Laparoscopic adrenalectomy in urological centres – the experience of the German Laparoscopic Working Group
2011
Study Type – Practice patterns (retrospective cohort)
Level of Evidence 2b
OBJECTIVE
• To evaluate the safety and feasibility of laparoscopic adrenalectomy (LA) performed in several German centres with different laparoscopic experience, as LA has become the gold-standard approach for benign surgical adrenal disorders; however, for solitary metastasis or primary adrenal cancer its precise role is uncertain.
PATIENTS AND METHODS
• The data of 363 patients who underwent a LA were prospectively collected in 23 centres.
• All centres were stratified into three groups according to their experience: group A ( 20 LAs/year).
• In all, 15 centres used a transperitoneal approach, four a retroperitoneal approach and four both approaches.
• Demographic data, perioperative and postoperative variables, including operating time, surgical approach, tumour size, estimated blood loss, complications, hospital stay and histological tumour staging, were collected and analysed.
RESULTS
• The transperitoneal approach was used in 281 cases (77.4%) and the retroperitoneal approach was used in 82 patients (22.6%).
• In all, 263 of 363 lesions (72.5%) were benign and 100 (27.5%) were malignant.
• The mean (sd) operating time was 127.22 (55.56) min and 130.16 (49.88) min after transperitoneal and retroperitoneal LA, respectively.
• The mean complication rates for transperitoneal and retroperitoneal LA were 5% and 10.9%, respectively.
CONCLUSION
• LAs performed by urologists experienced in laparoscopy is safe for the removal of benign and malignant adrenal masses. LA for malignant adrenal tumours should be performed only in high-volume centres by a surgeon performing at least >10 LAs/year.
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