Category: Laparoscopic/ Robotic: Adrenal

VS17-3 - Differences in Laparoscopic Right and Left Adrenalectomy Outcomes, Learning Curve and Efficacy of Surgical Experience on Outcomes

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

Laparoscopic adrenalectomy (LA) is the standard surgical option for the majority of adrenal masses. Since the anatomy of the left and right adrenal gland varies, the difficulty of LA and the surgical outcomes may not be the same for each side. We aimed to evaluate the surgical outcomes of the right and left side laparoscopic adrenalectomy and also the affects of the learning curve. We have also followed the pathological findings in these cases.

Methods :

The medical records of patients who underwent LA between 2006-2017 were reviewed retrospectively. Operations were performed by three experienced surgeons by transperitoneal lateral approach. We analyzed operation times by using the “moving average” method in order to evaluate the learning curve of laparoscopic adrenalectomy. We evaluated the mean age, gender, operation time, diameter of the mass, estimated blood loss (EBL) and length of hospital stay for both right and left side LA. We also evaluated these outcomes to asses the learning curve, pheochromocytoma, metastatic adrenal masses and large masses of more than 5 cm in diameter.

Results :

Over an eleven year period a total of 272 patients underwent single side LA. While 135 (49.6%) patients underwent right LA, 137 (50.4%) patients underwent left LA. Both sides revealed similar outcomes.
The analysis of operation times by moving average method showed that the mean operation time was stabilzed after the first 20 cases and statistically longer in the first 20 ones. So we considered the first 20 cases as the proper learning curve for LA. When we compared right and left LA outcomes in learning curve, EBL on right side was significantly higher than left.
The comparison of 22 right and 19 left side PHE outcomes were similar. The EBL on the right side was higher than the left side but without statistical difference.
The comparison of LA outcomes of metastatic adrenal masses between 14 right and 19 left cases showed similar outcomes, although right side EBL was higher than left side,but without statistical difference.
The Comparison of LA outcomes of adrenal masses bigger than 5cm showed no statistical difference between 45 right and 41 left side cases, although right side EBL was higher than left side.

Conclusions :

If laparoscopic adrenalectomy is performed without adequate experience, the right side could be more likely to bleed even if the mass size is smaller. After achieving the learning curve left and right laparoscopic adrenalectomy have similar surgical outcomes. In addition even in the hands of experienced surgeons right side laparoscopic adrenalectomy for pheochromocytoma, metastasis or masses bigger than 5cm can cause more blood loss than left side.

Kadir Ö. Günseren

Specialist Doctor
Uludag University School of Medicine Department of Urology
bursa, Bursa, Turkey

I earned my degree in the İstanbul University of Medicine and Pharmacy. Currently, I am employed as a an urologist at Urology department of Uludag University of Medicine. İ am working for aproximately 9 years in this department (residency and the first part of my specialist career) i interest about laroscopic skills, transplantation, endourology procedures and open surgery.

Mehmet Ç.. Çicek

Bursa, Bursa, Turkey

Ismet Yavascaoglu

bursa, Bursa, Turkey