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Di Buono G, Buscemi S, Lo Monte AI, Geraci G, Sorce V, Citarrella R, Gulotta E, Palumbo VD, Fazzotta S, Gulotta L, Albano D, Galia M, Romano G, Agrusa A. Laparoscopic adrenalectomy: preoperative data, surgical technique and clinical outcomes. BMC Surg 2019; 18:128. [PMID: 31074390 PMCID: PMC7402565 DOI: 10.1186/s12893-018-0456-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background laparoscopic adrenalectomy has become the standard treatment for adrenal lesions. The better clinical outcoms of laparoscopic technique are valid for treatment of small benign masses (< 5–6 cm), instead there are still open questions in literature regarding the correct management of larger lesions (> 6 cm) or in case of potentially malignant adrenal tumors. The aim of this study is to evaluate the outcomes of laparoscopic adrenalectomy in a referral surgical department for endocrine surgery. Methods at the University Hospital Policlinico “P. Giaccone” of Palermo between January 2010 and December 2017 we performed a total of 81 laparoscopic adrenalectomy. We created a retrospective database with analysis of patients data, morphologic and hormonal characteristics of adrenal lesions, surgical procedures and postoperative results with histological diagnosis and complications. Results Mean size of adrenal neoplasm was 7,5 cm (range 1.5 to 18 cm). The mean operative time was 145 min (range 75–240). In statistical analysis lenght of surgery was correlated to the lesion diameter (p < 0.05) but not with pre-operative features or histological results. 5 intraoperative complications occurred. Among these patients 4 presented bleeding and 1 a diaphagmatic lesion. No conversion to open surgery was necessary and no intraoperative blood transfusion were required. Mean estimated blood loss was 95 ml (range 50–350). There was no capsular disruption during adrenal dissection. Mean length of hospital stay was 3.7 days (range 3–6 days). Conclusions Laparoscopic adrenalectomy is a safe procedure with low rate of morbidity. An accurate preoperative radiological examination is fundamental to obtain a stringent patients selection. The lesion diameter is related to longer operative time and appeares as the main predictive parameter of intraoperative complications but these results are not statistically significant. On the other side secreting adrenal tumors require more attention in operative management without increased rate of postoperative complications.
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Affiliation(s)
- Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy.
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Girolamo Geraci
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Vincenzo Sorce
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Roberto Citarrella
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - Eliana Gulotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Vincenzo Davide Palumbo
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Salvatore Fazzotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Leonardo Gulotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Domenico Albano
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy, Via L. Giuffrè, 5, 90127, Palermo, Italy
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