Abstract
PurposeIdentifying patients in whom adrenalectomy may be more difficult can help with surgical decision-making. This study investigated the perioperative factors affecting the difficulty of retroperitoneal laparoscopic adrenalectomy (RLA).MethodsSixty-eight patients who underwent RLA at our hospital between December 1, 2020 and May 1, 2021 were included. The difficulty of RLA was assessed by operating time and intraoperative blood loss. We analyzed the relationship between surgical difficulty and patient sex, age, and body mass index, pathological type, tumor side, tumor size, distance from the lower pole of the adrenal tumor to the upper pole of the kidney (DAK), and distance from the lower pole of the adrenal tumor to the renal pedicle (DARP).ResultsMean operating time was 105.38 ± 33.31 min and mean intraoperative blood loss was 32.28 ± 22.88 ml. Univariate linear regression analysis showed that age (P = 0.047), tumor size (P = 0.002), DAK (P = 0.002), and DARP (P < 0.001) were significantly correlated with a longer operating time. Univariate logistic regression analysis showed that DARP (P = 0.001), DAK (P = 0.001), tumor size (P = 0.002), and age (P = 0.033) were significantly correlated with a longer operating time. Multivariate logistic regression indicated that DARP (OR 5.341; 95% CI 1.704–16.739; P = 0.004), and tumor size (OR 4.433; 95% CI 1.434–13.709; P = 0.010) were independent predictors of operating time.ConclusionAge, tumor size, DAK, and DARP were predictors of the difficulty of RLA. Older age, lower DARP and DAK, and a larger tumor size were associated with a longer operating time. DARP and tumor size were independent predictors of surgical difficulty.
Highlights
Compared with traditional open surgery, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of adrenal disease because of its good exposure and precise local anatomy [1]
Univariate linear regression analysis showed that age (r = 0.242, P = 0.047), tumor size (r = 0.377, P = 0.002), DAK (r = − 0.363, P = 0.002) and DARP (r = − 0.453, P < 0.001) were significantly correlated with operating time (Fig. 1)
We found that DAK and DARP were the strongest predictors of the difficulty of retroperitoneal laparoscopic adrenalectomy, the smaller the DARP and DAK, the longer the operating time
Summary
Compared with traditional open surgery, laparoscopic adrenalectomy has become the gold standard for the surgical treatment of adrenal disease because of its good exposure and precise local anatomy [1]. At the same time, compared with the transperitoneal approach, the retroperitoneal approach can avoid intraoperative intestinal interference and postoperative intestinal obstruction as well as other related complications, so is. Retroperitoneal adrenalectomy relies more heavily on the accuracy of the surgical approach, and the incidence of complications is estimated to be 3%–20% [2, 3]. Evaluation of the difficulty of surgery preoperatively is important in terms of avoiding iatrogenic harm, reducing intraoperative blood loss, shortening the operating time, lowering the risk of postoperative complications, and minimizing the length of hospital stay. We investigated patients who have undergone retroperitoneal adrenalectomy for adrenal tumors at our institution in recent years with the aim of identifying factors that affect the difficulty of this operation
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