Abstract
Background
Adrenal surgery has been radically changed by laparoscopy and it is reasonable to wonder whether the increase in the number of adrenalectomies is entirely justified. There is still debate on the transperitoneal versus the retroperitoneal approach, the advantages and drawbacks of which are discussed here.
Methods
Between 1983 and 2007, we performed 279 adrenalectomies in 264 consecutive patients, divided into two groups: before and after the advent of laparoscopic adrenalectomy (LA). We analyzed the factors that increased the number of adrenalectomies in recent years. The LAs were further divided into three consecutive periods and the morbidity and conversion rates, and mean operating times were compared.
Results
More procedures were performed after the advent of LA, i.e., 55 (19.7%) beforehand versus 224 (80.3%) afterwards, irrespective of the type of disease, for instance: incidentaloma, 17.6% versus 82.4% (p < 0.0001); pheochromocytoma, 20.7% versus 79.3% (p < 0.0001); Conn’s disease, 19.8% versus 80.2% (p < 0.0001); Cushing’s disease, 17.2% versus 82.8% (p < 0.0001); cortical carcinoma, 30% versus 70% (p < 0.001). Analyzing the three LA periods, operating times were the only statistically significant variable (p < 0.0001).
Conclusions
The progressive increase in the number of adrenalectomies performed is due more to a better understanding of adrenal disease than to the availability of minimally invasive techniques. The choice of a laparoscopic approach (trans- or retroperitoneal) should depend on the surgeon’s experience.
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References
Brunt ML (2006) Minimal access adrenal surgery. Surg Endosc 20:351–361
Assalia A, Gagner M (2004) Laparoscopic adrenalectomy. Br J Surg 91:1259–1274
Gumbs A, Gagner M (2006) Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metabol 20:483–499
Toniato A, Boschin IM, Bernante P, Opocher G, Guolo A, Pelizzo MR, Mantero F (2007) Laparoscopic adrenalectomy for pheochromocytoma: is it really more difficult? Surg Endosc 21:1323–1326
Walz MK, Alesina PF, Wenger FA (2006) Posterior retroperitoneoscopic adrenalectomy: results of 560 procedures in 520 patients. Surgery 140:943–948
Barczynski M, Konturek A, Golkowski F, Cichon S, Huszno B, Peitgen K, Walz MK (2007) Posterior retroperitoneoscopic adrenalectomy: a comparison between the initial experience in the invention phase and introductory phase of the new surgical technique. World J Surg 31:65–71
Takeda M, Watanabe R, Kurumada S (1997) Retroperitoneal laparoscopic adrenalectomy for functional adrenal tumor: comparison with conventional transperitoneal laparoscopic adrenalectomy. J Urol 157:19–23
Bonjer HJ, Lange JF, Kazemier G, de Herder WW, Steyerberg E, Bruining HA (1997) Comparison of three techniques for adrenalectomy. Br J Surg 84:679–682
Linos DA, Stylopoulos N, Boukis M, Souvatzogiou A, Raptus S, Papadimitriou J (1997) Anterior, posterior, or laparoscopic approach for the management of adrenal diseases? Am J Surg 173:120–125
Siperstein AE, Berber E, Engle KL, Duh QY, Clark OH (2000) Laparoscopic posterior adrenalectomy: technical considerations. Arch Surg 135:967–971
Terachi T, Yoshida O, Matsuda T (2000) Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan. Biomed Pharmacoter 54:211–214
Brunaud L, Kebebew E, Sebag F, Zarnegar R, Clark OH, Duh QY (2006) Observation or laparoscopic adrenalectomy for adrenal incidentaloma? A surgical decision analysis. Med Sci Monit 12:355–362
Toniato A, Boschin IM, Opocher G, Guolo A, Pelizzo MR, Mantero F (2007) Is the laparoscopic adrenalectomy for pheochromocytoma the best treatment? Surgery 141(6):723–727
Prinz RA (1995) A comparison of laparoscopic and open adrenalectomy. Arch Surg 130:489–492
Plaggemars HJ, Targarona EM, van Couwelaar G, Ambra M, Garcia A, Rebasa P, Rius X, Trias M (2005) What has changed in adrenalectomy? From open surgery to laparoscopy? Cir Esp 77:132–138
Goitein D, Mintz Y, Gross D, Reissman P (2004) Laparoscopic adrenalectomy: ascending the learnig curve. Surg Endosc 18:771–773
Toniato A, Bernante P, Rossi GP, Pelizzo MR (2006) The role of adrenal venous sampling in the surgical management of primary aldosteronism. World J Surg 30:624–627
Miccoli P, Raffaelli M, Berti P, Materazzi G, Massi M, Bernini G (2002) Adrenal surgery before and after the introduction of laparoscopic adrenalectomy. Br J Surg 89:779–782
Meyer A, Behrend M (2006) Indications and results of surgery for incidentally found adrenal tumors. Urol Int 77:173–178
Valeri A, Borrelli A, Presenti L (2002) The influence of new technologies on laparoscopic adrenalectomy: our personal experience with 91 patients. Surg Endosc 16:1274–1279
NIH state of the science statement on management of the clinically inapparent adrenal mass. NIH Consens State Sci Statements 2002, 19:1–25
Chavez-Rodriguez J, Pasieka JL (2005) Adrenal lesions assessed in the era of laparoscopic adrenalectomy: a modern day series. Am J Surg 189:581–586
Kwan TL, Lam CM, Yuen A, Lo CY (2007) Adrenalectomy in Hong Kong: a critical review of adoption of laparoscopic approach. Am J Surg 194:153–158
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Toniato, A., Boschin, I., Bernante, P. et al. Factors influencing the rising rates of adrenal surgery: analysis of a 25-year experience. Surg Endosc 23, 503–507 (2009). https://doi.org/10.1007/s00464-008-0061-3
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DOI: https://doi.org/10.1007/s00464-008-0061-3