3D LATERAL TRANSPERITONEAL LAPAROSCOPIC ADRENALECTOMY EXPERIENCE: SINGLE-CENTRE OUTCOMES OF THE FIRST 150 CASES

AUTHORS:
J.I. Rodríguez-Hermosa (Girona, Spain) , J. Gironès (Girona, Spain) , J. García-Adámez (Girona, Spain) , A. Ranea (Girona, Spain) , E. García-Moriana (Girona, Spain) , O. Delisau (Girona, Spain) , M. Bertrand (Girona, Spain) , B. Tió (Girona, Spain) , D. Sambrano (Girona, Spain) , L. Cornejo (Girona, Spain) , R. Farrés (Girona, Spain)
Background:
Three-dimensional laparoscopic surgery offers new possibilities in treating adrenal pathologies with a minimally invasive approach. High-quality 3D laparoscopy systems might improve surgical outcomes for adrenalectomy. This study aimed to analyze our preliminary results (short term outcomes) to treat benign and malignant adrenal tumors.
Methods:
Between January 2013 and November 2023, consecutive patients undergoing unilateral 3D lateral transperitoneal laparoscopic adrenalectomy (LTLA) were included in a prospectively maintained database and analyzed prospectively (clinicaltrials.gov NCT04905706). The intraoperative outcome variables were operative time (OT), estimated blood loss (EBL), and conversion to open surgery. The postoperative outcome variables were complications, length of stay (LOS), readmission, and mortality.
Results:
A total of 150 patients (86 women/64 men; median age, 56.5 years) underwent 3D LTLA for Cushing's adenoma (n=49), pheochromocytoma (n=35), malignant tumor (n=25), incidentaloma (n=23), and aldosteronoma (n=18). The mean OT was 62.2±26.6 min (range 20-180) [median 60 min]; the mean EBL was 45.6±77.0 mL (range 5-400) [median 10 mL]; and conversion rate was 2 (1.3%). According to Clavien-Dindo classification, 3 complications (2%) occurred (one grade IIIb - bleeding, one grade II - pancreatic fistula, and one grade I - acute urine retention). The mean LOS was 2.1±0.9 days (range 1-7) [median 2 days]. The 30-day readmission rate was 0%, and the mortality was nihil.
Conclusions:
When done by experienced endocrine surgeons, 3D LTLA is safe and effective for benign and malignant adrenal tumors, resulting in low operative time and blood loss, with very low conversion and complication rates, and with a short hospital stay.