽

Morphological Examination ◽

Number Of Patients ◽

Immunohistochemical Studies

Relevance of research: аdrenalectomy remains the only method of potentially radical treatment of adrenocortical carcinoma (AСС), and the complete resection is considered one of the leading factors in the prognosis of disease. The question of the possibility and feasibility of using video- endoscopic technologies in the treatment of patients with ACC is still being discussed. Objective: the purpose of our study was to evaluate the effectiveness of laparoscopic adrenalectomy in the treatment of ACC patients. Material and methods: the study is based on the analysis of the results of diagnostics and surgical treatment of 12 patients who underwent laparoscopic adrenalectomy and verified ACC during histological and immunohistochemical studies. Results: stage I were verified (according to the ENSAT) in 4 cases, in 4 - II stage, and in 4 - III stage. The median of tumor size was 4.9 cm. Intraoperative and postoperative complications did not occur. In all cases, the R0-resection was confirmed by morphological examination. The median patient follow-up was 71 months (1; 141), during this period 11 patients were alive, 1 patient, who had surgery in stage III died of disease progression (distant metastases) 49 months after surgery. During the follow-up period tumor recurrence did not occur. Overall 5-year survival was 75% (95% CI; 30-95%). Conclusion: despite the small number of patients included in this study, satisfactory immediate results (absence of complications, R0-resection) and long-term results allow us to consider video- endoscopic surgery as an effective treatment for patients with ACC.

Download Full-text

Resection of malignant tumors invading the vena cava: Perioperative complications and long-term follow-up

Journal of Vascular Surgery ◽

10.1016/j.jvs.2007.04.067 ◽

2007 ◽

Vol 46 (3) ◽

pp. 533-540 ◽

Cited By ~ 31

Author(s):

Andreas Kuehnl ◽

Michael Schmidt ◽

Hans-Martin Hornung ◽

Anno Graser ◽

Karl-Walter Jauch ◽

...

Keyword(s):

Malignant Tumors ◽

Perioperative Complications ◽

Vena Cava ◽

Long Term Follow Up

Download Full-text

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

The American Surgeon ◽

10.1177/000313481307900226 ◽

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.

Download Full-text

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

Frontiers in Oncology ◽

10.3389/fonc.2021.667985 ◽

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

Download Full-text

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Surgery Today ◽

10.1007/s00595-020-02163-8 ◽

2020 ◽

Author(s):

Hao Lu ◽

Jian Gu ◽

Xiao-feng Qian ◽

Xin-zheng Dai

Keyword(s):

Blood Loss ◽

Indocyanine Green ◽

Operative Time ◽

Malignant Tumors ◽

Laparoscopic Hepatectomy ◽

Surgical Margin ◽

Baseline Data ◽

R0 Resection ◽

Intraoperative Blood Loss ◽

Indocyanine Green Fluorescence

Abstract Purpose To explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation. Methods The subjects of this retrospective study were 120 patients who underwent laparoscopic hepatectomy; divided into an ICG-FN group (n = 57) and a non-ICG-FN group (n = 63). We analyzed the baseline data and operative data. Results There were no remarkable differences in baseline data such as demographic characteristics, lesion-related characteristics, and liver function parameters between the groups. Operative time and intraoperative blood loss were significantly lower in the ICG-FN group. The rate of R0 resection of malignant tumors was comparable in the ICG-FN and non-ICG-FN groups, but the wide surgical margin rate was significantly higher in the ICG-FN group. The administration of ICG 0–3 or 4–7 days preoperatively did not affect the intraoperative fluorescence imaging. Operative time, intraoperative blood loss, and a wide surgical margin correlated with ICG fluorescence navigation. ICG fluorescence navigation helped to minimize intraoperative blood loss and achieve a wide surgical margin. Conclusion ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to achieve a wide surgical margin, which could result in a better prognosis. The administration of ICG 0–3 days preoperatively is acceptable.

Download Full-text

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.

Download Full-text