Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology.

Autor: Pavan N; University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA.; Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy., Autorino R; University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA. ricautor@gmail.com., Lee H; Department of Urology, University of California San Diego Health System, La Jolla, CA, USA., Porpiglia F; Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy., Sun Y; Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China., Greco F; Department of Urology, Romolo Hospital, Rocca di Neto, Italy., Jeff Chueh S; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Han DH; Department of Urology, Samsung Medical Center, Seoul, Italy., Cindolo L; Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy., Ferro M; Department of Urology, European Institute of Oncology, Milan, Italy., Chen X; Xiangya Hospital Central South University, Changsha, China., Branco A; Department of Urology, Cruz Vermelha Hospital, Curitiba, Brazil., Fornara P; Department of Urology, Martin-Luther-University, Halle Saale, Germany., Liao CH; Department of Urology, Medical College, National Taiwan University, Taipei City, Taiwan., Miyajima A; Department of Urology, Keio University School of Medicine, Tokyo, Japan., Kyriazis I; Department of Urology, University of Patras, Patras, Greece., Puglisi M; Guy's and St Thomas' Hospitals, London, UK., Fiori C; Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy., Yang B; Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China., Fei G; Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China., Altieri V; Department of Urology, Romolo Hospital, Rocca di Neto, Italy., Jeong BC; Department of Urology, Samsung Medical Center, Seoul, Italy., Berardinelli F; Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy., Schips L; Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy., De Cobelli O; Department of Urology, European Institute of Oncology, Milan, Italy., Chen Z; Xiangya Hospital Central South University, Changsha, China., Haber GP; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., He Y; Xiangya Hospital Central South University, Changsha, China., Oya M; Department of Urology, Keio University School of Medicine, Tokyo, Japan., Liatsikos E; Department of Urology, University of Patras, Patras, Greece., Brandao L; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Challacombe B; Guy's and St Thomas' Hospitals, London, UK., Kaouk J; Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Darweesh I; Department of Urology, University of California San Diego Health System, La Jolla, CA, USA.
Jazyk: angličtina
Zdroj: World journal of urology [World J Urol] 2016 Oct; Vol. 34 (10), pp. 1473-9. Date of Electronic Publication: 2016 Feb 29.
DOI: 10.1007/s00345-016-1791-9
Abstrakt: Objective: To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide.
Methods: A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities.
Results: Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p < 0.001). European centers mostly adopted CL and ML techniques, whereas those from Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis.
Conclusions: Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.
Databáze: MEDLINE
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