Advertisement

Surgical Endoscopy

, Volume 29, Issue 7, pp 1741–1745 | Cite as

Factors affecting the surgical approach and timing of bilateral adrenalectomy

  • Billy Y. LanEmail author
  • Halit E. Taskin
  • Erol Aksoy
  • Onur Birsen
  • Cem Dural
  • Jamie Mitchell
  • Allan Siperstein
  • Eren Berber
Article

Abstract

Background

Laparoscopic adrenalectomy has gained widespread acceptance. However, the optimal surgical approach to laparoscopic bilateral adrenalectomy has not been clearly defined. The aim of this study is to analyze the patient and intraoperative factors affecting the feasibility and outcome of different surgical approaches to define an algorithm for bilateral adrenalectomy.

Methods

Between 2000 and 2013, all patients who underwent bilateral adrenalectomy at a single institution were selected for retrospective analysis. Patient factors, surgical approach, operative outcomes, and complications were analyzed.

Results

From 2000 to 2013, 28 patients underwent bilateral adrenalectomy. Patient diagnoses included Cushing’s disease (n = 19), pheochromocytoma (n = 7), and adrenal metastasis (n = 2). Of these 28 patients, successful laparoscopic adrenalectomy was performed in all but 2 patients. Twenty-three out of the 26 adrenalectomies were completed in a single stage, while three were performed as a staged approach due to deterioration in intraoperative respiratory status in two patients and patient body habitus in one. Of the adrenalectomies completed using the minimally invasive approach, a posterior retroperitoneal (PR) approach was performed in 17 patients and lateral transabdominal (LT) approach in 9 patients. Patients who underwent a LT approach had higher BMI, larger tumor size, and other concomitant intraabdominal pathology. Hospital stay for laparoscopic adrenalectomy was 3.5 days compared to 5 and 12 days for the two open cases. There were no 30-day hospital mortality and 5 patients had minor complications for the entire cohort.

Conclusions

A minimally invasive operation is feasible in 93 % of patients undergoing bilateral adrenalectomy with 65 % of adrenalectomies performed using the PR approach. Indications for the LT approach include morbid obesity, tumor size >6 cm, and other concomitant intraabdominal pathology. Single-stage adrenalectomies are feasible in most patients, with prolonged operative time causing respiratory instability being the main indication for a staged approach.

Keywords

Adrenal Endocrinology Surgical Technical 

Notes

Disclosures

Lan, Taskin, Aksoy, Birsen, Dural, Mitchell, Siperstein, and Berber have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Barzon L, Scaroni C, Sonino N, Fallo F, Gregianin M, Macri C, Boscaro M (1998) Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab 83:55–62. doi: 10.1210/jcem.83.1.4501 PubMedGoogle Scholar
  2. 2.
    McLeod MK (1991) Complications following adrenal surgery. J Natl Med Assoc 83:161–164PubMedCentralPubMedGoogle Scholar
  3. 3.
    Thompson SK, Hayman AV, Ludlam WH, Deveney CW, Loriaux DL, Sheppard BC (2007) Improved quality of life after bilateral laparoscopic adrenalectomy for Cushing’s disease: a 10-year experience. Ann Surg 245:790–794. doi: 10.1097/01.sla.0000251578.03883.2f PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Kawasaki Y, Ishidoya S, Kaiho Y, Ito A, Satoh F, Morimoto R, Nakagawa H, Arai Y (2011) Laparoscopic simultaneous bilateral adrenalectomy: assessment of feasibility and potential indications. Int J Urol 18:762–767. doi: 10.1111/j.1442-2042.2011.02846.x PubMedCrossRefGoogle Scholar
  5. 5.
    Raffaelli M, Brunaud L, De Crea C, Hoche G, Oragano L, Bresler L, Bellantone R, Lombardi CP (2014) Synchronous bilateral adrenalectomy for Cushing’s syndrome: laparoscopic versus posterior retroperitoneoscopic versus robotic approach. World J Surg 38:709–715. doi: 10.1007/s00268-013-2326-9 PubMedCrossRefGoogle Scholar
  6. 6.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033. doi: 10.1056/NEJM199210013271417
  7. 7.
    Mercan S, Seven R, Ozarmagan S, Tezelman S (1995) Endoscopic retroperitoneal adrenalectomy. Surgery 118:1071–1075 (discussion 1075–1076)PubMedCrossRefGoogle Scholar
  8. 8.
    Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, Moinzadeh A, Ukimura O, Desai MM, Kaouk J, Bravo E (2005) Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol 174:442–445; discussion 445PubMedCrossRefGoogle Scholar
  9. 9.
    Ramacciato G, Nigri GR, Petrucciani N, Di Santo V, Piccoli M, Buniva P, Valabrega S, D’Angelo F, Aurello P, Mercantini P, Del Gaudio M, Melotti G (2011) Minimally invasive adrenalectomy: a multicenter comparison of transperitoneal and retroperitoneal approaches. Am Surg 77:409–416PubMedGoogle Scholar
  10. 10.
    Sharma R, Ganpule A, Veeramani M, Sabnis RB, Desai M (2009) Laparoscopic management of adrenal lesions larger than 5 cm in diameter. Urol J 6:254–259PubMedGoogle Scholar
  11. 11.
    Siperstein AE, Berber E, Engle KL, Duh QY, Clark OH (2000) Laparoscopic posterior adrenalectomy: technical considerations. Arch Surg 135:967–971PubMedCrossRefGoogle Scholar
  12. 12.
    Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, Ommer A, Groeben H, Peitgen K, Janssen OE, Philipp T, Neumann HP, Schmid KW, Mann K (2006) Posterior retroperitoneoscopic adrenalectomy–results of 560 procedures in 520 patients. Surgery 140:943–948. doi: 10.1016/j.surg.2006.07.039 discussion 948–950PubMedCrossRefGoogle Scholar
  13. 13.
    Hsu TH, Gill IS (2002) Bilateral laparoscopic adrenalectomy: retroperitoneal and transperitoneal approaches. Urology 59:184–189PubMedCrossRefGoogle Scholar
  14. 14.
    Jager F, Heintz A, Junginger T (2004) Synchronous bilateral endoscopic adrenalectomy: experiences after 18 operations. Surg Endosc 18:314–318. doi: 10.1007/s00464-002-9243-6 PubMedCrossRefGoogle Scholar
  15. 15.
    Takata MC, Kebebew E, Clark OH, Duh QY (2008) Laparoscopic bilateral adrenalectomy: results for 30 consecutive cases. Surg Endosc 22:202–207. doi: 10.1007/s00464-007-9478-3 PubMedCrossRefGoogle Scholar
  16. 16.
    Vella A, Thompson GB, Grant CS, van Heerden JA, Farley DR, Young WF Jr (2001) Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 86:1596–1599. doi: 10.1210/jcem.86.4.7399 PubMedGoogle Scholar
  17. 17.
    Porterfield JR, Thompson GB, Young WF Jr, Chow JT, Fryrear RS, van Heerden JA, Farley DR, Atkinson JL, Meyer FB, Abboud CF, Nippoldt TB, Natt N, Erickson D, Vella A, Carpenter PC, Richards M, Carney JA, Larson D, Schleck C, Churchward M, Grant CS (2008) Surgery for Cushing’s syndrome: an historical review and recent ten-year experience. World J Surg 32:659–677. doi: 10.1007/s00268-007-9387-6 PubMedCrossRefGoogle Scholar
  18. 18.
    Agcaoglu O, Sahin DA, Siperstein A, Berber E (2012) Selection algorithm for posterior versus lateral approach in laparoscopic adrenalectomy. Surgery 151:731–735. doi: 10.1016/j.surg.2011.12.010 PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Billy Y. Lan
    • 1
    Email author
  • Halit E. Taskin
    • 2
  • Erol Aksoy
    • 2
  • Onur Birsen
    • 2
  • Cem Dural
    • 2
  • Jamie Mitchell
    • 1
    • 2
  • Allan Siperstein
    • 1
    • 2
  • Eren Berber
    • 1
    • 2
  1. 1.Department of General Surgery, Digestive Disease InstituteThe Cleveland ClinicClevelandUSA
  2. 2.Department of Endocrine Surgery, Endocrinology and Metabolism InstituteThe Cleveland ClinicClevelandUSA

Personalised recommendations