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Ohzeki T, Kita H, Kunishige R, Hayashi T, Nishioka T. Initial experience with robot-assisted adrenalectomy for giant adrenal tumors. Asian J Urol 2024; 11:507-508. [PMID: 39139523 PMCID: PMC11318410 DOI: 10.1016/j.ajur.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/12/2023] [Indexed: 08/15/2024] Open
Affiliation(s)
- Takayuki Ohzeki
- Department of Urology, Izumi City General Hospital, 4-5-1 Wakecho, Izumi, Osaka 594-0073, Japan
| | - Hiroyuki Kita
- Department of Urology, Izumi City General Hospital, 4-5-1 Wakecho, Izumi, Osaka 594-0073, Japan
| | - Remon Kunishige
- Department of Urology, Izumi City General Hospital, 4-5-1 Wakecho, Izumi, Osaka 594-0073, Japan
| | - Taiji Hayashi
- Department of Urology, Izumi City General Hospital, 4-5-1 Wakecho, Izumi, Osaka 594-0073, Japan
| | - Tsukasa Nishioka
- Department of Urology, Izumi City General Hospital, 4-5-1 Wakecho, Izumi, Osaka 594-0073, Japan
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Hu M, Wu Y, Xu X, Cai W, Lin J, Cai W, Pan H, Yang Z, Ye L, Wu J. Modified versus three-level technique of retroperitoneal laparoscopic adrenalectomy for all patients with adrenal lesions ≤ 6cm: a retrospective, case-controlled study. Front Endocrinol (Lausanne) 2024; 15:1342240. [PMID: 38501101 PMCID: PMC10944954 DOI: 10.3389/fendo.2024.1342240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Objectives The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m2. This paper aims to summarize our institution's seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm. Patients and methods Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang's technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05. Results In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05). Conclusion MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases. Patient summary We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.
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Affiliation(s)
- Minxiong Hu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Yangbiao Wu
- The Graduate School of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiao Xu
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Wenchao Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Jiangui Lin
- Department of Urology, Zhangzhou Municipal Hospital, Zhangzhou, Fujian, China
| | - Wanghai Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Honghong Pan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Zesong Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital South Branch, Fuzhou, Fujian, China
| | - Liefu Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Jinfeng Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China
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Anceschi U, Tufano A, Flammia RS, Mormando M, Fiori C, Zappalà O, De Concilio B, Carrara A, Maria Consiglia F, Tuderti G, Brassetti A, Misuraca L, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Gallucci M, Simone G. Clinical cure vs a novel trifecta system for evaluating long-term outcomes of minimally-invasive partial or total adrenalectomy for unilateral primary aldosteronism: results of a multicentric series. Cent European J Urol 2023; 75:345-351. [PMID: 36794029 PMCID: PMC9903164 DOI: 10.5173/ceju.2022.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 02/17/2023] Open
Abstract
Introduction Several predictive scores to evaluate outcomes of adrenal surgery for unilateral primary aldosteronism (UPA), have been conceived. We compared a novel trifecta that summarizes outcomes of adrenal surgery for UPA with the clinical cure proposed by Vorselaars. Material and methods Between March 2011 and January 2022, a multi-institutional dataset was queried for UPA. Baseline, perioperative and functional data were collected. Clinical and biochemical complete and partial success rates according to Primary Aldosteronism Surgical Outcome (PASO) criteria were assessed for the overall cohort. Clinical cure was defined either as normotension without antihypertensive medications or normotension with lower or equal use of antihypertensive medications. Trifecta was defined as the coexistence of ≥50% antihypertensive therapeutic intensity score (TIS) reduction (ΔTIS), no electrolyte impairment at 3-months and no Clavien-Dindo (2-5) complications. Cox regression analyses were used to identify predictors of long-term clinical and biochemical success. For all analyses, a two-sided p <0.05 was considered significant. Results Baseline, perioperative and functional outcomes were analyzed. Out of 90 patients, at a median follow-up of 42 months (IQR 27-54) a complete and partial clinical success was observed in 60% and 17.7% of cases while a complete and partial biochemical success was achieved in 83.3% and 12.3% of cases, respectively. Overall trifecta and clinical cure rates were 21.1% and 58.9%, respectively. On multivariable Cox regression analysis, trifecta achievement (HR 2.87; 95% CI 1.45-5.58; p = 0.02) was the only independent predictor of complete clinical success at long-term follow-up. Conclusions Despite its complex estimation and more restrictive criteria, trifecta but not clinical cure allows to independently predict composite PASO endpoints on the long run.
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Affiliation(s)
- Umberto Anceschi
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Marilda Mormando
- Oncological Endocrinology Unit, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi-Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Orazio Zappalà
- Department of General Surgery, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Bernardino De Concilio
- Department of Urology, ULSS 7 Pedemontana - San Bassiano Hospital, Bassano del Grappa, Italy
| | - Alessandro Carrara
- Department of General Surgery, Santa Maria del Carmine Hospital, Azienda Sanitaria per i Servizi Sanitari, Rovereto, Italy
| | | | - Gabriele Tuderti
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
| | - Giuseppe Tirone
- Department of General Surgery, Santa Chiara Regional Hospital, Largo Medaglie d'Oro, Trento, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi-Gonzaga Hospital, University of Turin, Orbassano, Italy
| | - Antonio Celia
- Department of Urology, ULSS 7 Pedemontana - San Bassiano Hospital, Bassano del Grappa, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCSS 'Regina Elena' National Cancer Institute, Rome, Italy
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Anceschi U, Mormando M, Flammia RS, Fiori C, Zappalà O, De Concilio B, Brassetti A, Carrara A, Ferriero MC, Tuderti G, Misuraca L, Prata F, Tufano A, Bove AM, Mastroianni R, Appetecchia M, Tirone G, Porpiglia F, Celia A, Simone G. The Therapeutic Intensity Score as Predictor of Clinical Outcomes after Total and Partial Adrenalectomy for Unilateral Primary Aldosteronism: Results of a Multicentric Series. J Clin Med 2023; 12:jcm12030997. [PMID: 36769646 PMCID: PMC9917842 DOI: 10.3390/jcm12030997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To evaluate the ability of therapeutic intensity score (TIS) in predicting the clinical outcomes of partial (PA) and total adrenalectomy (TA) for UPA. METHODS Between 2011 and 2022, a four-center adrenalectomy dataset was queried for "unilateral adrenal mass" and "UPA" (n = 90). Preoperative TIS of each antihypertensive medication were individually calculated and merged to create a single, cumulative variable. Probability of complete clinical, partial, and absent pooled success rates according to TIS were assessed for the overall cohort by Kaplan-Meier. Cox analyses were used to identify predictors of complete clinical and partial/absent success, respectively. For all analyses, a two-sided p < 0.05 was considered significant. RESULTS At a median follow-up of 42 months (IQR 27-54) complete partial, and absent clinical success were observed in 60%, 17.7%, and 22.3%, respectively. On Kaplan-Meier analysis, TIS < 1 predicted higher complete success rates (p < 0.001), while TIS ≥ 1 was predictor of either partial and absent clinical success (p = 0.008). On multivariable analysis, TIS < 1 (HR 0.25; 95% CI 0.11-0.57; p = 0.001) and adenoma size (HR 1.11; 95% CI 1-1.23; p = 0.0049) were independent predictors of complete clinical success, while TIS ≥ 1 (HR 2.84; 95% CI 1.32-6.1; p = 0.007) was the only independent predictor of absent clinical success. CONCLUSIONS TIS score and adenoma size may help to identify patients who are likely to be at risk of persistent hypertension after surgery.
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Affiliation(s)
- Umberto Anceschi
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
- Correspondence: ; Tel.: +39-339-583-6431 or +39-379-175-0925
| | - Marilda Mormando
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Rocco Simone Flammia
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Cristian Fiori
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Orazio Zappalà
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Bernardino De Concilio
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Aldo Brassetti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Alessandro Carrara
- APSS, Santa Maria del Carmine Hospital, Department of General Surgery, Corso Verona, 38068 Rovereto, Italy
| | - Maria Consiglia Ferriero
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Gabriele Tuderti
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Leonardo Misuraca
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Francesco Prata
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Antonio Tufano
- “La Sapienza” University of Rome, Department of Maternal Infant and Urologic Sciences, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy
| | - Alfredo Maria Bove
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
| | - Marialuisa Appetecchia
- IRCCS “Regina Elena” National Cancer Institute, Oncologic Endocrinology Unit, Via Elio Chianesi, 00144 Rome, Italy
| | - Giuseppe Tirone
- APSS, Santa Chiara Regional Hospital, Department of General Surgery, Largo Medaglie d’Oro, 38122 Trento, Italy
| | - Francesco Porpiglia
- AOU San Luigi Gonzaga, Department of Urology, Regione Gonzole, 10043 Orbassano, Italy
| | - Antonio Celia
- ULSS 7 Pedemontana, San Bassiano Hospital, Department of Urology, Via dei Lotti, 36061 Bassano del Grappa, Italy
| | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, Via Elio Chianesi, 00144 Rome, Italy
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Dong J, Ji R, Liu G, Zhou J, Wang H, Xu W, Ji Z, Cui L. Feasibility, safety and effectiveness of robot-assisted retroperitoneal partial adrenalectomy with a new robotic surgical system: A prospective clinical study. Front Surg 2023; 10:1071321. [PMID: 36911621 PMCID: PMC9992795 DOI: 10.3389/fsurg.2023.1071321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/07/2023] [Indexed: 02/24/2023] Open
Abstract
Objectives To evaluate the feasibility, safety and efficacy of the newly developed KD-SR-01® robotic system for retroperitoneal partial adrenalectomy. Subjects and Methods We prospectively enrolled patients with benign adrenal mass undergoing KD-SR-01® robot-assisted partial adrenalectomy in our institution from November 2020 to May 2022. Surgeries were performed via a retroperitoneal approach using the KD-SR-01® robotic system. The baseline, perioperative and short-term follow-up data were prospectively collected. A descriptive statistical analysis was performed. Results A total of 23 patients were enrolled, including nine (39.1%) patients with hormone-active tumors. All patients received partial adrenalectomy via the retroperitoneal approach without conversions to other procedures. The median operative time was 86.5 min [interquartile range (IQR), 60.0-112.5] and the median estimated blood loss was 50 ml (range, 20-400). Three (13.0%) patients developed Clavien-Dindo grade I-II postoperative complications. The median postoperative stay was 4.0 days (IQR, 3.0-5.0). All surgical margins were negative. The short-term follow-up demonstrated complete or partial clinical and biochemical success as well as absence of imaging recurrence in all patients with hormone-active tumors. Conclusions Initial results illustrate that the KD-SR-01® robotic system is safe, feasible and effective for the surgical management of benign adrenal tumors.
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Affiliation(s)
- Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ruoyu Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guanghua Liu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingmin Zhou
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huizhen Wang
- Department of Operation Room, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Cui
- Department of Urology, Civil Aviation General Hospital, Civil Aviation Medical College of Peking University, Beijing, China
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Aldosterone Suppresses Endothelial Mitochondria through Mineralocorticoid Receptor/Mitochondrial Reactive Oxygen Species Pathway. Biomedicines 2022; 10:biomedicines10051119. [PMID: 35625856 PMCID: PMC9138689 DOI: 10.3390/biomedicines10051119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 02/05/2023] Open
Abstract
Excessive aldosterone secretion causes endothelial dysfunction, vascular inflammation, and vascular fibrosis in patients with primary aldosteronism (PA). Endothelial function is closely related to endothelial mitochondria. However, the effects of elevated aldosterone levels on endothelial mitochondria remain unclear. In this study, we used primary cultured human umbilical vein endothelial cells (HUVECs) to investigate the effects of aldosterone on endothelial mitochondria. Mineralocorticoid receptor (MR) small interfering (si)RNA or glucocorticoid receptor (GR) siRNA were used to confirm the pathway by which aldosterone exerts its effects on the mitochondria of HUVECs. The results showed that excess aldosterone suppressed mitochondrial DNA copy numbers, anti-mitochondrial protein, and SOD2 protein expression in a dose- and time-dependent manner. These effects were attenuated by treatment with MR siRNA, but not with GR siRNA. Furthermore, it was attenuated by treatment with a mitochondria-targeted antioxidant (Mito-TEMPO, associated with mitochondrial reactive oxygen species (ROS) production), but not N-acetyl-L-cysteine (associated with cytosolic ROS production), which suggests that the process was through the mitochondrial ROS pathway, but not the cytosolic ROS pathway. In conclusion, aldosterone excess suppressed endothelial mitochondria through the MR/mitochondrial ROS pathway.
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