Factors influencing the rising rates of adrenal surgery: analysis of a 25-year experience

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

  1. 1.

    Brunt ML (2006) Minimal access adrenal surgery. Surg Endosc 20:351–361

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Assalia A, Gagner M (2004) Laparoscopic adrenalectomy. Br J Surg 91:1259–1274

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Gumbs A, Gagner M (2006) Laparoscopic adrenalectomy. Best Pract Res Clin Endocrinol Metabol 20:483–499

    Article  Google Scholar 

  4. 4.

    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

    PubMed  Article  Google Scholar 

  5. 5.

    Walz MK, Alesina PF, Wenger FA (2006) Posterior retroperitoneoscopic adrenalectomy: results of 560 procedures in 520 patients. Surgery 140:943–948

    PubMed  Article  Google Scholar 

  6. 6.

    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

    PubMed  Article  Google Scholar 

  7. 7.

    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

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    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

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    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

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Siperstein AE, Berber E, Engle KL, Duh QY, Clark OH (2000) Laparoscopic posterior adrenalectomy: technical considerations. Arch Surg 135:967–971

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Terachi T, Yoshida O, Matsuda T (2000) Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan. Biomed Pharmacoter 54:211–214

    Article  Google Scholar 

  12. 12.

    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

    Google Scholar 

  13. 13.

    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

    PubMed  Article  Google Scholar 

  14. 14.

    Prinz RA (1995) A comparison of laparoscopic and open adrenalectomy. Arch Surg 130:489–492

    PubMed  CAS  Google Scholar 

  15. 15.

    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

    PubMed  Article  Google Scholar 

  16. 16.

    Goitein D, Mintz Y, Gross D, Reissman P (2004) Laparoscopic adrenalectomy: ascending the learnig curve. Surg Endosc 18:771–773

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    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

    PubMed  Article  Google Scholar 

  18. 18.

    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

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Meyer A, Behrend M (2006) Indications and results of surgery for incidentally found adrenal tumors. Urol Int 77:173–178

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    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

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    NIH state of the science statement on management of the clinically inapparent adrenal mass. NIH Consens State Sci Statements 2002, 19:1–25

    Google Scholar 

  22. 22.

    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

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    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

    PubMed  Article  Google Scholar 

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Correspondence to Antonio Toniato.

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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 (2009). https://doi.org/10.1007/s00464-008-0061-3

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Keyword

  • Adrenal surgery
  • Laparoscopy