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Territo A, Di Buono G, Buscemi S, Mantica G, Falco V, Palacios VH, Verri P, Antelo RA, Rosas-Nava JE, Crisan N, Andras I, Medas F, Amato G, Romano G, Breda A, Agrusa A. Evaluation of predictive factors for i-CLARAS (intraoperative complications in laparoscopic renal and adrenal surgery): a multicentre international retrospective cohort study. Sci Rep 2024; 14:1372. [PMID: 38228705 DOI: 10.1038/s41598-024-51696-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
The laparoscopic approach represents the standard of treatment for renal and adrenal diseases, and its use is increasing even outside referral centres. Although most procedures are routinely performed, intraoperative complications do not occur, and the rate and predictive factors of these complications have not been established. The aim of this study was to evaluate the incidence and type of intraoperative complications and to identify predictive factors in patients undergoing laparoscopic renal and adrenal surgery. This was a cohort, multicentre, international retrospective study. Patients who underwent laparoscopic renal and adrenal surgeries between April 2017 and March 2022 were included in the study. Bivariate analysis was performed using contingency tables and the χ2 test for independent samples to compare qualitative variables and the T test and Mood test for continuous variables. Multivariate analysis was performed using a logistic regression model to obtain adjusted odds ratios. A total of 2374 patients were included in the study. Intraoperative complications were reported for 8.09% of patients who underwent renal surgery, with the most common complications reported being hollow viscus and vascular complications, and for 6.75% of patients who underwent adrenal surgery, with the most common complication reported being parenchymatous viscous complications. Multivariate analysis revealed that both adrenal and renal surgery radiological preoperative factors, such as invasive features during adrenalectomy and the RENAL score during nephrectomy, are predictive factors of intraoperative complications. In contrast to existing data, surgeon experience was not associated with a reduction in the incidence of perioperative complications.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Guglielmo Mantica
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Vincenzo Falco
- Department of Economics, Business and Statistics, University of Palermo, Palermo, Italy
| | - Vital Hevia Palacios
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Paolo Verri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Turin, Italy
| | | | | | - Nicolae Crisan
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Iulia Andras
- Urology Department, Clinical Municipal Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giuseppe Amato
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via L. Giuffrè, 5, 90127, Palermo, Italy
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Zhou X, Li L, Lin L, Ju K, Kwong JSW, Xu C. Methodological quality for systematic reviews of adverse events with surgical interventions: a cross-sectional survey. BMC Med Res Methodol 2021; 21:223. [PMID: 34689759 PMCID: PMC8543966 DOI: 10.1186/s12874-021-01423-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND An increasing number of systematic reviews assessed the safety of surgical interventions over time. How well these systematic reviews were designed and conducted determines the reliability of evidence. In this study, we aimed to assess the methodological quality of systematic reviews on the safety of surgical interventions. METHODS We searched PubMed for systematic reviews of surgical interventions with safety as the exclusive outcome from 1st-Jan, 2015 to 1st-Jan, 2020. The methodological quality of eligible systematic reviews was evaluated according to the AMSTAR 2.0 instrument. The primary outcomes were the number of methodological weaknesses and the global methodological quality. The proportion of each methodological weakness among eligible systematic reviews was compared by three pre-defined stratification variables. The absolute difference of the proportion (PD) was used as the effect estimator, with the two-tailed z-test for the significance. RESULTS We identified 127 systematic reviews from 18,636 records. None (n = 0, 0.00%) of them could be rated as "high" in terms of the global methodological quality; in contrast, they were either rated as "low" (n = 18, 14.17%) or as "critically low" (n = 109, 85.83%). The median number of methodological weaknesses of these systematic reviews was 8 (interquartile range, IQR: 6 to 9), in which 4 (IQR: 2 to 4) were critical weaknesses. Systematic reviews that used any reporting guideline (e.g., domain 13, PD = -0.22, 95% CI: - 0.39, - 0.06; p = 0.01) and developed a protocol in advance (e.g., domain 6, PD = -0.20, 95% CI: - 0.39, - 0.01; p = 0.04) were less likely to have methodological weakness in some domains but not for the rest (e.g., domain 8, PD = 0.04, 95% CI: - 0.14, 0.21; p = 0.68; with protocol vs. without). CONCLUSIONS The methodological quality of current systematic reviews of adverse events with surgical interventions was poor. Further efforts, for example, encouraging researchers to develop a protocol in advance, are needed to enhance the methodological quality of these systematic reviews.
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Affiliation(s)
- Xiaoqin Zhou
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Linji Li
- Department of Anesthesiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, China
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Ke Ju
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Joey S W Kwong
- Global Health Nursing, St. Luke's International University, Tokyo, Japan
| | - Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Al Jamiaa Street, P. O. Box 2713, Doha, Qatar.
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Vetshev PS, Yankin PL, Zhivotov VA, Poddubniy EI. [Preferable surgery for benign tumors of the adrenal glands]. Khirurgiia (Mosk) 2018:66-76. [PMID: 29953103 DOI: 10.17116/hirurgia2018666-76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine optimal surgical approach in patients with adrenal tumors. MATERIAL AND METHODS Overall experience of treatment of patients with adrenal tumors comprises over 300 procedures including 152 minimally invasive surgeries. RESULTS We have presented the advantages and relative disadvantages of various technologies which are useful to be considered to determine the most optimal surgery in these patients. CONCLUSION There are no serious contradictions to use existing surgical methods in patients with adrenal tumors. Minimally invasive procedures along with conventional (open) interventions significantly enlarged rational choice in surgery for adrenal neoplasms and optimized personified approach.
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Affiliation(s)
- P S Vetshev
- Pirogov National Medical and Surgical Center, Healthcare Ministry of Russia, Moscow, Russia
| | - P L Yankin
- Pirogov National Medical and Surgical Center, Healthcare Ministry of Russia, Moscow, Russia
| | - V A Zhivotov
- Pirogov National Medical and Surgical Center, Healthcare Ministry of Russia, Moscow, Russia
| | - E I Poddubniy
- Pirogov National Medical and Surgical Center, Healthcare Ministry of Russia, Moscow, Russia
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Tuncel A, Balcı M, Köseoğlu E, Aslan Y, Güzel Ö, Keten T, Berker D, Göler S, Atan A. Transperitoneal laparoscopic adrenalectomy: five years' experience with 35 patients. Turk J Urol 2015; 39:214-9. [PMID: 26328113 DOI: 10.5152/tud.2013.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 07/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present our laparoscopic surgery experience in the treatment of adrenal masses. MATERIAL AND METHODS Between January 2008 and February 2013, a total of 35 patients (24 females, 11 males) underwent transperitoneal laparoscopic adrenalectomy to treat an adrenal mass. The patients underwent hormonal evaluation, chemical shift magnetic resonance imaging, or abdominal computed tomography. Twenty-seven patients (77.1%) had a hormone-active adrenal mass. RESULTS Eighteen right, 16 left, and one bilateral transperitoneal laparoscopic adrenalectomies were performed. The mean age and body mass index of the patients were 47.4 years and 26.6 kg/m(2), respectively. The mean adrenal mass size, operation time, estimated blood loss, and hospitalization duration were 41.9 mm, 94.7 min, 30 cc, and 2.4 days, respectively. No minor or major complications were observed perioperatively or postoperatively. In one patient (2.8%), the laparoscopic approach was converted to open surgery due to severe bradycardia resulting from chronic obstructive pulmonary disease. Histopathological examinations revealed adrenocortical hyperplasia in 23 (66%) patients, benign pheochromocytoma in 8 (22.8%) patients, and periadrenal paraganglioma, adrenocortical carcinoma, myeloid metaplasia, and myelolipoma in one (2.8%) patient for each entity. CONCLUSION Transperitoneal laparoscopic adrenalectomy is a safe and efficient minimally invasive treatment option with a low morbidity rate in the surgical treatment of adrenal masses.
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Affiliation(s)
- Altuğ Tuncel
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Melih Balcı
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Ersin Köseoğlu
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Yılmaz Aslan
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Özer Güzel
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Tanju Keten
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Dilek Berker
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Serdar Göler
- Department of Endocrinology and Metabolism, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Ali Atan
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Ankara, Turkey
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Michael A, Sheridan-Jonah A, Kovac JR, Allard CB, Matsumoto ED. A novel endoscopic treatment for ureteric remnant hemorrhage post laparoscopic radical nephrectomy. Scand J Urol 2012; 47:244-7. [PMID: 23035794 DOI: 10.3109/00365599.2012.729223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laparoscopic radical nephrectomy is commonly used to treat renal masses. Given the ubiquitous presence of this technique, rare complications are becoming more commonplace. It is thus essential that practicing urologists be aware of all possible complications as well as the novel management approaches that exist. This report presents a situation in which a patient developed rapid-onset, postoperative gross hematuria. This complication is rare and multiple sources of bleeding must be considered. In the situation reported here, the ureteric remnant was the cause of the unremitting gross hematuria. While others have described surgical exploration as the primary treatment, the authors were successful in using a minimally invasive endoscopic approach with fulguration and instillation of a fibrin sealant. Indeed, they propose that the endoscopic approach described herein may be considered first line in cases of unremitting gross hematuria originating from the ureteric remnant.
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Affiliation(s)
- Amanda Michael
- McMaster Institute of Urology, St. Joseph's Hospital, Hamilton, Ontario, Canada
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Bellorin O, Abdemur A, Sucandy I, Szomstein S, Rosenthal RJ. Understanding the significance, reasons and patterns of abnormal vital signs after gastric bypass for morbid obesity. Obes Surg 2011; 21:707-13. [PMID: 20582574 DOI: 10.1007/s11695-010-0221-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anastomotic leaks and bleeding are the two most feared major complications in patients undergoing laparoscopic gastric bypass (LRYGB). This study was designed to evaluate if there is a clinical correlation between abnormal vital signs and postoperative leaks and bleeding. After IRB approval and adherence to HIPAA guidelines, a retrospective review of medical records was performed on 518 patients who underwent LRYGB between October 2002 and October 2006. Vital signs from each patient were monitored hourly. Eight patients out of 518 (1.54%) were discovered to have anastomotic leak. A marked increase in heart rate up to 120 bpm at 20 h after surgery occurred in five of eight patients (62.5%). Of the eight patients who had a leak, seven (87.5%) experienced sustained tachycardia above 120 bpm. On the other hand, 20 patients out of 518 (3.86%) were discovered to have postoperative bleeding. A gradual rather than a dramatic increase in heart rate was recorded in 17 of 20 patients (85%) starting 8 h after surgery. Five patients (25%) had unsustained tachycardia above 120 bpm. Twelve patients in this group (60%) were seen to have cyclical tachycardia that never exceeded 120 bpm at any point during hospitalization. Marginal hypotension was found in seven patients (35%) in this group. Sustained tachycardia with a heart rate exceeding 120 bpm appears to be an indicator of anastomotic leak. Tachycardia less than 120 bpm that has occurred in a cyclical pattern strongly pointed toward postoperative bleeding. Anastomotic leaks and bleeding are the two most feared major complications in patients undergoing LRYGB. This study was designed to evaluate if there is a clinical correlation between abnormal vital signs and postoperative leaks and bleeding.
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Affiliation(s)
- Omar Bellorin
- Section of Minimally Invasive Surgery, Department of General and Vascular Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Kendrick M, Ercolano E, McCorkle R. Interventions to Prevent Postoperative Complications in Women With Ovarian Cancer. Clin J Oncol Nurs 2011; 15:195-202. [DOI: 10.1188/11.cjon.195-202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Richstone L, Montag S, Ost MC, Reggio E, Seideman C, Permpongkosol S, Rastinehad AR, Kavoussi LR. Predictors of Hemorrhage After Laparoscopic Partial Nephrectomy. Urology 2011; 77:88-91. [DOI: 10.1016/j.urology.2008.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 03/11/2008] [Accepted: 05/27/2008] [Indexed: 10/18/2022]
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Abstract
The retroperitoneal laparoscopic approach to the kidney offers a minimally invasive access that mimics the open surgical techniques of renal surgery. It allows renal surgery without violation of the peritoneal cavity with its attendant complications such as bowel injury and ileus. Over the last two decades, all renal surgery has been shown to be feasible through this technique. This includes complicated procedures such as a donor nephrectomy and radical nephroureterectomy for upper tract transitional cell cancers. We began performing retroperitoneoscopic renal surgery in the early 1990s and have developed a number of modifications to existing techniques so as to make this surgery easy and cost effective. In this review, we discuss the evolution of retroperitoneoscopic renal surgery, the indications, techniques and outcome of all types of retroperitoneoscopic renal surgery.
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Huber J, Pahernik S, Hallscheidt P, Sommer CM, Hatiboglu G, Haferkamp A, Hohenfellner M. Risk factors and clinical management of haemorrhage after open nephron-sparing surgery. BJU Int 2010; 106:1488-93. [DOI: 10.1111/j.1464-410x.2010.09345.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Strebel RT, Müntener M, Sulser T. Intraoperative complications of laparoscopic adrenalectomy. World J Urol 2008; 26:555-60. [PMID: 18481069 DOI: 10.1007/s00345-008-0272-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 04/19/2008] [Indexed: 12/12/2022] Open
Abstract
A laparoscopic or retroperitoneoscopic access to the adrenal gland is the standard of care for adrenalectomy in most cases. Although in laparoscopic adrenalectomy the approach is minimally invasive, the procedure is challenging. This is reflected in the scope of possible complications. The surgeon must consider complications related to the anatomical topography of the adrenal gland, which typically encompasses the complications known from open surgery and complications related to the minimal invasive access. In this topic paper we will address the most frequently encountered complications of adrenalectomy: vascular injuries, injuries of the bowel, pleural tears, and injuries to the liver, spleen and pancreas. Fortunately, these complications occur rarely. However, many of these complications can have devastating consequences. Therefore, it's the surgeon's obligation to be aware of the possible complications he might encounter during laparoscopic adrenalectomy. This awareness is essential for their prevention and it helps the laparoscopic surgeon to identify complications intraoperatively.
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Affiliation(s)
- Raeto T Strebel
- Department of Urology, Kantonsspital Graubünden, Loëstr. 170, 7000, Chur, Switzerland.
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Rimington P, Dasgupta P. The management of postoperative hemorrhage after laparoscopic renal and adrenal surgery. NATURE CLINICAL PRACTICE. UROLOGY 2007; 4:414-5. [PMID: 17534347 DOI: 10.1038/ncpuro0833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 04/30/2007] [Indexed: 05/15/2023]
Affiliation(s)
- Peter Rimington
- Department of Urology, Eastbourne District General Hospital, Eastbourne, East Sussex, UK.
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