Skip to main content
SpringerLink
Log in

Retroperitoneoscopic Adrenalectomy in Obese Patients: Is It Suitable?

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to evaluate the suitability of posterior retroperitoneoscopic adrenalectomy for patients with morbid obesity.

Methods

This retrospective clinical cohort study included patients who underwent elective posterior retroperitoneoscopic adrenalectomy. Intraoperative (operative time, blood loss, intraoperative complications, conversion rate) and postoperative (hospital stay, morbidity, mortality) parameters were compared between the two study subgroups: obese (body mass index [BMI] ≥30 kg/m2) and non-obese patients (BMI <30 kg/m2).

Results

A total of 137 subsequent patients were enrolled in the study (41 obese and 96 non-obese patients). Mean tumour size was 5.2 ± 2.2 cm; aldosteronism and incidentaloma were the most frequent indications. Operative time was significantly longer (87 vs. 65 min; P = 0.0006) in obese patients. There was no difference in operative blood loss. One conversion was necessary. Overall, the 30-day postoperative morbidity was significantly higher in obese patients (26.8 vs. 11.5 %; P = 0.025). The hospital stay was significantly longer in obese patients (3.1 vs. 2.5 days; P = 0.003).

Conclusions

Dorsal retroperitoneoscopic adrenalectomy can be safely performed in morbidly obese patients, maintaining the advantages of minimally invasive surgery. Avoiding an abdominal approach is beneficial for patients. There is a more favourable postoperative course, shorter hospital stay, better cosmetic outcome and quicker recovery with dorsal retroperitoneoscopic adrenalectomy. The prolonged operative time, longer hospital stay and higher risk of postoperative complications that occurred in obese patients were acceptable in light of the generally higher risk associated with surgeries performed in obese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Snow LL. Endoscopic general surgery: an update. Laser Highlights. 1991;2:1–3.

    Google Scholar 

  2. Gagner M, Lacroix A, Bolte E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992;327:1033.

    Article  CAS  PubMed  Google Scholar 

  3. Smith CD, Weber CJ, Merson JR. Laparoscopic adrenalectomy: a new gold standard. World J Surg. 1999;23:389.

    Article  CAS  PubMed  Google Scholar 

  4. 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. doi:10.1016/j.eururo.2006.01.014.

    Article  PubMed  Google Scholar 

  5. Gaur DD. Laparoscopic operative retroperitoneoscopy: use of a new device. J Urol. 1992;148:1137–9.

    CAS  PubMed  Google Scholar 

  6. Mandressi A, Buizza C, Antonelli D, et al. Retroperitoneoscopy. Ann Urol (Paris). 1995;29:91–6.

    CAS  Google Scholar 

  7. Mercan S, Seven R, Ozarmagan S. Endoscopic retroperitoneal adrenalectomy. Surgery. 1995;118:1071–5.

    Article  CAS  PubMed  Google Scholar 

  8. Walz MK, Peitgen K, Krause U, et al. Die dorsale Adrenalektomie – eine operative Technik. Zentralbl Chir. 1995;120:53–8.

    CAS  PubMed  Google Scholar 

  9. Rubinstein M, Gill IS, Aron M, et al. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005;174:442–5. doi:10.1097/01.ju.0000165336.44836.2d.

    Article  PubMed  Google Scholar 

  10. Mazzaglia PJ, Vezeridis MP. Laparoscopic adrenalectomy: balancing the operative indications with the technical advances. J Surg Oncol. 2010;101:739–44. doi:10.1002/jso.21565.

    Article  PubMed  Google Scholar 

  11. Constantinides VA, Christakis I, Touska P, et al. Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg. 2012;99:1639–48. doi:10.1002/bjs.8921.

    Article  CAS  PubMed  Google Scholar 

  12. Pierpont YN, Dinh TP, Salas RE, et al. Obesity and surgical wound healing: a current review, ISRN Obesity Volume 2014, Article ID 638936, 13 pages, doi.10.1155/2014/638936.

  13. Kazaure HS, Roman SA, Sosa JA. Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy. World J Surg. 2011;35:1287–95. doi:10.1007/s00268-011-1070-2.

    Article  PubMed  Google Scholar 

  14. Muth A, Taft C, Hammarstedt L, et al. Patient-reported impacts of a conservative management programme for the clinically inapparent adrenal mass. Endocrine. 2013;44:228–36. doi:10.1007/s12020-012-9856-z. mPublished online Dec 20, 2012.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Fazeli-Matin S, Gill IS, Hsu TH, et al. Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery. J Urol. 1999;162:665–9. doi:10.1097/00005392-199909010-00005.

    Article  CAS  PubMed  Google Scholar 

  16. Varela E. Retroperitoneoscopic adrenalectomy for pheochromocytoma in morbidly obese. Obes Surg. 2009;19:1180–2. doi:10.1007/s11695-009-9805-y.

    Article  PubMed  Google Scholar 

  17. Aksoy E, Taskin HE, Aliyev S, et al. Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc. 2013;27:1233–6. doi:10.1007/s00464-012-2580-1.

    Article  PubMed  Google Scholar 

  18. Shen ZJ, Chen SW, Wang S, et al. Predictive factors for conversion of laparoscopic adrenalectomy: a 13-year review of 456 cases. J Endourol. 2007;21:1333–7. doi:10.1089/end.2006.450.

    Article  CAS  PubMed  Google Scholar 

  19. Agha A, Breitenbuch P, Gahli N, et al. Retroperitoneoscopic adrenalectomy: lateral versus dorsal approach. J Surg Oncol. 2008;97:90–3. doi:10.1002/jso.20793.

    Article  PubMed  Google Scholar 

  20. Walz MK, Peitgen K, Walz MV, et al. Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years. World J Surg. 2001;25:728–34. doi:10.1007/s00268-001-0023-6.

    Article  CAS  PubMed  Google Scholar 

  21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. doi:10.1097/01.sla.0000133083.54934.ae.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Guerrieri M, Campagnacci R, De Sanctis A, et al. The learning curve in laparoscopic adrenalectomy. J Endocrinol Investig. 2008;31:531–6.

    Article  CAS  Google Scholar 

  23. Schreinemakers JM, Kiela GJ, Valk GD, et al. Retroperitoneal endoscopic adrenalectomy is safe and effective. Br J Surg. 2010;97:1667–72. doi:10.1002/bjs.7191.

    Article  CAS  PubMed  Google Scholar 

  24. Lin Y, Li L, Zhu J, et al. Experience of retroperitoneoscopic adrenalectomy in 195 patients with primary aldosteronism. Int J Urol. 2007;14:910–3. doi:10.1111/j.1442-2042.2007.01860.x.

    Article  PubMed  Google Scholar 

  25. Zhang X, Fu B, Lang B. Technique of anatomical retroperitoneoscopic adrenalectomy with report of 800 cases. J Urol. 2007;177:1254–7. doi:10.1016/j.juro.2006.11.098.

    Article  PubMed  Google Scholar 

  26. Suzuki K. Laparoscopic adrenalectomy: retroperitoneal approach. Urol Clin N Am. 2001;28:85–95.

    Article  CAS  Google Scholar 

  27. Berber E, Tellioglu G, Harvey A, et al. Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery. 2009;146:621–5. doi:10.1016/j.surg.2009.06.057.

    Article  PubMed  Google Scholar 

  28. Lee CR, Walz MK, Park S, et al. A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol. 2012;19:2629–34. doi:10.1245/s10434-012-2352-0.

    Article  PubMed  Google Scholar 

  29. Ramacciato G, Nigri GR, Petrucciani N, et al. Minimally invasive adrenalectomy: a multicenter comparison of transperitoneal and retroperitoneal approaches. Am Surg. 2011;77:409–16.

    PubMed  Google Scholar 

  30. Nigri G, Rosman AS, Petrucciani N, et al. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013;153:111–9. doi:10.1016/j.surg.2012.05.042.

    Article  PubMed  Google Scholar 

  31. Zonča P, Cambal M, Labas P, et al. Retroperitoneoscopic adrenalectomy with dorsal approach. Rozhl Chir. 2012;91:235–40.

    PubMed  Google Scholar 

  32. Dickson PV, Jimenez C, Chisholm GB, et al. Posterior retroperitoneoscopic adrenalectomy: a contemporary American experience. J Am Coll Surg. 2011;212:659–65. doi:10.1016/j.jamcollsurg.2010.12.023.

    Article  PubMed  Google Scholar 

Download references

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the University hospital and Faculty of Medicine, University of Ostrava, Czech Republic, in accordance with the ethical standards of the Helsinki Declaration of 1975, as revised in 2000. For this type of study, formal consent is not required.

Conflict of Interest

Dr. Zonča, Dr. Bužga, Dr. Ihnát and Dr. Martínek do not have a conflict of interest. The authors are all independent from funders. The sponsors had no influence in the writing of the manuscript. No other relationships or activities exist that could appear to have influenced the submitted work.

Author information

Authors and Affiliations

  1. Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic

    Pavel Zonča, Peter Ihnát & Lubomír Martínek

  2. Department of Surgery, University Hospital Ostrava, 17.listopadu 1790, Ostrava, 70852, Czech Republic

    Pavel Zonča, Peter Ihnát & Lubomír Martínek

  3. Department of Physiology and Pathophysiology, Faculty of Medicine, University of Ostrava, Syllabova 19, Ostrava, 703 00, Czech Republic

    Marek Bužga

Authors
  1. Pavel Zonča
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marek Bužga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Ihnát
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lubomír Martínek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pavel Zonča.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zonča, P., Bužga, M., Ihnát, P. et al. Retroperitoneoscopic Adrenalectomy in Obese Patients: Is It Suitable?. OBES SURG 25, 1203–1208 (2015). https://doi.org/10.1007/s11695-014-1475-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-014-1475-8

Keywords

Search

Navigation