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Is laparoscopic left adrenalectomy with the anterior submesocolic approach for Conn’s or Cushing’s syndrome equally safe and effective as the lateral and anterior ones?

  • 2018 EAES Oral
  • Published:
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Abstract

Background

The aim of the present study is to report and to compare the results of three different laparoscopic transperitoneal surgical approaches [lateral transperitoneal (LT), anterior transperitoneal (AT) and anterior transperitoneal submesocolic (ATS)] for the treatment of Conn’s and Cushing’s syndrome from left adrenal disease.

Methods

This study is a retrospective analysis of prospectively collected data. From 1994 to 2017, 535 laparoscopic adrenalectomies (LA) were performed. One hundred and sixty-four patients with Conn’s or Cushing’s syndrome underwent left LA. Patients were divided in three groups based on the approach: LT (Group A), AT (Group B) and ATS (Group C).

Results

The diagnosis was Conn’s and Cushing’s syndrome in 99 and 65 patients, respectively. LT was used in 13 cases, AT in 55 and ATS in 96. No significant differences in patient’s gender, age and BMI were observed. Mean operative time was 117.6 ± 33.7, 107.6 ± 40.3 and 96.2 ± 47.5 min for Groups A, B and C, respectively. Conversion to open surgery was observed in 4 Group C patients (4.1%). Morbidity occurred in 2 Group B (2%) and in 5 Group C patients (5.2%).

Conclusions

In case of Conn’s or Cushing’s syndrome, left LA with ATS approach is equally safe and effective as compared to the LT and AT approaches. Early control of the adrenal vein with minimal gland manipulation and limited surgical dissection are the major advantages of the submesocolic approach. Even if statistically significant differences are not observed, postoperative results are the same as those reported in the literature with other approaches.

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Authors and Affiliations

  1. Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Andrea Balla, Silvia Quaresima, Livia Palmieri & Alessandro M. Paganini

  2. Department of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121, Ancona, Italy

    Monica Ortenzi & Mario Guerrieri

  3. Department of Experimental Medicine, Sapienza, University of Rome, Viale del Policlinico 155, 00161, Rome, Italy

    Emilia Sbardella, Giulia Puliani & Andrea M. Isidori

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  1. Andrea Balla
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  2. Silvia Quaresima
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  9. Alessandro M. Paganini
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Correspondence to Andrea Balla.

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Disclosures

Dr. Andrea Balla, Dr. Silvia Quaresima, Dr. Livia Palmieri, Dr. Monica Ortenzi, Dr. Emilia Sbardella, Dr. Giulia Puliani, Prof. Andrea M. Isidori, Prof. Mario Guerrieri and Prof. Alessandro M. Paganini have no conflicts of interest or financial ties to disclose.

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Balla, A., Quaresima, S., Palmieri, L. et al. Is laparoscopic left adrenalectomy with the anterior submesocolic approach for Conn’s or Cushing’s syndrome equally safe and effective as the lateral and anterior ones?. Surg Endosc 33, 3026–3033 (2019). https://doi.org/10.1007/s00464-018-6601-6

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