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Selection algorithm for posterior versus lateral approach in laparoscopic adrenalectomy.

Orhan Agcaoglu1, Dursun Ali Sahin, Allan Siperstein

  • 1Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, USA.

Surgery
|January 21, 2012
PubMed
Summary

This study introduces an objective algorithm for selecting laparoscopic posterior retroperitoneal (PR) versus lateral transabdominal (LT) approaches for adrenalectomy. The algorithm uses patient measurements to ensure favorable perioperative outcomes.

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Lack of objective criteria for choosing laparoscopic posterior retroperitoneal (PR) versus lateral transabdominal (LT) adrenalectomy approaches.
  • Need for a standardized method to guide surgical technique selection.

Purpose of the Study:

  • To quantify and validate a clinical algorithm for selecting between laparoscopic PR and LT approaches for adrenalectomy.
  • To establish objective criteria for patient selection based on tumor characteristics and patient anatomy.

Main Methods:

  • Retrospective analysis of 219 laparoscopic adrenalectomies performed over 11 years.
  • Application of specific criteria (tumor size >6 cm for LT; anthropometric parameters for <6 cm tumors) for approach selection.
  • Quantification of anthropometric parameters from CT scans and correlation with operative time in 82 patients.

Main Results:

  • 52 patients underwent LT and 30 underwent PR adrenalectomy.
  • PR approach selected if Gerota's fascia to skin distance <5 cm and 12th rib at or rostral to renal hilum.
  • Operative time correlated with BMI (LT) and perinephric fat thickness/tumor proximity to kidney (PR).

Conclusions:

  • An objective algorithm for selecting laparoscopic PR or LT approach in patients with unilateral adrenal tumors <6 cm has been described.
  • The algorithm facilitates patient selection, leading to favorable perioperative outcomes.