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Laparoscopic bilateral anterior transperitoneal adrenalectomy: 24 years experience

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Abstract

Background

The aim of this study is to evaluate the feasibility, safety, advantages and surgical outcomes of laparoscopic bilateral adrenalectomy (LBA) by an anterior transperitoneal approach.

Methods

From 1994 to 2018, 552 patients underwent laparoscopic adrenalectomy, unilateral in 531 and bilateral in 21 patients (9 females and 12 males). All patients who underwent LBA were approached via a transperitoneal anterior route and form our study population. Indications included: Cushing’s disease (n = 11), pheochromocytoma (n = 6), Conn’s disease (n = 3) and adrenal cysts (n = 1).

Results

Mean operative time was 195 ± 86.2 min (range 55–360 min). Conversion was necessary in one case for bleeding. Three patients underwent concurrent laparoscopic cholecystectomy with laparoscopic common bile duct exploration and ductal stone extraction in one. Three postoperative complications occurred in one patient each: subhepatic fluid collection, intestinal ileus and pleural effusion. Mean hospital stay was 6.1 ± 4.7 days (range 2–18 days).

Conclusions

In our experience, transperitoneal anterior LBA was feasible and safe. Based on our results, we believe that this approach leads to prompt recognition of anatomical landmarks with early division of the main adrenal vein prior to any gland manipulation, with a low risk of bleeding and without the need to change patient position. Unlike the lateral approach, there is no need to mobilize the spleno-pancreatic complex on the left or the liver on the right. The ability to perform associated intraperitoneal procedures, if required, is an added benefit.

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Acknowledgements

The authors are grateful to Professor Abe Fingerhut for his critical review of this manuscript.

Disclosures

Dr. Andrea Balla, Dr. Monica Ortenzi, Dr. Livia Palmieri, Dr. Diletta Corallino, Dr. Francesca Meoli, Dr. Pietro Ursi, Dr. Giulia Puliani, Dr. Emilia Sbardella, Prof. Andrea M. Isidori, Prof. Mario Guerrieri, Dr. Silvia Quaresima and Prof. Alessandro M. Paganini declare that they have no conflict of interest or financial ties to disclose.

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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, Livia Palmieri, Diletta Corallino, Francesca Meoli, Pietro Ursi, Silvia Quaresima & 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

    Giulia Puliani, Emilia Sbardella & Andrea M. Isidori

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  1. Andrea Balla
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Correspondence to Andrea Balla.

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Balla, A., Ortenzi, M., Palmieri, L. et al. Laparoscopic bilateral anterior transperitoneal adrenalectomy: 24 years experience. Surg Endosc 33, 3718–3724 (2019). https://doi.org/10.1007/s00464-019-06665-6

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