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Updates in Surgery Jun 2021Although safe and feasible, partial adrenalectomy is not a widespread procedure. Endorsement of robotic technologies and fluorescence techniques in adrenal surgery might...
Although safe and feasible, partial adrenalectomy is not a widespread procedure. Endorsement of robotic technologies and fluorescence techniques in adrenal surgery might help develop partial adrenalectomy and could avoid unnecessary total adrenalectomies. When performed in selected cases, partial adrenalectomy is associated with good postoperative outcomes comparable with those reported after total adrenalectomy. It has been hypothesized that one of the advantages of the robotic approach in adrenal-sparing surgery is to reduce manipulation of the gland allowing preservation of the vascularization of the residual adrenal, overcoming some limits when performing a laparoscopic conventional approach. A major drawback of the robotic surgery is its cost, but the overcost due to the use of the robotic system could be balanced by the execution of a high number of partial adrenalectomies leading to fewer life-long replacement steroid treatment. Partial adrenalectomy could become the recommended management for small benign and hormonal active adrenal tumors. Indocyanine green fluorescence (IGF) also seems to be a useful technique to help surgeons identify the adrenal gland and to locate small tumors from the normal adrenal tissue in difficult patients. It is likely that the use of a robotic approach associated with IGF may extend indications of partial adrenalectomy in the years to come.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Indocyanine Green; Laparoscopy; Robotic Surgical Procedures; Robotics
PubMed: 33411221
DOI: 10.1007/s13304-020-00957-6 -
Veterinary Surgery : VS Apr 2022To report data related to the short- and long-term survival of dogs undergoing adrenalectomy for pheochromocytoma, and to determine the influence of preoperative...
OBJECTIVE
To report data related to the short- and long-term survival of dogs undergoing adrenalectomy for pheochromocytoma, and to determine the influence of preoperative alpha-blocker therapy.
STUDY DESIGN
Retrospective.
ANIMALS
Fifty-three dogs.
METHODS
Medical records were reviewed for dogs diagnosed with pheochromocytoma and treated with adrenalectomy between 2010 and 2020. Preoperative management, imaging studies, intraoperative cardiovascular instability, complications, and procedural information were recorded. When applicable, duration of survival and cause of death, time to recurrence or metastasis, and postoperative complications were recorded.
RESULTS
During anesthesia, a hypertensive episode was documented in 46/53 dogs and arrhythmias were recorded in 16/53 dogs. Of these, 37/46 hypertensive dogs and 11/16 dogs with arrhythmias were treated with an alpha-blocker before surgery. Intraoperative systolic blood pressures reached higher levels by a magnitude of nearly 20% in dogs that were treated preoperatively with an alpha-blocker (P = .01). All dogs survived surgery and 44 survived to discharge. Follow up ranged from 6 to 1653 days (median 450 days). Median survival time for dogs discharged from the hospital was 1169 days (3.2 years). Recurrence and metastasis were suspected in 3 and 8 dogs, respectively.
CONCLUSION
Most dogs survived the immediate postoperative period and achieved long-term survival with a low reported incidence of tumor recurrence or metastasis. Preoperative alpha-blocker therapy was not associated with increased survival.
CLINICAL SIGNIFICANCE
The favorable outcomes reported in this study should be taken into consideration when discussing treatment options for dogs with pheochromocytomas. This study provides no evidence to support preoperative alpha-blocker therapy.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Animals; Dog Diseases; Dogs; Pheochromocytoma; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35141905
DOI: 10.1111/vsu.13771 -
Problemy Endokrinologii Nov 2023This review article contains a summary of modern aspects of preoperative preparation, surgical treatment, and follow-up of patients with adrenal pheochromocytomas. The... (Review)
Review
This review article contains a summary of modern aspects of preoperative preparation, surgical treatment, and follow-up of patients with adrenal pheochromocytomas. The main component of preoperative preparation is the use of alpha-blockers. The need to prescribe them to all patients is increasingly disputed, especially for patients without severe hypertension. An increasing number of publications demonstrate positive results of treatment without the use of alpha-blockers, advocating an individual approach and the use of the drug according to certain indications. Minimally invasive endoscopic techniques of adrenalectomy have become widespread in surgical treatment. They are represented by laparoscopic and retroperitonescopic technic, including using their single-port modifications. The earliest possible intersection of the central vein in the past was considered the most important aspect of adrenalectomy for pheochromocytoma, currently, due to the development of surgical techniques and anesthesiological manuals, this has ceased to be a mandatory rule of successful surgery. Despite the significant influence of the intersection of this vessel on intraoperative hemodynamics, surgical tactics with its later intersection have their own justifications and do not lead to a deterioration in treatment results. The standard volume of surgical intervention for pheochromocytomas is total adrenalectomy, however, in the presence of hereditary syndromes, such as multiple endocrine neoplasia type 2 syndrome, neurofibomatosis type 1, von Hippel-Lindau syndrome, it is possible to perform cortical-sparing adrenalectomy.
Topics: Humans; Pheochromocytoma; von Hippel-Lindau Disease; Adrenal Gland Neoplasms; Multiple Endocrine Neoplasia Type 2a; Adrenalectomy; Syndrome
PubMed: 37968950
DOI: 10.14341/probl13283 -
Surgery Jun 2021
Topics: Adrenalectomy; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 33589247
DOI: 10.1016/j.surg.2020.12.037 -
Urology Apr 2016
Topics: Adrenal Gland Diseases; Adrenal Glands; Adrenalectomy; Humans; Male; Printing, Three-Dimensional
PubMed: 27036687
DOI: 10.1016/j.urology.2015.11.044 -
The Urologic Clinics of North America Nov 2014Robotic-assisted adrenalectomy is an increasingly used intervention for patients with a variety of surgical adrenal lesions, including adenomas, aldosteronomas,... (Review)
Review
Robotic-assisted adrenalectomy is an increasingly used intervention for patients with a variety of surgical adrenal lesions, including adenomas, aldosteronomas, pheochromocytomas, and metastases to the adrenal gland. Compared with traditional laparoscopy, robotic adrenalectomy has comparable perioperative outcomes and is associated with improved hospital length of stay and blood loss, though it does come at a cost premium. Emerging literature also supports a role for robotics in partial adrenalectomy and metastasectomy. Ultimately, well-conducted prospective trials are needed to fully define the role of robotics in the surgical management of adrenal disease.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Laparoscopy; Metastasectomy; Robotic Surgical Procedures
PubMed: 25306165
DOI: 10.1016/j.ucl.2014.07.008 -
Urology Apr 2016
Topics: Adrenal Gland Diseases; Adrenal Glands; Adrenalectomy; Humans; Male; Printing, Three-Dimensional
PubMed: 27036688
DOI: 10.1016/j.urology.2015.11.045 -
International Journal of Surgery... Apr 2015Partial adrenalectomy is typically performed for the treatment of hereditary and sporadic bilateral tumours, to reduce the risk of adrenal failure, particularly in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Partial adrenalectomy is typically performed for the treatment of hereditary and sporadic bilateral tumours, to reduce the risk of adrenal failure, particularly in younger patients. Partial adrenalectomy proposes a postoperative steroid-free course nevertheless, is associated with the risk of local recurrence. In this study we evaluate the recurrence and functional outcomes of partial adrenalectomy.
METHODS
A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. The search identified 60 relevant articles reporting on patients who underwent partial adrenalectomy. Data was extracted from each study and used to calculate a pooled event rate and 95% confidence interval (95% CI).
RESULTS
The overall recurrence rate was 8% (95% CI: 0.05-0.12) and the 85% (95% CI: 0.78-0.9) of the patients were steroid free. The recurrence rates were the least in the retroperitoneoscopic group 1% (95% CI: 0-0.04) and Conn's syndrome group 2% (95% CI: 0.01-0.05) and highest in open group 15% (95% CI: 0.07-0.28) and Pheochromocytoma group 10% (95% CI: 0.07-0.16). Steroid independence rates were best in the Conn's syndrome group 97% (95% CI: 0.85-0.99) and laparoscopic group 88% (95% CI: 0.75-0.95).
CONCLUSIONS
Partial adrenalectomy can obviate the need for steroid replacement in the majority of patients and local recurrence rates appear to be infrequent. For patients with hereditary and bilateral adrenal tumours, partial adrenalectomy should be recommended as a primary surgical approach whenever possible.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Global Health; Humans; Incidence; Laparoscopy; Neoplasm Recurrence, Local; Pheochromocytoma; Postoperative Period
PubMed: 25681039
DOI: 10.1016/j.ijsu.2015.01.015 -
The Surgical Clinics of North America Aug 2019Adrenalectomy can be performed open, endoscopically or robotically, utilizing a transabdominal or retroperitoneal approach. This chapter describes the relevant anatomy,... (Review)
Review
Adrenalectomy can be performed open, endoscopically or robotically, utilizing a transabdominal or retroperitoneal approach. This chapter describes the relevant anatomy, various approaches and surgical techniques, pre-operative work-up and optimization, and post-operative management of patients undergoing an adrenalectomy.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Adrenalectomy; Humans; Laparoscopy; Retroperitoneal Space; Robotics
PubMed: 31255206
DOI: 10.1016/j.suc.2019.04.013 -
World Journal of Surgery Nov 2017Adrenalectomy can be performed via open and various minimally invasive approaches. The aim of this systematic review was to summarize the current evidence on surgical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adrenalectomy can be performed via open and various minimally invasive approaches. The aim of this systematic review was to summarize the current evidence on surgical techniques of adrenalectomy.
METHODS
Systematic literature searches (MEDLINE, EMBASE, Web of Science, Cochrane Library) were conducted to identify randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing at least two surgical procedures for adrenalectomy. Statistical analyses were performed, and meta-analyses were conducted. Furthermore, an indirect comparison of RCTs and a network meta-analysis of CCTs were carried out for each outcome.
RESULTS
Twenty-six trials (1710 patients) were included. Postoperative complication rates did not show differences for open and minimally invasive techniques. Operation time was significantly shorter for open adrenalectomy than for the robotic approach (p < 0.001). No differences were found between laparoscopic and robotic approaches. Network meta-analysis showed open adrenalectomy to be the fastest technique. Blood loss was significantly reduced in the robotic arm compared with open and laparoscopic adrenalectomy (p = 0.01). Length of hospital stay (LOS) was significantly lower after conventional laparoscopy than open adrenalectomy in CCTs (p < 0.001). Furthermore, both retroperitoneoscopic (p < 0.001) and robotic access (p < 0.001) led to another significant reduction of LOS compared with conventional laparoscopy. This difference was not consistent in RCTs. Network meta-analysis revealed the lowest LOS after retroperitoneoscopic adrenalectomy.
CONCLUSION
Minimally invasive adrenalectomy is safe and should be preferred over open adrenalectomy due to shorter LOS, lower blood loss, and equivalent complication rates. The retroperitoneoscopic access features the shortest LOS and operating time. Further high-quality RCTs are warranted, especially to compare the posterior retroperitoneoscopic and the transperitoneal robotic approach.
Topics: Adrenalectomy; Blood Loss, Surgical; Humans; Laparoscopy; Length of Stay; Network Meta-Analysis; Operative Time; Randomized Controlled Trials as Topic; Robotic Surgical Procedures
PubMed: 28634842
DOI: 10.1007/s00268-017-4095-3