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Comparison of synchronous bilateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy: results of a multicenter study

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Abstract

Background

Different techniques for laparoscopic adrenalectomy have been proposed with the lateral transperitoneal approach and posterior retroperitoneal approach being the two more frequently minimally invasive surgeries in most of the clinics. There are no sufficient studies in which the results of lateral transperitoneal and posterior retroperitoneal approaches in synchronous bilateral laparoscopic adrenalectomy have been compared. In the current study, we aimed to report our multicenter results of the lateral transperitoneal and posterior retroperitoneal synchronous bilateral laparoscopic adrenalectomy experience in patients who had different bilateral adrenal pathologies and to compare the outcomes of these two different operative procedures.

Methods

Between 2012 and 2018, a total of 52 patients with a mean age of 43.5 years underwent simultaneous bilateral laparoscopic adrenalectomy at 6 different centers. Twenty-seven and 25 patients underwent bilateral lateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy, respectively. Patients' age, gender, body max index, operative indications, mass size, operation time, blood loss, length of hospitalization, intraoperative and postoperative complications and pathology reports were analyzed.

Results

Synchronous bilateral transperitoneal group was younger than synchronous posterior retroperitoneal group (37 years vs. 50.4 years.) (p: 0.001). Posterior retroperitoneal group had significantly decreased operating time and less blood loss than transperitoneal group. No significant difference was found with regard to postoperative hospital stay, perioperative and postoperative complications between two groups. Majority of the histopathological results were adrenal hyperplasia associated with Cushing’s disease (61.5%). Less frequent pathological results were adrenal adenoma and pheochromocytoma (15.4% and 13.5%, respectively). During the follow-up period, no recurrence or disease-related mortality was observed in the patients.

Conclusion

Our results shows that shorter operative time and less bleeding can be achieved with posterior retroperitoneal approach in synchronous bilateral laparoscopic adrenalectomy. In our series, intraoperative and postoperative complication rates were similar between both surgical approaches.

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Abbreviations

LA:

Laparoscopic adrenalectomy

BTLA:

Bilateral transperitoneal laparoscopic adrenalectomy

BRLA:

Bilateral retroperitoneal laparoscopic adrenalectomy

ACTH:

Adrenocorticotropin hormone

BMI:

Body mass index

References

  1. Young WF Jr (2007) Clinical practice. The incidentally discovered adrenal mass. NEJM 356:601–610

    Article  CAS  Google Scholar 

  2. Barzon L, Scaroni C, Sonino N et al (1998) Incidentally discovered adrenal tumors: endocrine and scintigraphic correlates. J Clin Endocrinol Metab 83:55–62

    CAS  PubMed  Google Scholar 

  3. Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. NEJM 327:1003–1006

    Google Scholar 

  4. Gagner M, Pomp A, Heniford BT et al (1997) Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 226:238–247

    Article  CAS  Google Scholar 

  5. Brunt LM, Doherty GM, Norton JA et al (1998) Laparoscopic adrenalectomy compared to open adrenalectomy for benign adrenal neoplasms. J Am Coll Surg 183:1–10

    Google Scholar 

  6. Imai T, Kikumori T, Ohiwa M et al (1999) A case-controlled study of laparoscopic compared with open lateral adrenalectomy. Am J Surg 178:50–54

    Article  CAS  Google Scholar 

  7. Chapuis Y, Chastanet S, Doussent B et al (1997) Bilateral laparoscopic adrenalectomy for Cushing’s disease. Br J Surg 84:1009

    Article  CAS  Google Scholar 

  8. Vella A, Thompson GB, Grant CS et al (2001) Laparoscopic adrenalectomy for adrenocorticotropin-dependent Cushing’s syndrome. J Clin Endocrinol Metab 86:1596–1599

    CAS  PubMed  Google Scholar 

  9. Hasan R, Harold KL, Matthews BD et al (2002) Outcomes for laparoscopic bilateral adrenalectomy. J Laparoendosc Adv Surg Tech A 12:233–236

    Article  CAS  Google Scholar 

  10. Hawn MT, Cook D, Deveney C et al (2002) Quality of life after laparoscopic bilateral adrenalectomy for Cushing’s disease. Surgery 32:1064–1069

    Article  Google Scholar 

  11. Porpiglia F, Fiori C, Bovio S et al (2004) Bilateral adrenalectomy for Cushing’s syndrome: a comparison between laparoscopy and open surgery. J Endocrin Invest 27:654–658

    Article  CAS  Google Scholar 

  12. Jager E, Heintz A, Junginner T (2004) Synchronous bilateral endoscopic adrenalectomy:experience after 18 operations. Surg Endosc 18:314–318

    Article  CAS  Google Scholar 

  13. Mc T, Kebebew W, Clark OH et al (2008) Laparoscopic bilateral adrenalectomy:results for 30 consecutive cases. Surg Endosc 22:202–207

    Article  Google Scholar 

  14. Castilla OA, Lopez-Fontana G, Vitagliano G (2011) Laparoscopic synchronous bilateral adrenalectomy. Arch Esp Urol 64:114–120

    Google Scholar 

  15. Lan BY, Taskin HE, Aksoy E et al (2015) Factors affecting the surgical approach and timing of bilateral adrenalectomy. Surg Endosc 29:1741–1745

    Article  Google Scholar 

  16. Satava RM (2005) Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol 14:257–261

    Article  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  18. Berber E, Tellioglu G, Harvey A et al (2009) Comparison of laparoscopic Transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 146:621–625

    Article  Google Scholar 

  19. Lee JE, Evans DB, Hickey RC et al (1998) Unknown primary cancer presenting as an adrenal mass: frequency and implications for diagnostic evaluation of adrenal incidentalomas. Surgery 124:1115–1122

    Article  CAS  Google Scholar 

  20. Hsu TH, Gill IS (2002) Bilateral laparoscopic adrenalectomy:retroperitoneal and transperitoneal approaches. Urology 59:184–189

    Article  Google Scholar 

  21. Miccoli P, Materazzi G, Brauckhoff M et al (2011) No outcome differences between a laparoscopic and retroperitoneoscopic approach in synchronous bilateral adrenal surgery. World J Surg 35:2698–2702

    Article  Google Scholar 

  22. Raffaelli M, Brunaud L, De Crea C et al (2014) Synchronous bilateral adrenalectomy for Cushing’s syndrome:laparoscopic versus posterior retroperitoneoscopic versus robotic approach. World J Surg 38:709–715

    Article  Google Scholar 

  23. Taskin HE, Aliyev S, Aksoy E et al (2014) Bilateral posterior retroperitoneal robotic adrenalectomy for ACTH-independent Cushing syndrome. Surg Laparosc Endosc Percutan Tech 24:e113–e115

    Article  Google Scholar 

  24. Lezoche E, Guerrieri M, Feliciotti F et al (2011) Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Am Surg 16:96–99

    Google Scholar 

  25. Lee CR, Walz MK, Park S et al (2012) A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol 19:2629–2634

    Article  Google Scholar 

  26. Walz MK, Peitgen K, Hoermann R et al (1996) Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy:results of 30 adrenalectomies in 27 patients. World J Surg 20:769–774

    Article  CAS  Google Scholar 

  27. Goitein D, Mintz Y, Gross D et al (2004) Laparoscopic adrenalectomy:ascending the learning curve. Surg Endosc 18:771–773

    Article  CAS  Google Scholar 

  28. Zulewski H, Oertli D (2013) Transperitoneal laparoscopic adrenalectomy:assessment of the surgical learning curve. ISRN. https://doi.org/10.1155/2013/936209

    Article  Google Scholar 

  29. Virielink OM, Engelsman AF, Hemmer PHJ (2018) Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy. Br J Surg 105:544–551

    Article  Google Scholar 

  30. Puccini M, Panicucci E, Candalise V et al (2017) The role of laparoscopic resection of metastases to adrenal glands. Gland Surg 6:350–354

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey

    Altug Tuncel, Anil Erkan & Yilmaz Aslan

  2. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands

    Johan Langenhuijsen

  3. Department of Urology, Moscow Central Aviation Hospital, Moscow, Russia

    Taras Mikhaylikov & Eduard Gallyamov

  4. Department of Urology, Okan University, Istanbul, Turkey

    Murat Arslan

  5. Department Endocrinology and Metabolism Diseases, Ankara Numune Research and Training Hospital, University of Health Sciences, Ankara, Turkey

    Dilek Berker

  6. Department of Urology, Yuksek Ihtisas University, Ankara, Turkey

    Yasar Ozgok

  7. Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany

    Ali Serdar Gozen

Authors
  1. Altug Tuncel
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  2. Johan Langenhuijsen
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  3. Anil Erkan
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  4. Taras Mikhaylikov
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  6. Yilmaz Aslan
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  7. Dilek Berker
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  9. Eduard Gallyamov
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  10. Ali Serdar Gozen
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Corresponding author

Correspondence to Ali Serdar Gozen.

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Disclosure

Drs. Altug Tuncel, Johan Langenhuijsen, Anil Erkan, Taras Mikhaylikov, Murat Arslan, Yilmaz Aslan, Dilek Berker, Yasar Ozgok, Eduard Gallyamov and Ali Serdar Gozen have no conflicts of interest or financial ties to disclose.

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Tuncel, A., Langenhuijsen, J., Erkan, A. et al. Comparison of synchronous bilateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy: results of a multicenter study. Surg Endosc 35, 1101–1107 (2021). https://doi.org/10.1007/s00464-020-07474-y

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  • DOI: https://doi.org/10.1007/s00464-020-07474-y

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