Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?

O M Vrielink; K P Wevers; J W Kist; I H M Borel Rinkes; P H J Hemmer; M R Vriens; J de Vries; S Kruijff

doi:https://doi.org/10.1007/s00423-016-1533-x

Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?

O M Vrielink, K P Wevers, J W Kist, I H M Borel Rinkes, P H J Hemmer, M R Vriens, J de Vries, S Kruijff

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

PURPOSE: There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.

METHODS: A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches.

RESULTS: Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches.

CONCLUSIONS: Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.

Original language	English
Pages (from-to)	767-773
Number of pages	7
Journal	Langenbeck's Archives of Surgery
Volume	402
Issue number	5
DOIs	https://doi.org/10.1007/s00423-016-1533-x
Publication status	Published - Aug 2017

Keywords

Adrenal Gland Neoplasms/surgery
Adrenalectomy/methods
Blood Loss, Surgical
Female
Humans
Laparoscopy/methods
Male
Middle Aged
Operative Time
Postoperative Complications/epidemiology
Retrospective Studies
Treatment Outcome

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https://doi.org/10.1007/s00423-016-1533-x

Cite this

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title = "Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?",

abstract = "PURPOSE: There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the {"}classic{"} laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.METHODS: A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches.RESULTS: Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches.CONCLUSIONS: Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.",

keywords = "Adrenal Gland Neoplasms/surgery, Adrenalectomy/methods, Blood Loss, Surgical, Female, Humans, Laparoscopy/methods, Male, Middle Aged, Operative Time, Postoperative Complications/epidemiology, Retrospective Studies, Treatment Outcome",

author = "Vrielink, {O M} and Wevers, {K P} and Kist, {J W} and {Borel Rinkes}, {I H M} and Hemmer, {P H J} and Vriens, {M R} and {de Vries}, J and S Kruijff",

year = "2017",

month = aug,

doi = "https://doi.org/10.1007/s00423-016-1533-x",

language = "English",

volume = "402",

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journal = "Langenbeck's Archives of Surgery",

issn = "1435-2443",

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TY - JOUR

T1 - Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy

T2 - a shift to a new golden standard?

AU - Vrielink, O M

AU - Wevers, K P

AU - Kist, J W

AU - Borel Rinkes, I H M

AU - Hemmer, P H J

AU - Vriens, M R

AU - de Vries, J

AU - Kruijff, S

PY - 2017/8

Y1 - 2017/8

N2 - PURPOSE: There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.METHODS: A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches.RESULTS: Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches.CONCLUSIONS: Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.

AB - PURPOSE: There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.METHODS: A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches.RESULTS: Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches.CONCLUSIONS: Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.

KW - Adrenal Gland Neoplasms/surgery

KW - Adrenalectomy/methods

KW - Blood Loss, Surgical

KW - Female

KW - Humans

KW - Laparoscopy/methods

KW - Male

KW - Middle Aged

KW - Operative Time

KW - Postoperative Complications/epidemiology

KW - Retrospective Studies

KW - Treatment Outcome

U2 - https://doi.org/10.1007/s00423-016-1533-x

DO - https://doi.org/10.1007/s00423-016-1533-x

M3 - Article

C2 - 27888343

SN - 1435-2443

VL - 402

SP - 767

EP - 773

JO - Langenbeck's Archives of Surgery

JF - Langenbeck's Archives of Surgery

IS - 5

ER -