Transperitoneal Laparoscopic Adrenalectomy Research Articles

Side-specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study

BackgroundAdrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA).MethodsWe retrospectively analyzed two hundred and seventy-one patients aged > 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included.ResultsIntraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p < 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147–27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996–30.38, p < 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323–47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07–1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other.ConclusionLRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI.

P269 - Visceral adiposity as a predictor for prolonged operating time of transperitoneal laparoscopic adrenalectomy

P269 - Visceral adiposity as a predictor for prolonged operating time of transperitoneal laparoscopic adrenalectomy

Laparoscopic Transperitoneal Adrenalectomy for Adrenal Tumors in Children: Technical Considerations and Surgical Experience.

Aims: This study aimed to review our surgical experience of laparoscopic adrenalectomy (LA) for adrenal masses in the pediatric age group. Materials and Methods: The electronic medical records of all patients younger than 18 years of age who underwent LA between 2016 and 2023 were retrospectively reviewed. Children with adrenal tumors localized to the site of origin without evidence of encasement of major vasculature or involvement of adjacent organs were considered for LA. Patients with diagnosis of malignant adrenal tumor on preoperative work-up underwent open adrenalectomy. Data were collected regarding demography, clinical presentation, hormonal workup, imaging, duration of surgery, transfusion requirement, conversion rate, postoperative recovery, duration of intravenous (i.v.) analgesia and hospital stay, pathology, complications, and status at follow-up. Results: Between 2016 and 2023, LA adrenalectomy was performed in 11 patients (6 boys and 5 girls) with a mean age of 46.3 (8-120) months. A functional tumor was detected in 6 (54.5%) children, manifesting clinically with Cushing's syndrome (3), virilization (1), feminization (1), or Conn's syndrome (1). Seven (63.6%) tumors originated from the right adrenal, and 4 (36.4%) from the left adrenal gland. The mean tumor weight and size was 49.1 (10-80) g and 5.6 (3-8) cm, respectively. Histopathology included adrenal adenoma (5), ganglioneuroma (3), ganglioneuroblastoma (1), myelolipoma (1), and intermediate adrenocortical tumor (1). The mean surgery duration was 186.6 (120-265) minutes. Intraoperative blood transfusion was required in 2 (18.2%) patients and none required conversion. Full feeds were resumed at 42.7 (24-60) hours, i.v. analgesia requirement was for 54.5 (36-72) hours and mean hospital stay was 5.1 (3-8) days. All patients were symptom-free with no recurrence at mean follow-up period of 50.6 (3-83) months. Conclusions: In children with well-circumscribed, localized, and noninvasive adrenal tumors, LA is feasible, effective, and safe with all advantages of minimally invasive surgery.

Perirenal fat thickness is a powerful predictor for surgical outcomes of transperitoneal laparoscopic adrenalectomy.

Laparoscopic adrenalectomy has been the gold standard surgical procedure. However, the adaptation criteria for malignant tumors and predictors of perioperative outcomes are not well defined. Therefore, this study tried to identify valid predictors for perioperative outcomes of laparoscopic adrenalectomy and consider the adaptation criteria. We retrospectively reviewed the preoperative and perioperative data of 216 patients who underwent transperitoneal laparoscopic adrenalectomy in our hospital. Preoperative factors associated with perioperative outcomes were analyzed using multiple regression analysis. Among 216 patients, 165 (76.4%), 26 (12.0%), and 25 (11.6%) were suspected of having benign tumors, pheochromocytoma, and malignant tumors, respectively. Median tumor size was 25.0 mm (interquartile range 18.0-35.0); median perirenal fat thickness was 9.2 mm (interquartile range 4.9-15.6) on preoperative computed tomography scans. The median operative time was 145.5 min (interquartile range 117.5-184.0) and the median estimated blood loss was 0.0 mL (interquartile range 0.0-27.3). Perirenal fat thickness (p < 0.001), tumor size (p < 0.001), and malignant tumors (p = 0.020) were associated with operative time, and perirenal fat thickness (p = 0.038) and malignant tumors (p = 0.002) were associated with estimated blood loss. Perirenal fat thickness, tumor size, and malignant tumors are valid predictors of the surgical outcomes of transperitoneal laparoscopic adrenalectomy. As only perirenal fat thickness is associated with both surgical outcomes except for malignant tumors, it is a powerful predictor. Transperitoneal laparoscopic adrenalectomy for large malignant adrenal tumors with thick perirenal fat should be performed with caution.

PRIMARY SUPRARENAL GLANDULAR TUBERCULOSIS MIMICKING A MALIGNANT TUMOR

ABSTRAK&#x0D; Objective: Our case demonstrates effective tuberculosis-related Addison's disease care with laparoscopic adrenalectomy and anti-tuberculosis medication. Case(s) Presentation: A 43-year-old patient complained of left flank pain for two months before admission, unexplained weight loss, general weakness, decreased appetite, and without long-term cough. The physical examination resulted in hyperpigmentation on the fingers of both hands. MRI revealed an enlarged left adrenal gland and the blood test showed elevated cortisol to 1668 mmol/L. Three-port left laparoscopic transperitoneal adrenalectomy was used. Histopathology results showed epitheloid histiocytes that formed granulomas with caseous necrosis and Datia Langerhans cells referring to tuberculosis; no malignancy was found from the same sample. Discussion: Addison's illness is the primary cause of tuberculosis. Due to the widespread use of anti-TB medications, the incidence of adrenal tuberculosis has been on the decline recently; nonetheless, in developing nations, tuberculosis is still the predominant cause of Addison's disease. Conclusion: Surgery and standard treatment for extrapulmonary tuberculosis were adequate to diagnose and alleviate the symptoms of cortisol disturbance caused by Addison’s disease.&#x0D; Keywords: Endocrine glands, adrenalectomy, tuberculosis endocrine.

Laparoscopic Bilateral Adrenalectomy with the Transabdominal Lateral Approach

Background: Laparoscopic adrenalectomy (LA) is a widely accepted method for most adrenal lesions. However, bilateral LA is performed less often than unilateral adrenalectomy. The most common indication for bilateral LA is adrenocorticotropin hormone (ACTH)-dependent Cushing’s syndrome, including persistent Cushing’s disease following unsuccessful transsphenoidal surgery and ectopic ACTH syndrome. Objectives: This retrospective study was conducted to assess the indications, safety, efficacy, and outcomes for bilateral LA with the transabdominal lateral approach. Methods: This retrospective study was conducted between January 2004 and February 2022. During the study period, transperitoneal LA was performed on 279 patients, among whom, 258 cases were unilateral LA. Therefore, our analysis included 21 consecutive patients who underwent laparoscopic bilateral LA with the transabdominal lateral approach. The surgery indication, tumor side and weight, operation time, conversion to open surgery, need for an additional trocar, complications, hospital stay, and follow-up information were analyzed. Results: Indications of bilateral LA were refractory Cushing’s disease (n=14), occult ectopic primary bilateral macronodular adrenal hyperplasia (n=5), ACTH secretion (n=1), and bilateral pheochromocytoma (n=1). The mean operative time was 207.8±21.3 min, including repositioning time. Intraoperative and postoperative complications were seen in 3 (14%) and 4 (19%) patients, respectively. No conversion to open surgery was observed. Median hospital stay was 7 (range, 5-10) days and median follow-up was 81 (range, 55-94.5) months. Three patients died at 62, 64, and 88 months after adrenalectomy due to heart failure, renal failure, and myocardial infarction, respectively. No adrenal insufficiency or signs of recurrent hypercortisolism was observed. Conclusion: Our results demonstrated that laparoscopic bilateral LA was safe and effective, allowing acceptable morbidity and hospital stay. The most common surgical indication was ACTH-dependent Cushing's syndrome, followed by ACTH-independent Cushing's syndrome. The lateral transperitoneal approach obtains an excellent anatomical view. In our series, operative time and conversion to open surgery rate were in line with the literature.

Perioperative Surgical Morbidity of Laparoscopic Transperitoneal Adrenalectomy in the Treatment of Adrenal Masses

Background: Laparoscopic adrenalectomy has become the gold standard for the treatment of benign lesions of the adrenal glands [1,2]. The aim of this study is to evaluate the perioperative surgical morbidity of laparoscopic transperitoneal adrenalectomy for the treatment of adrenal masses less than 6 cm in size. Material and methods: This is a prospective descriptive single-centre study of perioperative morbidity of transperitoneal laparoscopic adrenalectomy of 36 adrenal masses less than 6 cm in size, performed over a two-year period. Results: The average age of the patients was 44.2 ± 10.1 years, with a sex ratio of 0.4; the average BMI was 26.5 ± 4.5 kg/m2; the abdominal-pelvic surgery background was found in 19.4% of the cases. The average size of the lesions was 25.86 mm. The indication for surgery was the secreting nature of the adrenal masses in 32 patients and the suspicion of malignancy on imaging in 4 patients. The average operating duration was 115.56 ± 37.5 min and the average blood loss was 36.8 ± 50.1 ml. The average hospital stay was 2.3 ± 1.1 days (1-3 days). Postoperative complications occurred in 8.4% of the patients; they were all Clavien-Dindo grade 2 and were generally benign. Conclusion: Adequate patient preparation, with meticulous surgical technique, is the key to a good patient outcome. Treatment outcomes do not depend on the experience of a one surgeon, but on the experience of the whole team involved in perioperative care.

Association of the Size of Adrenal Tumor with Safety and Efficacy of Laparoscopic Adrenalectomy

Introduction: Laparoscopic adrenalectomy (LA) is the gold standard treatment for small adrenal tumor. But the role of laparoscopic adrenalectomy (LA) in a large tumor is still debatable due to risk of technical difficulty and malignant potential. This study was aimed to find out the association of the size of adrenal tumor with safety and efficacy of laparoscopic adrenalectomy in a tertiary level hospital. Objective: To observe the association of the size of adrenal tumor with safety and efficacy of laparoscopic adrenalectomy. Methods: Following convenience sampling 24 patients of adrenal tumor who underwent unilateral transperitoneal LA in the Department of General Surgery, Bangabandhu Sheikh Mujib Medical University, from January 2020 to December 2021 were included and classified by tumor size into 2 groups. Patients in group I had tumor size &lt;5 cm (n = 11) and patient in group II had tumor size ≥ 5 cm (n = 13). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. Data were analyzed with SPSS version 23 and Chi-square (χ2) test and unpaired t test were done to find out the impaction of the size of adrenal tumor with safety and efficacy of laparoscopic adrenalectomy. Result: Average size of the tumour was 3.21±1.17 cm (range 1.5-4.9 cm) for group I, 5.58±0.69 cm (range 5-7 cm) for group II respectively. Operative time was 61.82±12.3 minutes (range 50 to 80 minutes) for group I, 68.08±9.69 minutes (range 55 to 90 minutes) for group II. Estimated blood loss, mean was 47.27±18.62 mL (range 30 to 80 mL) and 71.92±26.26 mL (range 40 to 120 mL) for groups I and II respectively. We observed no complications in groups I and II respectively. Average hospital stay was 5.2±1.8 days (range 3 to 9 days), 5.4±2.1days (range 4 to 12 days) respectively for groups I and II. Operative time and mean hospital stay were not significantly different for group II compared with group I. Conclusion: Laparoscopic transperitoneal ......

Laparoscopic transperitoneal adrenalectomy for adrenal tumours of 6 cm or greater: A single-centre experience.

The present study aimed to evaluate the safety and efficacy of transperitoneal laparoscopic adrenalectomy (LA) for large adrenal tumours by comparing the outcomes of tumours larger than 6 cm with those smaller than 6 cm and also to identify the risk factors associated with prolonged operative time in transperitoneal LA. One hundred and sixty-three patients underwent LA at our clinic from January 2014 to December 2020. Bilateral LA was performed in 20 of these 163 patients. A total of 143 patients were included in this study. Data were analysed retrospectively from the patients' medical records collected. Large tumour (LT) group consists of 33 patients and the small tumour (ST) group consists of 110 patients. There was no statistically significant difference between the groups regarding conversion to open surgery and complications. A multiple regression analysis was conducted to identify the independent predictors of prolonged operation time. The tumour size ≥8 cm (odds ratio [OR], 19.132; 95% confidence interval [CI], 3.881-94.303; P < 0.001) and diagnosis of pheochromocytoma (OR, 2.762; 95% CI, (1.123-6.789, P = 0.026) were the significant predictors of prolonged operation time. Our study shows that LA can be considered the treatment of choice for small and large adrenal tumours. The tumour size ≥8 cm and diagnosis of pheochromocytoma are the independent risk factors for the prolonged operative time in transperitoneal LA.

Renal‑rotation techniques in retroperitoneoscopic adrenalectomy for giant pheochromocytomas: a clinical intervention study with historical controls

BackgroundDealing with the giant pheochromocytomas (maximum diameter ≥ 6 cm) has long been a tough challenge for urologists. We introduced a new retroperitoneoscopic adrenalectomy method modified with renal-rotation techniques to treat giant pheochromocytomas.Methods28 diagnosed patients were prospectively recruited as the intervention group. Meanwhile, by referring to the historical records in our database, matched patients who had undergone routine retroperitoneoscopic adrenalectomy (RA), transperitoneal laparoscopic adrenalectomy (TA), or open adrenalectomy (OA) for giant pheochromocytomas were selected as controls. Perioperative and follow-up data were collected for comparative assessment.ResultsAmong all the groups, the intervention group had the minimal bleeding volume (28.93 ± 25.94 ml, p < 0.05), the least intraoperative blood pressure variation (59.11 ± 25.68 mmHg, p < 0.05), the shortest operation time (115.32 ± 30.69 min, p < 0.05), the lowest postoperative ICU admission rates (7.14%, p < 0.05), and shortest drainage time length (2.57 ± 0.50 days, p < 0.05). Besides, compared with TA and OA groups, intervention group was also characterized by lower pain scores (3.21 ± 0.63, p < 0.05), less postoperative complications (p < 0.05), earlier diet initiation time (1.32 ± 0.48 postoperative days, p < 0.05) and ambulation time (2.68 ± 0.48 postoperative days, p < 0.05). Follow-up blood pressure and metanephrine and normetanephrine levels in all intervention group patients remained normal.ConclusionCompared with RA, TA, and OA, retroperitoneoscopic adrenalectomy with renal-rotation techniques is a more feasible, efficient, and secure surgical treatment for giant pheochromocytomas.Trial registrationThis study has been prospectively registered on the Chinese Clinical Trial Registry website (ChiCTR2200059953, date of first registration: 14/05/2022).

İkinci basamak devlet hastanesinde laparoskopik adrenalektomi uygulanabilirliği ve deneyimlerimiz

Objective: Since the laparoscopy education had became widespread, the advance laparoscopic procedures can be performed even at secondary public hospitals. In this study, we aimed to present our experience of the first seven years of laparoscopic transperitoneal adrenalectomy. Material And Methods: the study included 30 patients with laparoscopic transperitoneal adrenalectomy (LA) performed from October 2012 to April 2019. The retrospective assessment investigated age, sex, body mass index, adrenal mass characteristics, hormonal activity, operation duration, hemorrhage status, transfusion requirements, final pathology and complication rates. Results: Mean age was 54.3±11.5 years and mean body mass index was 25.6±2.7 kg/m2. Mean mass size was 48.5±23 mm and mean operation duration was 70.2±21.6 minutes. Mean peroperative hemorrhage amount was 41±48.8 cc, while only 2 patients required transfusion. Mean hospitalization duration was 1.3±0.88 days. None of the laparoscopic cases was converted to open surgery, and no major complications such as death recorded. Conclusion: Transperitoneal laparoscopic adrenalectomy (LA) surgery may be performed safely after adequate training for appropriate patients with low morbidity and mortality. Keywords: laparoscopy, adrenalectomy, experience, open surgery, transperitoneal

Comparison of the retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for large (≥6cm) pheochromocytomas: A single-centre retrospective study.

To compare the efficacy and safety of retroperitoneal laparoscopic adrenalectomy (RLA) and transperitoneal laparoscopic adrenalectomy (TLA) in the treatment of large (≥6cm) adrenal pheochromocytomas. We retrospectively collected the clinical data of 130 patients with large pheochromocytoma who underwent RLA or TLA in our hospital from 2012 to 2022. The perioperative parameters and follow-up outcomes of the two groups were compared, and univariate and multivariate analyses were used to evaluate the risk factors of hemodynamic instability (HI). A total of 57 patients underwent TLA and 73 underwent RLA. There was no difference in demographic characteristics such as age, sex and tumor size between the two groups. Compared with the TLA group, patients in the RLA group had shorter operation time (P<0.001) and less estimated blood loss (EBL) (P<0.001). The time to ambulation, time to oral food and time to removal of drainage of RLA group were earlier than those of TLA group. In addition, the hospital stay was shorter in the RLA group than in the TLA group. There were no differences in HI, complications, or blood pressure (BP) improvement between the two groups. The mean follow-up time was 61.4 and 65.5 months, respectively, during which no tumors recurred or metastasized. Multivariate analysis showed that elevated hormone levels and larger tumor size were independent risk factors for HI. Both RLA and TLA are effective treatment methods for large pheochromocytomas, but the perioperative outcomes of RLA are better than that of TLA. Our study demonstrates the superiority of RLA for the treatment of large pheochromocytomas.

Nature of Complications of the Adrenal Tumor in Laparoscopic Adrenalectomy

Introduction: Small adrenal tumors are treated by laparoscopic adrenalectomy. Due to technical complexity and carcinogenic potential, laparoscopic adrenalectomy (LA) is debatable for big tumors. This study examined the relationship between adrenal tumor size and safe laparoscopic adrenalectomy at a tertiary institution. Objective: To observe the Nature of complications of the adrenal tumor in laparoscopic adrenalectomy. Methods: After convenience sampling, 24 adrenal tumor patients who had unilateral transperitoneal LA at Bangabandhu Sheikh Mujib Medical University from January 2020 to December 2021 were divided by tumor size. In group I (n = 11), tumors were ≤5 cm and in group II (n = 13) size &gt; 5 cm. Comparing group's demographic, perioperative and pathologic data. Data were examined using SPSS version 23 and Chi-square (2) and unpaired t tests to determine the impact of adrenal tumor size on laparoscopic adrenalectomy safety and efficacy. Result: Group I tumours averaged 3.21±1.17 cm (1.5-4.9 cm) and group II tumours averaged 5.58±0.69 cm (5-7 cm). Group I operative time was 61.82±12.3 minutes (50 to 80 minutes), and group II was 68.08±9.69 minutes (55 to 90 minutes). Mean blood loss was 47.27±18.62 mL (range 30 to 80 mL) and 71.92± 26.26(40-120ml) for groups I and II, respectively. I and II had no difficulties. Groups I and II had average hospital stays of 5.2±1.8 (3-9 days) and 5.4±2.1 (4-12 days). Group II's operative time and mean hospital stay didn't differ from group I's. Conclusion: Blood loss was the only major intraoperative risks associated with laparoscopic transperitoneal adrenalectomy for big adrenal tumors &gt; 5 cm. The most important component in laparoscopically removing a large adrenal tumor is carefully selecting patients to undergo the procedure with a skilled surgeon in adrenal surgery.

Is transperitoneal laparoscopic adrenalectomy for pheochromocytoma really more challenging? A propensity score-matched analysis

PurposeMinimally invasive surgery is the gold standard treatment for adrenal masses, but it may be a challenging procedure in the case of pheochromocytoma (PHEO). The aim of the present study is to report the results of transperitoneal laparoscopic adrenalectomy (TLA) in cases of PHEO in comparison to other types of adrenal lesions.MethodsFrom 1994 to 2021, 629 patients underwent adrenalectomy. Twenty-two and thirty-five patients, respectively, were excluded because they underwent bilateral and open adrenalectomy, leaving 572 patients for inclusion. Of these, 114 patients had PHEO (Group A), and 458 had other types of lesions (Group B). To adjust for potential baseline confounders, a propensity score matching (PSM) analysis was conducted.ResultsAfter PSM, 114 matched pairs of patients were identified from each group. Statistically significant differences were not observed when comparing the median operative time (85 and 90 min in Groups A and B, respectively, p = 0.627), conversion rate [6 (5.3%) in each group, p = 1.000], transfusion rate [4 (3.5%) and 3 (2.6%) in Groups A and B, respectively, p = 1.000], complication rate [7 (6.1%) and 9 (7.9%) in Groups A and B, respectively, p = 0.796), median postoperative hospital stay (3.9 and 3.6 days in Groups A and B, respectively, p = 0.110), and mortality rate [1 (0.9%) in each group, p = 1.000].ConclusionsBased on this analysis, the results of TLA for PHEO are equivalent to those of TLA for other types of adrenal lesions, but the fundamental requirements are multidisciplinary patient management and adequate surgeon experience. Further prospective studies are required to draw definitive conclusions.

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

Comparison of robotic and laparoscopic lateral transperitoneal adrenalectomies.

This study aimed to compare the intraoperative and postoperative outcomes between robotic and laparoscopic transperitoneal adrenalectomies. In this retrospective study, 93 patients underwent adrenalectomy using 2 surgical modalities: 45 patients underwent adrenalectomy using the da Vinci Xi system (robotic group), and 48 patients using laparoscopic devices (laparoscopic group). We compared the operation time, intraoperative bleeding, and hospital stay according to the surgical modality and tumor characteristics. There were no significant differences in the operative time (P = 0.827), hospital stay (P = 0.177), and intraoperative bleeding (P = 0.174) between the groups. However, the robotic group showed a lower coefficient of variation in total operative time than that of the laparoscopic group (100.6 ± 23.3 minutes vs. 101.9±32.7 minutes, 0.230 vs. 0.321). When divided into 2 subgroups based on the tumor size (<3 cm and ≥3 cm), the robotic group with a tumor sized >3 cm had a shorter operative time than that of the laparoscopic group (P = 0.032). The robotic group also had fewer cases of intraoperative bleeding (P = 0.034). Compared to the laparoscopic transperitoneal adrenalectomy, the robotic one achieved a lower deviation in total operative time and showed less bleeding and a shorter operative time, especially for tumors sized >3 cm.

Prevention of conversion in posterior retroperitoneal adrenalectomy by measuring pre-operative anatomical conditions on cross-sectional imaging (computerised tomography or magnetic resonance imaging).

In addition to the common laparoscopic lateral transperitoneal adrenalectomy (LTA), the posterior retroperitoneal adrenalectomy (PRA) is becoming increasingly important. Both techniques overlap in their indication, resulting in uncertainty about the preferred approach in some patients. We hypothesise that by determining anatomical characteristics on cross-sectional imaging computerised tomography or magnetic resonance imaging, we can show the limitations of the PRA and prevent patients from being converted to LTA. This retrospective study includes 14 patients who underwent PRA (n = 15) at a single institution between 2016 and 2018. Previously described parameters such as the retroperitoneal fat mass (RPF) were measured on pre-operative imaging. We compared data from one patient who had a conversion with those from 13 patients without conversion. Furthermore, we explored the influence of these parameters on the operative time. Conversion to LTA was necessary during 1 PRA procedure. Fourteen PRAs in 13 patients were successfully completed. The mean body mass index was 30 kg/m2 and the mean operation time was 98 min. One patient who underwent a conversion had a substantially higher RPF (25 mm) compared to the patients with successfully completed PRA (median: 5.5 mm [P = 0.001]). Furthermore, the operation time strongly correlated with the RPF (P = 0.004, r = 0.713). Surgeons can use pre-operative imaging to assess the anatomical features to determine whether a PRA can be performed. Patients with an RPF under 14.3 mm can be safely treated with PRA. In contrast, LTA access should be considered for patients with a higher RPF (>25 mm).

PS-C21-2: PREDICTORS OF CLINICAL AND BIOCHEMICAL SUCCESS OF ADRENALECTOMY IN PATIENTS WITH UNILATERAL PRIMARY ALDOSTERONISM

Objective: Our study aimed to evaluate clinical and laboratory predictors of outcome of unilateral adrenalectomy in patients with primary aldosteronism (PA). Design and method: Data from patients with unilateral PA verified by adrenal venous sampling who subsequently underwent transperitoneal laparoscopic adrenalectomy between 2008 and 2019 were analyzed. We assessed patient demographics, preoperative and postoperative clinical, pharmacological, laboratory, and radiological data. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication. Statistical assessments included univariable and multivariable logistic regression analysis. Results: 87 patients with PA were enrolled. Complete biochemical success of surgery, defined as normalisation of the aldosterone-to-renin ratio and correction of hypokalaemia, was reached in 67 patients (77%), 19 patients (22%) had partial biochemical success (please see the Figure). Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure - partial clinical success. Multivariable logistic regression showed that complete clinical success was independently associated with female gender (odds ratio: OR 3.71, 95% CI 1.16–11.87, P = 0.027) and baseline sum of antihypertensive drugs DDD &lt; 4 (OR 5.30, 95% CI 1.68–16.67, P = 0.004). None of the analysed clinical or laboratory parameters was found to be a significant predictor of biochemical success. Conclusion: A majority of patients undergoing unilateral adrenalectomy for PA achieved markedly improved hypertension control while almost halving their antihypertensive medication. Females and patients using lower number of antihypertensive drugs preoperatively were more likely to be completely cured by the surgery.

The Role of Intraoperative Indocyanine Green (ICG) and Preoperative 3-Dimensional (3D) Reconstruction in Laparoscopic Adrenalectomy: A Propensity Score-matched Analysis.

Laparoscopic adrenalectomy (LA) is considered the "gold standard" treatment of adrenal lesions that are often coincidentally diagnosed during the radiologic workup of other diseases. This study aims to evaluate the intraoperative role of indocyanine green (ICG) fluorescence associated with preoperative 3-dimensional reconstruction (3DR) in laparoscopic adrenalectomy in terms of perioperative outcomes. To our knowledge, this is the first prospective case-controlled report comparing these techniques. All consecutive patients aged≥18 and undergoing laparoscopic transperitoneal adrenalectomy for all adrenal masses from January 1, 2019 to January 31, 2022 were prospectively enrolled. Patients undertaking standard LA and those undergoing preoperative 3D reconstruction and intraoperative ICG fluorescence were matched through a one-on-one propensity score matching analysis (PSM) for age, gender, BMI, CCI score, ASA score, lesion histology, tumor side, and lesion diameter. Differences in operative time, blood loss, intraoperative and postoperative complications, conversion rate, and length of stay were analyzed. After propensity score matching analysis, we obtained a cohort of 36 patients divided into 2 groups of 18 patients each. The operative time and intraoperative blood loss were shorter in patients of the 3DR group ( P =0,004 and P =0,004, respectively). There was no difference in terms of length of stay, conversion rate, and intraoperative and postoperative complications between the 2 groups. The use of intraoperative ICG in LA and preoperative planning with 3DR images is a safe and useful addition to surgery. Furthermore, we observed a reduction in terms of operating time and intraoperative blood loss.

Comparative Analysis of Laparoscopic and Robotic Transperitoneal Adrenalectomy Performed at a Single Institution.

Background and Objectives: Laparoscopic adrenalectomy (LA) is the standard surgical approach for adrenalectomy. At present, robotic adrenalectomy (RA) has been introduced at various hospitals. This study evaluated our initial experience with robotic adrenalectomy compared with conventional laparoscopic adrenalectomy. Materials and Methods: From October 2018 to March 2022, 56 adrenalectomies were performed by a single endocrine surgeon. Thirty-two patients underwent LA (LA group), and twenty-four patients underwent RA (RA group). Results: Patients in the RA group were significantly younger than those in the LA group (48.6 ± 9.7 years vs. 55.1 ± 11.4 years, p = 0.013). The RA group had a shorter operation time than the LA group (76.1 ± 28.2 min vs. 118.0 ± 54.3 min, p < 0.001). The length of hospital stay and postoperative pain level between the two groups were similar. There were no complications in the RA group. There was no significant difference in the pathologic diagnosis between the two groups. The cost of surgery was significantly higher in the RA group than in the LA group (5288.5 US dollars vs. 441.5 ± 136.8 US dollars, p < 0.001). Conclusions: In our initial experience, RA showed a shorter operation time than LA and no complications. RA could be a viable alternative surgical option for adrenalectomy, notwithstanding its higher cost.