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Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing

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Abstract

Background

Laparoscopic adrenalectomy is the standard surgical approach to adrenal lesions. Adrenal vessel sealing is the critical surgical phase of laparoscopic adrenalectomy. This study aimed at comparing perioperative outcomes of laparoscopic transperitoneal adrenalectomy by means of radiofrequency energy-based device (LARFD) to those performed with traditional clipping device (LACD), while focusing on the different adrenal vessel control techniques.

Methods

Patients who underwent adrenalectomy for adrenal disease between January 1994 and April 2019 at the Surgical Clinic, Polytechnic University of Marche were included in the study. Overall, 414 patients met inclusion criteria for study eligibility: 211 and 203 patients underwent LARFD and LACD, respectively. Multiple models of quantile regression, logistic regression and Poisson finite mixture regression were used to assess the relationship between operative time, conversion to open procedure, length of stay (LoS), surgical procedure and patient characteristics, respectively.

Results

LARFD reduced operative time of about 12 min compared to LACD. Additional operative time-related factors were surgery side, surgery approach, conversion to open procedure and trocar number. The probability of conversion to open procedure decreased by about 76% for each added trocar, whereas it increased by about 49% for each added centimeter of adrenal lesion and by about 25% for each added year of surgery. Two patient clusters were identified based on the LoS: long-stay and short-stay. In the long-stay cluster, LoS decreased of about 30% in LARFD group and it was significantly associated with conversion to open procedure and postoperative complications, whereas in short-stay cluster only postoperative complications had a significant effect on LoS.

Conclusion

Laparoscopic transperitoneal adrenalectomy performed by means of radiofrequency energy-based device for the sealing of adrenal vessels is an effective procedure reducing operative time with potentially improved postoperative outcomes.

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References

  1. Gagner M, Lacroix A, Bolté E (1992) Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med 327(14):1033

    Article  CAS  Google Scholar 

  2. David G, Yoav M, Gross D, Reissman P (2004) Laparoscopic adrenalectomy. Ascending the learning curve. Surg Endosc 18:771–773

    Article  Google Scholar 

  3. Gagner M, Lacroix A, Prinz RA, Bolté E, Albala D, Potvin C, Hamet P, Kuchel O, Quérin S, Pomp A (1993) Early experience with laparoscopic approach for adrenalectomy. Surgery 114(6):1120–1124

    CAS  PubMed  Google Scholar 

  4. Gagner M, Pomp A, Heniford BT, Pharaid D, Lacroix A (1997) Laparoscopic adrenalectomy: lesson learned from 100 consecutive procedure. Ann Surg 226:238–247

    Article  CAS  Google Scholar 

  5. Lezoche E, Guerrieri M, Crosta F, Paganini AM, De Sanctis A, D’Ambrosio G, Lezoche G, Campagnacci R (2008) Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Surg Endosc 22(2):522–526

    Article  Google Scholar 

  6. Smith CD, Weber CJ, Amerson JR (1999) Laparoscopic adrenalectomy: new gold standard. World J Surg 23(4):389–396

    Article  CAS  Google Scholar 

  7. Henry JF, Sebag F, Iacobone M, Mirallie E (2002) Results of laparoscopic adrenalectomy for large and potentially malignant tumors. World J Surg 26(8):1043–1047

    Article  Google Scholar 

  8. Hallfeldt KK, Mussack T, Trupka A, Hohenbleicher F, Schmidbauer S (2003) Laparoscopic lateral adrenalectomy versus open posterior adrenalectomy for the treatment of benign adrenal tumors. Surg Endosc 17(2):264–267

    Article  CAS  Google Scholar 

  9. Lee JM, Kim MK, Ko SH, Koh JM, Kim BY, Kim SW, Kim SK, Kim HJ, Ryu OH, Park J, Lim JS, Kim SY, Shong YK, Yoo SJ; Korean Endocrine Society, Committee for Clinical Practice Guidelines (2017) Clinical guidelines for the management of adrenal incidentaloma. Endocrinol Metab 32(2):200–218

    Article  Google Scholar 

  10. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, Tsubosa Y, Satoh T, Yokomizo A, Fukuda H, Sasako M (2016) Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46(6):668–685

    Article  Google Scholar 

  11. Lezoche E, Guerrieri M, Paganini AM, Feliciotti F, Zenobi P, Antognini F, Mantero F (2000) Laparoscopic adrenalectomy by anterior transperitoneal approach. Results of 108 operations in unselected cases. Surg Endosc 14:920–925

    Article  CAS  Google Scholar 

  12. Lezoche E, Guerrieri M, Feliciotti F, Paganini AM, Perretta S, Baldarelli J, Bonjer J, Miccoli P (2002) Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc 16:96–99

    Article  CAS  Google Scholar 

  13. Perretta S, Campagnacci R, Guerrieri M, Paganini AM, De Sanctis A, Sarnari J, Rimini M, Lezoche E (2005) Sub-mesocolic access in laparoscopic left adrenalectomy. Surg Endosc 19(7):977–980

    Article  CAS  Google Scholar 

  14. Guerrieri M, Crosta F, De Sanctis A, Baldarelli M, Lezoche G, Campagnacci R (2008) Use of the electrothermal bipolar vessel system (EBVS) in laparoscopic adrenalectomy: a prospective study. Surg Endosc 22(1):141–145

    Article  Google Scholar 

  15. Koenker R (2005) Quantile regression. Cambridge University Press, New York

    Book  Google Scholar 

  16. Wang P, Puterman ML, Cockburn I, Le N (1996) Mixed poisson regression models with covariate dependent rates. Biometrics 52(2):381–400

    Article  CAS  Google Scholar 

  17. R Core Team (2019). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/.

  18. Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A (2009) Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 146:621–625

    Article  Google Scholar 

  19. Lezoche E, Guerrieri M, Crosta F, Lezoche G, Baldarelli M, Campagnacci R (2008) Flank approach versus anterior sub-mesocolic access in left laparoscopic adrenalectomy: a prospective randomized study. Surg Endosc 22(11):2373–2378

    Article  CAS  Google Scholar 

  20. Soon PS, Yeh MW, Sywak MS, Sidhu SB (2006) Use of the ligaSure vessel sealing system in laparoscopic adrenalectomy. ANZ J Surg 76(9):850–852

    Article  Google Scholar 

  21. Assalia A, Gagner M (2004) Laparoscopic adrenalectomy. Br J Surg 91(10):1259–1274

    Article  CAS  Google Scholar 

  22. Kennedy JS, Stranahan PL, Taylor KD, Chandler JG (1998) High-burst-strength, feedback-controlled bipolar vessel sealing. Surg Endosc 12(6):876–878

    Article  CAS  Google Scholar 

  23. Janssen PF, Brölmann HA, Huirne JA (2012) Effectiveness of electrothermal bipolar vessel-sealing devices versus other electrothermal and ultrasonic devices for abdominal surgical hemostasis: a systematic review. Surg Endosc 26(10):2892–2901

    Article  Google Scholar 

  24. Harold KL, Pollinger H, Matthews BD, Kercher KW, Sing RF, Heniford BT (2003) Comparison of ultrasonic energy, bipolar thermal energy, and vascular clips for the hemostasis of small-, medium-, and large-sized arteries. Surg Endosc 17(8):1228–1230

    Article  CAS  Google Scholar 

  25. Person B, Vivas DA, Ruiz D, Talcott M, Coad JE, Wexner SD (2008) Comparison of four energy-based vascular sealing and cutting instruments: a porcine model. Surg Endosc 22(2):534–538

    Article  Google Scholar 

  26. Landman J, Kerbl K, Rehman J, Andreoni C, Humphrey PA, Collyer W, Olweny E, Sundaram C, Clayman RV (2003) Evaluation of a vessel sealing system, bipolar electrosurgery, harmonic scalpel, titanium clips, endoscopic gastrointestinal anastomosis vascular staples and sutures for arterial and venous ligation in a porcine model. J Urol 169(2):697–700

    Article  Google Scholar 

  27. Yavuz N (2005) Laparoscopic transperitoneal adrenalectomy using the LigaSure vessel sealing system. J Laparoendosc Adv Surg Tech A 15(6):591–595

    Article  Google Scholar 

  28. Rieder JM, Nisbet AA, Wuerstle MC, Tran VQ, Kwon EO, Chien GW (2010) Differences in left and right laparoscopic adrenalectomy. JSLS 14(3):369–373

    Article  Google Scholar 

  29. Telem DA, Nguyen SQ, Chin EH, Weber K, Divino M (2009) Laparoscopic resection of giant adrenal cavernous hemangioma. JSLS 13(2):260–262

    PubMed  PubMed Central  Google Scholar 

  30. Zografos GN, Kothonidis K, Ageli C, Kopanakis N, Dimitriou K, Papaliodi E, Kaltsas G, Pagoni M, Papastratis G (2007) Laparoscopic resection of large adrenal ganglioneuroma. JSLS 11(4):487–492

    CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Surgical Clinic, Department of Experimental and Clinical Medicine, Section of Surgical Sciences, Polytechnic University of Marche, Via Tronto 10/A, 60126, Ancona, Italy

    Luca Cardinali, Elisa Catani, Monica Ortenzi & Mario Guerrieri

  2. Centre of Epidemiology, Biostatistics and Information Technology, School of Medicine, Polytechnic University of Marche, Ancona, Italy

    Edlira Skrami & Flavia Carle

  3. Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza University of Rome, Rome, Italy

    Andrea Balla

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  1. Luca Cardinali
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  2. Edlira Skrami
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  3. Elisa Catani
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  4. Flavia Carle
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  5. Monica Ortenzi
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  6. Andrea Balla
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  7. Mario Guerrieri
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Correspondence to Luca Cardinali.

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Disclosures

Drs. Luca Cardinali, Edlira Skrami, Elisa Catani, Flavia Carle, Monica Ortenzi, Andrea Balla, Mario Guerrieri have no conflicts of interest or financial ties to disclose.

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Cardinali, L., Skrami, E., Catani, E. et al. Laparoscopic transperitoneal adrenalectomy: a comparative study of different techniques for vessel sealing. Surg Endosc 35, 673–683 (2021). https://doi.org/10.1007/s00464-020-07432-8

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  • DOI: https://doi.org/10.1007/s00464-020-07432-8

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