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 ORIGINAL ARTICLE
Year : 2014  |  Volume : 10  |  Issue : 2  |  Page : 57-61

Laparoscopic trans- and retroperitoneal adrenal surgery for large tumors


1 Department of Surgery, University Hospital Regensburg, Regensburg, Germany
2 Department of Surgery, University Hospital Regensburg, Regensburg; Department of Surgery, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
3 Department of Radiology, University Hospital Regensburg, Regensburg, Germany

Correspondence Address:
Ayman Agha
Department of Surgery, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, Regensburg - 93053
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.129943

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Background: Laparoscopic adrenalectomy for tumors larger than 6 cm is currently a matter of controversial discussion because of difficult mobilization from surrounding organs and a possible risk of capsule rupture. Materials and Methods: Data of consecutive patients undergoing laparoscopic adrenalectomy between 1/1994 and 7/2012 were collected and analysed retrospectively. Intra- and postoperative morbidity in patients with tumors ≤6 cm (group 1, n = 227) were compared to patients with tumors >6 cm, (group 2, n = 52). Results: Incidence of adrenocortical carcinoma was significantly higher in group 2 patients (6.3% vs. 0.4%, P = 0.039) whereas the incidence of aldosterone-producing adenoma was lower (2% vs. 25%, P = 0.001). Mean duration of surgery was longer (105 min vs. 88 min, P = 0.03) and the estimated blood loss was higher (470 mL vs. 150 mL) in group 2 patients. Intraoperative bleeding rate (5.7% vs. 0.8%, P = 0.041), and the conversion rate were significantly higher (5.7% vs. 1.3%, P = 0.011) in group 2. Also, postoperative complication rate was significantly higher in group 2 (11.5% vs. 3.0%, P = 0.022). However, only two major complications occurred, one in each group. Conclusion: Minimally invasive adrenal surgery can be performed by an experienced surgeon even in patients with large tumors (>6 cm) with an increased but still acceptable intra- and postoperative morbidity.






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