Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated Meta
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SCIENTIFIC REVIEW
Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated Meta-Analysis Paschalis Gavriilidis1,2 Fausto F. Palazzo1
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Christian Camenzuli1 • Anna Paspala2 • Aimee N. Di Marco1
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Accepted: 16 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Two main minimal access adrenalectomy techniques are available: laparoscopic transperitoneal (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA). This study aims to compare these approaches in an updated meta-analysis of randomised controlled (RCT) and non-randomised comparative (NRT) trials. Methods A systematic search of comparative LTA and PRA studies was performed. Standard demographic and surgical data were recorded. Outcome measures compared included: operative time, estimated blood loss (EBL), conversion to open, post-operative pain, time to oral intake and ambulation, early morbidity, hospital length of stay (HLOS) and mortality. Quality of RCTs and NRTs was assessed using Cochrane and ROBINS-I, respectively, and heterogeneity using the I2 test. Dichotomous and continuous variables were compared using odds ratios and mean/standard difference. Studies were then combined using the Mantel–Haenszel method. Meta-analysis was performed by fixed- and random-effect models. Results Following exclusions, 12 studies were included in the analysis: 3 RCTs and 9 NRTs. These reported a total of 775 patients: 341 (44%) PRA and 434 (56%) LTA. Demographics were similar except for tumour size which was smaller (by 0.78 cm) in PRA (p = 0.003). Significant differences in outcome were seen in EBL (18 mls less in PRA, p = 0.006), time to oral intake (3.4 h sooner in PRA p = 0.009) and HLOS (shorter in PRA by 0.84 day, p = 0.001). Conclusions This analysis demonstrates that while PRA tends to be performed for smaller tumours it allows for less EBL, earlier post-operative oral intake and shorter hospital stays. In appropriately selected patients, it represents an invaluable tool in the endocrine surgeon’s armamentarium.
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05759-w) contains supplementary material, which is available to authorized users. & Paschalis Gavriilidis [email protected] 1
Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 OHS, UK
2
Department of HPB Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 OHS, UK
Laparoscopic adrenalectomy was first described in 1992 by Gagner et al. and Higashihara et al. that each independently published case reports demonstrating that adrenal tumours can be excised laparoscopically [1, 2]. Ample data subsequently demonstrated the suitability of the lateral transperitoneal approach in removing all but the largest adrenal tumours with a reduction in pain and a shortened length of stay without increasing the operating time or morbidi
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