Laparoscopic Adrenalectomy In Patients Research Articles

Impact of Body Mass Index ≥35 kg/m2 on Minimally Invasive Adrenalectomy.

Introduction: Obesity is associated with numerous chronic conditions and an increased risk for surgical complications. Laparoscopic and robotic adrenalectomy have proven effective in the resection of adrenal tumors. This study analyzes the outcomes of severely obese patients (body-mass index [BMI] ≥35 kg/m2) following minimally invasive adrenalectomy. Materials and Methods: A retrospective analysis of patients who underwent minimally invasive adrenalectomy at our institution between 2010 and 2023 was conducted. Two matching analyses were performed. The first analysis compared patients with BMI greater versus lower than 35 kg/m2. The second analysis compared outcomes between robotic and laparoscopic adrenalectomy in patients with a BMI ≥35 kg/m2. Results: A total of 278 patients were included in the study. The median tumor size was 29 mm. Adrenal tumors had similar laterality, and most were hormonally active (66.2%). The most common pathological diagnosis was pheochromocytoma (25.5%). No statistical difference was found in peri- and postoperative outcomes between patients with BMI ≥35 and <35 kg/m2 who underwent minimally invasive adrenalectomy. When the surgical approach was compared in severely obese patients, robotic adrenalectomy was associated with shorter hospital length of stay with similar operative time as the laparoscopic approach. Conclusions: Minimally invasive adrenalectomy is safe and feasible in patients with BMI ≥35 kg/m2. Robotic and laparoscopic approaches are both safe and efficient for the resection of adrenal tumors in severely obese patients.

Evaluation of Outcomes between the Right and Left-Sided Transperitoneal Laparoscopic Adrenalectomy in a Tertiary Care Center: A Retrospective Study

Introduction: Several studies have corroborated the feasibility and safety of laparoscopic transperitoneal adrenalectomy for the removal of adrenal tumours however, there is very limited clinical evidence comparing right and left transperitoneal laparoscopic adrenalectomies. This comparison enables surgeons in preoperative counseling of patients regarding postoperative outcomes. Aim: To evaluate the outcomes between the right and left-sided laparoscopic adrenalectomy in patients admitted to a tertiary care center. Materials and Methods: The present retrospective study considered data from patients, who underwent transperitoneal laparoscopic adrenalectomy between December 2013- December 2019 admitted to the Vydehi Institute of Medical Sciences and Research Centre. All the selected subjects with adrenal tumours were operated on by a single surgeon through a standardised transperitoneal laparoscopic approach for right and left-side adrenalectomies. The data collected were age, gender, symptoms, size of the tumour, duration of surgery, intraoperative blood loss, complications, duration of stay and histopathology of tumours. Both sides were compared for age, gender, size of tumour, operative time, blood loss, duration of hospital stay, histopathological diagnosis, benign and malignant lesions. The Student’s t-test was used for the evaluation of continuous data and the Chi-square test and Fisher’s-exact test for categorical variables. Results: The study considered the data of 42 patients. The corresponding number of subjects who had undergone right and left adrenalectomies for various adrenal pathologies were 18 (42.85%, 9 each of both genders) and 24 (17 males, 7 females). The mean age for right-sided adrenalectomy was 44.17 and the left-side was 46.83. The mean tumour size (in cm) was significantly larger in the right-side group as opposed to the left-side (7.97±2.7 vs. 5.62±2.37, p-value=0.0053). The duration of surgery (136.22±25.53 vs.112.92±27.21 min, p=0.0074) and average intraoperative blood loss were also more in the rightside group (431.67±259.73 vs 277.08±193.92 mL, p=0.02). There was no significant difference in the mean duration of hospital stay between the groups (3.94±1.06 vs. 3.67±1.13, p=0.4212). The most common tumour was adenoma in both groups. No major complications were noted in either group. Conclusion: Outcomes were comparable between right and left-side adrenalectomies. However, longer mean operative time and larger tumour size were noted for right-side laparoscopic adrenalectomy

Is acute kidney injury after laparoscopic adrenalectomy related to the progression of chronic kidney disease in patients with primary aldosteronism?

PurposeThis study was conducted to investigate the predictors of kidney outcome after laparoscopic adrenalectomy in patients with primary aldosteronism (PA).Materials and MethodsWe retrospectively reviewed the medical records of 74 patients who underwent unilateral adrenalectomy for the treatment of PA from January 2011 to December 2019. Patient characteristics and serial data on postoperative changes in kidney function were analyzed and compared between the two groups according to the presence of acute kidney injury (AKI). Postoperative AKI was defined as a decline in the estimated glomerular filtration rate (eGFR) of >50% or an increase in the serum creatinine level of ≥0.3 mg/dL at 1 week after surgery compared with perioperative levels. Chronic kidney disease (CKD) was defined as an eGFR < 60 mL/min/1.73 m2 present for 3 months.ResultsNineteen patients (25.7%) had postoperative AKI. Patients who experienced postoperative AKI had higher aldosterone-to-renin ratios, higher rates of dyslipidemia, and more left ventricular hypertrophy than did patients without postoperative AKI (p=0.015, 0.036, and 0.033, respectively). Twenty-eight patients (37.8%) had CKD at 6 months after surgery, including 15 patients who had newly progressed to CKD postoperatively. In the multivariate regression analysis of patients without preoperative CKD, the only independent predictor of the progression to CKD was preoperative albuminuria (p=0.007).ConclusionsIn this study, one-quarter of the patients had postoperative AKI after unilateral adrenalectomy for the treatment of PA. However, postoperative AKI was not directly correlated with CKD progression. Preoperative albuminuria was an independent predictor of the progression of CKD.

Long-term outcome success after operative treatment for primary aldosteronism

BackgroundPrimary aldosteronism is a common cause of secondary hypertension. Resolution of hypertension and hypokalemia after adrenalectomy for primary aldosteronism is variable. This study examines preoperative factors for persistent hypertension and long-term outcome after laparoscopic adrenalectomy in patients with primary aldosteronism. MethodsWe reviewed all patients who underwent laparoscopic resection for adrenal tumors from 2010 to 2018. Biochemical success was defined as normalization of hypokalemia and the aldosterone-to-renin ratio. Clinical success was defined as normalization of blood pressure requiring no antihypertensive medications. Descriptive statistics and binary logistic regression analysis were used. ResultsOf 202 patients who underwent unilateral laparoscopic adrenalectomy, 37 (18%) had biochemical and clinical confirmation of primary aldosteronism. Postoperatively, biochemical success was attained in all 37 patients with primary aldosteronism. Complete, partial, and absent clinical success was achieved in 41%, 38%, and 21% of patients, respectively. Number of antihypertensives (odds ratio, 2.30 per medication; 95% confidence interval, 1.07−4.93; P < .05), duration of hypertension (odds ratio, 1.11 per year; 95% confidence interval, 1.03−1.25; P < .05), and increased body mass index (odds ratio, 1.13; 95% confidence interval, 1.01−1.29; P < .05) were preoperative factors associated with absent clinical success. ConclusionBiochemical success is more common than clinical resolution of hypertension after adrenalectomy for primary aldosteronism. The number of antihypertensive medications, longstanding hypertension, and high body mass index are preoperative factors associated with absent clinical success.

Comparison of the retroperitoneal versus Transperitoneal laparoscopic Adrenalectomy perioperative outcomes and safety for Pheochromocytoma: a meta-analysis

BackgroundTo compare the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy with those of retroperitoneal laparoscopic adrenalectomy for patients with pheochromocytoma.MethodsWe searched PubMed, EMBASE and the Cochrane Central Register for studies from 1999 to 2019 to assess the perioperative outcomes and safety of transperitoneal laparoscopic adrenalectomy and the retroperitoneal approach for laparoscopic adrenalectomy in patients with pheochromocytoma. After data extraction and quality assessments, we used RevMan 5.2 to pool the data.ResultsFour retrospective studies were obtained in our meta-analysis. Patients who underwent retroperitoneal laparoscopic adrenalectomy were associated with shorter operative time (WMD: 34.91, 95% CI: 27.02 to 42.80, I2 = 15%; p < 0.01), less intraoperative blood loss (WMD: 139.32, 95% CI: 125.38 to 153.26, I2 = 0, p < 0.01), and a shorter hospital stay (WMD: 2, 95% CI: 1.18 to 2.82, I2 = 82%, p < 0.01) than patients who underwent transperitoneal laparoscopic adrenalectomy. No significant differences were found in the complication rate (OR: 1.58, 95% CI: 0.58 to 4.33, I2 = 0; p = 0.38) or in the incidence of hemodynamic crisis (OR: 0.74, 95% CI: 0.19 to 2.94, p = 0.67) between the two groups.ConclusionRetroperitoneal laparoscopic adrenalectomy could achieve better perioperative outcomes than the transperitoneal approach for patients with pheochromocytoma.

Prevention of hemodynamic instability during laparoscopic adrenalectomy in patients after x-ray endovascular electrocoagulation occlusion of the adrenal vessels

Prevention of hemodynamic instability during laparoscopic adrenalectomy in patients after x-ray endovascular electrocoagulation occlusion of the adrenal vessels

Changes in quality of life after laparoscopic adrenalectomy for patients with primary aldosteronism: Prospective 2-year longitudinal cohort study in a Japanese tertiary center.

Changes in quality of life after laparoscopic adrenalectomy for patients with primary aldosteronism: Prospective 2-year longitudinal cohort study in a Japanese tertiary center.

Treatment Outcomes of Transperitoneal Laparoscopic Adrenalectomy in Patients with Functional Adrenal Gland Tumors

Treatment Outcomes of Transperitoneal Laparoscopic Adrenalectomy in Patients with Functional Adrenal Gland Tumors

Comparison of results of laparoscopic and open surgical techniques in adrenal masses larger than 6 cm

Aim: In this study, we aimed to compare the results of conventional and laparoscopic adrenalectomy in patients with adrenal masses greater than 6 cm.Material and Methods: Thirty-six patients with tumor size greater than 6 cm who underwent adrenalectomy between January 2011 and January 2018 were included in the study. Patients were divided into two groups as Group 1 conventional and Group 2 Laparoscopic surgery. The two groups were retrospectively compared in terms of age, sex, mass localization, mass size, duration of operation, amount of bleeding, duration of hospitalization, duration of onset of food intake, perioperative mortality, early period complications and re-admission to the hospital within 90 days. P0.05 was considered statistically significant.Results: There were 13 patients in Group 1 and 23 patients in Group 2. There was no statistically significant difference between the groups in terms of age, sex, tumor localization, tumor size, indications for operation, postoperative complications, perioperative mortality and readmission within 90 days. Duration of operation (min), amount of bleeding (ml), duration of oral intake (day) and duration of hospitalization (day) were higher in Group 1 and statistically significant.Conclusion: Laparoscopic adrenalectomy has demonstrated advantages in patients with a mass greater than 6 cm compared to conventional surgery, such as short operation duration, less blood loss, early onset of oral food intake and shorter hospital stay. It can be safely used in patients with a mass larger than 6 cm.

Obesity does not affect peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy.

ABSTRACTLaparoscopic adrenalectomy is the gold standard procedure for most adrenal tumors. Obesity is considered as a risk factor for surgical complications. This study aimed to evaluate whether obesity affects peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy using body mass index (BMI). This retrospective study included 98 patients who underwent transabdominal laparoscopic adrenalectomy between January 2011 and December 2016. We divided the patients into 2 groups: non-obese group (BMI < 25 kg/m2) and obese group (BMI ≥ 25 kg/m2). We assessed perioperative outcomes and postoperative complications between the groups. A total of 98 patients were analyzed (70 without obesity and 28 with obesity). There were no significant differences between the non-obese and obese groups regarding operative time (111 vs 107 min; p = 0.795), blood loss (3.5 vs 3.5 ml; p = 0.740), rate of placement of additional trocars (14.3% vs 17.9%; p = 0.657), rate of open conversion (2.6% vs 3.6%; p = 0.853), and postoperative length of hospital stay (6 vs 5 days; p = 0.237). Furthermore, obesity was not a significant risk factor for postoperative complications (postoperative bleeding, wound infection, and pneumonia). There are no significant differences in peri- and postoperative outcomes of transabdominal laparoscopic adrenalectomy in patients with obesity compared with those without obesity. Transabdominal laparoscopic adrenalectomy is feasible and safe for patients with obesity.

Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery - single-center experience.

IntroductionLateral transabdominal adrenalectomy (LTA) is the most common minimally invasive technique used to treat patients with adrenal tumors.AimTo analyze intra-operative and post-operative complications and reasons for conversion to open surgery in patients who underwent LTA and had previous abdominal surgery.Material and methodsFive hundred and nineteen patients underwent LTA in our center between 2005 and 2016. We identified a study group of 150 patients, with previous abdominal surgery. We analyzed the frequency of intra-operative and post-operative complications and the reasons for conversion from laparoscopic to open adrenalectomy.ResultsThe patients’ mean age was 58; they underwent LTA due to hormonally active tumors (n = 79, 53%) and non-functioning adrenal tumors (n = 71, 47%). The size of adrenal lesions ranged from 20 mm to 90 mm. Seventy-eight (52%) adrenal lesions were found in the right adrenal gland, and 72 (48%) lesions in the left adrenal gland. The mean operating time was 130 min. The mean stay in hospital was five days. The intra-operative complications included blood pressure fluctuations (n = 32), abnormal vascular supply of the adrenal glands causing difficulties with dissections (n = 3), and respiratory problems (n = 1). Two (1.3%) patients had post-operative bleeding at the site of removed adrenal glands; 1 patient had an exacerbation of asthma postoperatively. Of the 150 patients analyzed, 3 (2%) required conversion to open adrenalectomy. The conversions were not caused by abdominal adhesions.ConclusionsLateral transabdominal adrenalectomy is feasible and safe in patients with previous abdominal surgery. In our study, conversion from laparoscopic to open adrenalectomy was not caused by abdominal adhesions.

What factors impact the treatment outcomes of laparoscopic adrenalectomy in patients with functioning adrenal gland tumors?

IntroductionLaparoscopic adrenalectomy is currently considered a standard treatment for both functional and non-hormonal benign adrenal tumors. However, further studies are required to evaluate the factors that predict treatment outcomes in cases in which laparoscopic adrenalectomy is performed. Materials and methodsThis was a cross-sectional study conducted between 2011 and 2017. The inclusion criteria were a diagnosis of functioning adrenal gland tumors and having undergone transperitoneal laparoscopic adrenalectomy. Important factors affecting the outcomes of treatment were analyzed. ResultsThere were 68 patients enrolled in this study. Participants were divided into two groups based on whether they had cured or uncured hypertension. The median ages in the cured and uncured groups were 41.0 and 54.0 years, respectively (p-value 0.001). The mean tumor size was 20 mm in the cured group and 15 mm in the uncured group. Patients in the cured group experienced a median of 20 ml of blood loss in both groups. Average operating times were 95 and 85 min, respectively. Only two factors were independently associated with uncured hypertension: age and preoperative systolic blood pressure, with adjusted odds ratios (95% confidence interval) of 1.11 (1.03, 1.17) and 1.03 (1.01, 1.07), respectively. ConclusionPredictors for unsuccessful of treatment in patients who underwent laparoscopic adrenalectomy were older age at the time of the operation and preoperative systemic blood pressure.

Are large adrenal neoplasms technical limitation for laparoscopic adrenalectomy?

To study surgical features of laparoscopic adrenalectomy in patients with large adrenal neoplasms. The results of 32 laparoscopic adrenalectomy procedures were analyzed in patients with adrenal neoplasms over 5 cm. The control group consisted of 67 patients with adrenal neoplasms up to 5 cm. There were significant differences in duration of operations (96.3±13.44 min vs. 67.2±11.07 min; p<0.05) and some postoperative variables. Postoperative morbidity was similar (9.4% vs. 7.5%; p>0.05). Laparoscopic adrenalectomy for adrenal neoplasms from 5 to 8-9 cm is feasible, effective and safe surgical procedure.

Laparoscopic Adrenalectomy in Elderly Patients.

With increase life expectancy, surgical indications in elderly become more frequent. The aim of this study was to analyze indications and outcome of laparoscopic adrenalectomy in patients over 75. Between 1994 and 2014, 641 patients underwent laparoscopic adrenalectomy. Preoperatively, all patients had a standardized preoperative work-up. Patients over 75 were compared with a control group of younger patients. The median age was 52 years (41 to 61) and 3.6% of patients (n=23) were over 75. Patients over 75 were more frequently operated for malignant lesion (21.7% vs. 4.7%; P=0.005). There was no postoperative mortality. Conversion rate was 3.4% (n=22), with no significant difference between the groups. The overall morbidity and severe morbidity rates were, respectively, 16.9% and 3.3%, with no significant difference between the groups. In experienced team and for selected patients, laparoscopic adrenalectomy after 75 years is safe, without increased postoperative morbidity, as compared with younger population.

Predictors of hypertension urgency in primary aldosteronism patients during the first 24 hours after surgery.

Study about blood pressure variation in the first 24 hours post-operation is limited in patients with adrenal aldosterone-producing adenoma. We aim to evaluate the potential predictors for postoperative hypertension urgency during the first 24 hours after laparoscopic adrenalectomy in patients with aldosterone-producing adenoma. Clinical data of 177 patients with aldosterone-producing adenoma were retrospectively collected from January 2009 to December 2015 and the potential factors that may influence postoperative blood pressure during the first 24 hours after surgery were analyzed. The factors included gender, age, body mass index, preoperative maximum systolic blood pressure, number of antihypertensive medicines, preoperative spironolactone treatment, duration of hypertension, surgical method and approach, adenoma diameter, preoperative proteinuria, estimated glomerular filtration rate, serum potassium and serum aldosterone. Univariate and multivariate regression analyses were used to evaluate the relationship between the above variables and postoperative hypertension urgency. We found that the proportion of patients with a higher systolic blood pressure ≥ 160 mmHg and ≥ 180 mmHg were significantly increased post-operation (both p < 0.001). In multivariate analysis, the maximum systolic blood pressure was an independent predictor of postoperative hypertension urgency, and the cut-off point was 157 mmHg with the sensitivity of 66% and specificity of 82%. Multivariable analysis also showed that preoperative maximum systolic blood pressure and number of antihypertensive medicines were independent risk factors for higher postoperative systolic blood pressure. This study was derived from a high volume adrenal tumor center, and these data may provide a potential tool to guide preoperative counseling.

Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism.

Most patients with primary aldosteronism (PA) show a significant decrease in kidney function after surgery. Glomerular hyperfiltration peculiar to PA can mask mild renal failure before surgery. The aim of this retrospective study was to investigate postoperative renal functional outcomes in PA patients from different viewpoints and to develop novel nomograms that can predict renal functional outcomes in PA patients after surgery. 130 Japanese PA patients treated by unilateral laparoscopic adrenalectomy were retrospectively surveyed. Pre- and postoperative changes of estimated glomerular filtration rates (eGFRs) and the distribution of eGFR classification were compared. Furthermore, predictors of the following renal functional outcomes were investigated: (I) the percentage decrease >25% in eGFR and (II) the presence of new-onset eGFR <45ml/min/1.73m2. Finally, two nomograms that predicted postoperative renal functional outcomes were developed and internally validated. At 6months, the average decrease in eGFR was 16.7mL/min/1.73m2 (corresponding percent decrease: 19.7%). Upstaging of eGFR classification was observed in 54.6% of patients. Age, potassium, plasma aldosterone concentration, and initial eGFR were incorporated into a nomogram predicting a >25% postoperative decrease in eGFR. Duration of hypertension and initial eGFR were incorporated into a nomogram predicting new-onset eGFR <45ml/min/1.73m2. The value of the area under the receiver operating characteristics curve for each nomogram was 0.82 and 0.74, respectively. The first nomograms that can predict postoperative renal outcomes in PA patients were developed. They will help clinicians calculate the probability of renal dysfunction in PA patients after laparoscopic adrenalectomy.

Clinical Benefits of Unilateral Adrenalectomy in Patients with Subclinical Hypercortisolism Due to Adrenal Incidentaloma: Results from a Single Center.

This study was designed to evaluate the results of unilateral laparoscopic adrenalectomy in patients with subclinical hypercortisolism (SH) due to adrenal incidentaloma (AI) concerning the main cardiometabolic disorders. We have studied between January 2000 to December 2015, 645 patients with AI (283 males and 362 females; mean age 61.9±10years) and we found 70 patients with SH (27 males and 43 females; mean age 61.9±8.4years). Twenty-six (37%) SH patients (6 males and 20 females; mean age 58.7±7.1years) underwent unilateral laparoscopic adrenalectomy, whereas 44 SH patients (21 males and 23 females; mean age 63.9±9.9years) performed a conservative treatment. All SH patients were evaluated at diagnosis and after follow-up (mean 12months; range 9-15months). In only SH patients undergoing unilateral adrenalectomy we found a statistical significant reduction of the arterial hypertension and metabolic syndrome (p<0.05, respectively). In particular we observed a reduction of 24-h systolic blood pressure and "non-dipper" pattern (p<0.05, respectively) evaluated with ambulatory blood pressure monitoring (ABPM). Our study confirm the high prevalence of SH in AI, and the unilateral laparoscopic adrenalectomy seemed to have a beneficial effect on some cardiometabolic disorders.

Intraoperative correction of hemodynamic instability in patients with pheochromocytoma

Aim. Development, clinical evaluation and implementation of intraoperative hemodynamic monitoring system to ensure the modern anesthetic management of laparoscopic adrenalectomy in patients with pheochromocytoma in a specialized endocrinology center based on the algorithm of staged perioperative hemodynamic management (SPOHM).Materials and methods. We performed the analysis and comparison of hemodynamic parameters at the stage of selection of the tumor of the adrenal gland, after the clip overlay and intersection v. Centralis in 33 women operated for pheochromocytomas during 2013-2016 in the department of endocrine surgery of Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of Public of the Ministry of Health of Ukraine. Adrenal pheochromocytoma was removed by minimally invasive technologies — video-assisted laparoscopic adrenalectomy.Results and discussion. All patients had significantly (p &lt;0.001) increased levels of daily urine metanephrines to 1831.6±337.9 mg/24 h (control – 169.3±12.7 mg/24 h). In accordance to the SPOHM algorithm we used doxazosin 10.0±1.0 mg or urapidil 144.0±11.2 mg in 2 divided doses in the first stage. In a second step we performed hemodilution using 10% solution of HES (200/0.5) and controlled antihypertensive therapy by infusion of urapidil with an average speed 9.7±1.9 mg/hr. In the third stage intraoperative infusion rate of urapidil was 1.25±0.08 mg/min (at the moment of surgical separation of adrenal pheochromocytoma optional bolus of urapidil 25-50 mg was administered if even the slightest increase in blood pressure appears). After removal of the tumor we observed stabilization of hemodynamic parameters in the absence of significant hypotension. Sympathomimetics were not used. In the fourth stage prevention of adrenal insufficiency and hypovolemia was performed.Conclusions. The introduction of anesthetic management of patients with pheochromocytoma in the specialized endocrinology center provided high efficiency and safety of hemodynamic monitoring in laparoscopic adrenalectomy. The SPOHM algorithm in preparation for surgery and during surgery is an effective, easy to manage and secure method of hemodynamic parameters stabilization.

Preoperative drug preparation with α-blockers as an integral component of perioperative anesthetic management of laparoscopic adrenalectomy in patients with pheochromocytoma

Preoperative drug preparation with α-blockers as an integral component of perioperative anesthetic management of laparoscopic adrenalectomy in patients with pheochromocytoma

486 The implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism

486 The implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism