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3/2018
vol. 13
General surgery
abstract:
Original paper
Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery – single-center experience
Sadegh Toutounchi, Ryszard Pogorzelski, Małgorzata E. Legocka, Ewa Krajewska, Krzysztof Celejewski, Urszula Ambroziak, Zbigniew Gałązka
Videosurgery Miniinv 2018; 13 (3): 283–287
Online publish date: 2018/08/19
Introduction
Lateral transabdominal adrenalectomy (LTA) is the most common minimally invasive technique used to treat patients with adrenal tumors.
Aim
To 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 Methods
Five 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.
Results
The 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.
Conclusions
Lateral 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.
keywords:
laparoscopic adrenalectomy, minimally invasive techniques, adrenalectomy after previous surgery
references:
Stefanidis D, Goldfarb M, Kercher KW, et al. SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 2013; 27: 3960-80.
Heger P, Probst P, Hüttner FJ, et al. Evaluation of open and minimally invasive adrenalectomy: a systematic review and network meta-analysis. World J Surg 2017; 41: 2746-57.
Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg 1999; 23: 389-96.
Zacharias M, Haese A, Jurczok A, et al. Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome. Eur Urol 2006; 49: 448-59.
Morris L, Ituarte P, Zarnegar R, et al. Laparoscopic adrenalectomy after prior abdominal surgery. World J Surg 2008; 32: 897-903.
Seifman BD, Dunn RL, Wolf JS. Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications. J Urol 2003; 169: 36-40.
Pędziwiatr M, Matłok M, Kulawik J, et al. Laparoscopic adrenalectomy by the lateral transperitoneal approach in patients with a history of previous abdominal surgery. Videosurgery Miniinv 2013; 8: 146-51.
Economopoulos KP, Phitayakorn R, Lubitz CC, et al. Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy? Surgery 2016; 159: 240-8.
Mazeh H, Froyshteter AB, Wang TS, et al. Is previous same quadrant surgery a contraindication to laparoscopic adrenalectomy? Surgery 2012; 152: 1211-7.
Miller BS, Doherty GM. Surgical management of adrenocortical tumours. Nat Rev Endocrinol 2014; 10: 282-92.
Fiszer P, Toutounchi S, Pogorzelski R, et al. Is tumour size a contraindication to laparoscopic adrenalectomy? Case report. Videosurgery Miniinv 2012; 7: 144-6.
Lubikowski J, Umiński M, Andrysiak-Mamos E, et al. From open to laparoscopic adrenalectomy: thirty years’ experience of one medical centre. Endokrynol Pol 2010; 61: 94-101.
Gaujoux S, Bonnet S, Leconte M, et al. Risk factors for conversion and complications after unilateral laparoscopic adrenalectomy. Br J Surg 2011; 98: 1392-9.
Thompson LH, Nordenström E, Almquist M, et al. Risk factors for complications after adrenalectomy: results from a comprehensive national database. Langenbeck’s Arch Surg 2017; 402: 315-22.
Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol 2008; 26: 555-60.
Lombardi CP, Raffaelli M, De Crea C, et al. Endoscopic adrenalectomy: is there an optimal operative approach? Results of a single-center case-control study. Surgery 2008; 144: 1008-15.
Myśliwiec P, Marek-Safiejko M, Lukaszewicz J, et al. Videoscopic adrenalectomy – when does retroperitoneal seem better? Videosurgery Miniinv 2014; 9: 226-33.
Siperstein AE, Berber E, Engle KL, et al. Laparoscopic posterior adrenalectomy: technical considerations. Arch Surg 2000; 135: 967-71.
Kokorak L, Soltes M, Vladovic P, et al. Laparoscopic left and right adrenalectomy from an anterior approach – is there any difference? Outcomes in 176 consecutive patients. Videosurgery Miniinv 2016; 11: 268-73.
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