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Mini-retroperitoneoscopic adrenalectomy: our experience after 50 procedures
Francesco Porpiglia1, Cristian Fiori1, Riccardo Bertolo1
1Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
Objective:
To present our experience with retroperitoneoscopic adrenalectomy using 3-mm instruments (mini-rA) for adrenal tumors.
Materials And Methods:
From March 2009 to May 2013, patients with adrenal tumors <6 cm in size and body mass index ≤ 35 were involved in this prospective study and underwent mini-rA performed by 3-mm instruments. Demographic, endocrine and perioperative data, and cosmetic results (using Patient Scar Assessment Questionnaire and Scoring System) were recorded and analyzed.
Results:
Fifty procedures were performed in 48 patients. All procedures were performed with neither conversion to open surgery nor reoperation or mortality. Median operative time and blood loss were 90 minutes (range, 45-210 minutes) and 50 mL (range, 20-210 mL), respectively. Only 1 intraoperative complication (2%) was recorded. Conversion to conventional laparoscopy was needed in 4 procedures (8%). Postoperative complications were recorded in 6 cases (Clavien grade ≤ 2). No differences were recorded in terms of perioperative variables when comparing procedures performed in patients having secreting tumors (n = 18) with other ones (n = 32). On the contrary, procedures performed in patients having benign lesions (n = 41) had significantly lower operative times and complications with respect to those performed in patients with malignant lesions (n = 9). Median Patient Scar Assessment Questionnaire score was 30 (minimum score 28 = the best result; maximum score = 112, the worst result).
Conclusion:
In selected population, mini-rA is a feasible, safe, and effective technique in the treatment of adrenal masses <6 cm in size, offering objectively proven excellent patients' satisfaction with symptoms and cosmesis. Significant experience before embarking in this kind of surgery is recommended.
Insights
Retroperitoneoscopic adrenalectomy using 3-mm instruments (mini-rA) is safe and effective for adrenal tumors under 6 cm. This minimally invasive approach offers excellent patient satisfaction and cosmetic results.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Endocrine Surgery
Background:
- Adrenalectomy is a surgical procedure to remove adrenal glands or tumors.
- Minimally invasive techniques aim to reduce patient morbidity and improve cosmetic outcomes.
- Retroperitoneoscopic adrenalectomy offers advantages over traditional open surgery.
Purpose of the Study:
- To evaluate the feasibility, safety, and efficacy of retroperitoneoscopic adrenalectomy using 3-mm instruments (mini-rA).
- To assess perioperative outcomes and patient satisfaction, including cosmetic results, for mini-rA.
- To compare outcomes for mini-rA in patients with different types of adrenal lesions.
Main Methods:
- A prospective study involving 48 patients with adrenal tumors <6 cm and BMI ≤ 35.
- Fifty mini-rA procedures were performed using 3-mm instruments.
- Data collected included demographic, endocrine, perioperative variables, and cosmetic results using the Patient Scar Assessment Questionnaire.
Main Results:
- All 50 procedures were completed without conversion to open surgery, reoperation, or mortality.
- Low complication rates were observed: 2% intraoperative and 8% conversion to conventional laparoscopy.
- Patients with benign lesions had significantly shorter operative times and fewer complications than those with malignant lesions.
Conclusions:
- Mini-retroperitoneoscopic adrenalectomy (mini-rA) is a feasible, safe, and effective technique for selected adrenal masses <6 cm.
- The procedure demonstrates excellent patient satisfaction regarding both symptom management and cosmetic outcomes.
- Significant prior surgical experience is recommended before undertaking mini-rA.
