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Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience

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An Erratum to this article was published on 09 June 2017

Abstract

Background

Laparoscopic adrenalectomy (LA) has become the standard technique for most indications. The aim of this study was to determine the predictive factors of intra- and postoperative complications in order to inform the orientation of patient to a surgeon with more experience in adrenal surgery.

Methods

From January 1994 to December 2013, 520 consecutive patients benefited from LA at Huriez Hospital, Lille, France. Each complication was graded according to the Dindo–Clavien-grade scale. The predictive factors of complications were determined by logistic regression.

Results

Fifty-two surgeons under the supervision of 5 senior surgeons (individual experience >30 LA) participated. Postoperative complications with a grade of ≥2 occurred in 52 (10 %) patients (29 (5.6 %) medical, 19 (3.6 %) surgical, and 4 (0.8 %) mixed complications) leading to 12 (2.3 %) reoperations. There was no postoperative death. Intraoperative complication happened in 81 (15.6 %) patients responsible for conversion to open adrenalectomy (OA) [odds ratio (OR) 13.9, CI 95 % 4.74–40.77, p < 0.001]. History of upper mesocolic or retroperitoneal surgery was predictive of intraoperative complication (OR 2.02, 1.05–3.91, p = 0.036). Lesion diameter ≥45 mm was predictive of intraoperative complication (OR 1.94, 1.19–3.15, p = 0.008), conversion to OA (OR 7.46, 2.18–25.47, p = 0.001), and adrenal capsular breach (OR 4.416, 1.628–11.983, p = 0.004). Conversion to OA was the main predictive factor of postoperative complications (OR 5.42, 1.83–16.01, p = 0.002). Under adequate supervision, the surgeon’s individual experience and initial adrenal disease were not considered predictive of complications.

Conclusion

Lesion diameter over 45 mm is the determinant parameter for guidance of patients to surgeons with more extensive experience.

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Authors and Affiliations

  1. Department of General and Endocrine Surgery, CHU Lille, Rue Michel Polonovski, 59000, Lille, France

    Thibaut Coste, Robert Caiazzo, Fanelly Torres, Bruno Carnaille & François Pattou

  2. Department of Endocrinology, CHU Lille, 59000, Lille, France

    Marie Christine Vantyghem, Christine Do Cao & Claire Douillard

Authors
  1. Thibaut Coste
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  2. Robert Caiazzo
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  3. Fanelly Torres
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  4. Marie Christine Vantyghem
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  5. Bruno Carnaille
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  6. François Pattou
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  7. Christine Do Cao
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  8. Claire Douillard
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Corresponding author

Correspondence to François Pattou.

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Disclosures

Thibaut Coste, Robert Caiazzo, Fanelly Torres, Marie Christine Vanthygem, Bruno Carnaille, and François Pattou have no conflicts of interest or financial ties to disclose.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00464-017-5437-9.

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Coste, T., Caiazzo, R., Torres, F. et al. Laparoscopic adrenalectomy by transabdominal lateral approach: 20 years of experience. Surg Endosc 31, 2743–2751 (2017). https://doi.org/10.1007/s00464-016-4830-0

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