COMPARATIVE EVALUATION OF ADRENALECTOMY METHODS

Introduction. There are many approaches to performing adrenalectomy. laparoscopic adrenalectomy is considered the operation of choice. A uniform approach to the choice of access for adrenalectomy has not been established.
Purpose of the study: to compare the effectiveness of the laparotomic, standard laparoscopic approach, as well as the author's laparoscopic approach for the safe performance of adrenalectomy.
Materials and methods. 110 patients were operated on in the surgical hospital for the period from 2016 to 2019. Patients were divided into three groups: operated on by laparotomic access, laparoscopic and author's laparoscopic access.
Discussion. There is no uniform approach to the choice of access for an operation. Compared to laparotomy, the laparoscopic approach during adrenalectomy makes it possible to reduce the pain syndrome in the postoperative period, accelerate the medical and social rehabilitation of patients, reduce the risk of a number of complications, or completely avoid them. The principles formed proved to be effective in the prevention of intraoperative and postoperative complications in patients after laparoscopic adrenalectomy.
Conclusion. Comparative analysis showed the advantages of using the laparoscopic approach for performing adrenalectomies compared to the laparotomy approach. The developed principles of performing laparoscopic adrenalectomy make it possible to increase the efficiency and safety of laparoscopic adrenalectomy in comparison with standard laparoscopic intervention.

1. Heger P., Probst P., Huttner F.J., Gooben K., Proctor T., Muller-Stich B.P., Strobel O., Buchler M. W., Diener M. K. Evaluation of open and minimally invasive adrenalectomy: a systematic review and network meta- analysis. World Journal of surgery, 2017, 41(1), рр. 2746– 2757. https://doi.org/10.1007/s00268-017-4095-3

2. Alesina P.F. Retroperitoneal adrenalectomy – learning curve, practical tips and tricks, what limits wider uptake. Gland Surgery, 2019, 8(1), рр. 36–40. https://doi.org/10.21037/gs.2019.03.11

3. Hupe M.C., Imkamp F., Merseburger A.S. Minimally invasive approaches to adrenal tumors: an up-to-date summary including patient position and port placement of laparoscopic, retroperitoneoscopic, robot-assisted and single-site adrenalectomy. Current opinion in urology, 2017, 27(1), рр. 56–61. https://doi.org/10.1097/MOU.0000000000000339

4. Madani A., Lee J.A. Surgical approaches to the adrenal gland. The surgical clinics of North America, 2019, 99(4), рр. 773–791. https://doi.org/10.1016/j.suc.2019.04.013

5. Christakis I., Ng C.S., Chen C., Yiin Y.H., Grubbs E.G., Perrier N.D., Lee J.E., Graham P.H. Operation duration and adrenal gland size, but not BMI are correlated with complication rate for posterior retroperitoneoscopic adrenalectomy for benign diseases. Surgery, 2019, 165(3), рр. 637–643. https://doi.org/10.1016/j.Surg.2018.09.044

6. Mihai R., Donatini G., Vidal O., Brunaud L. Volume-outcome correlation in adrenal surgery – an ESES consensus statement. Langenbeck’s archives of surgery, 2019, 404(7), рр. 795–806. https://doi.org/10.1007/s00423-019-01827-5

7. Zonca P., Peterja M., Varra P., Richter V., Ostruszka P. The risk of retroperitoneoscopic adrenalectomy. Rozhledy v chirurgii, 2017, 96(3), рр. 130–133. PMID: 28433046.

8. Kostek M., Aygun N., Uludag M. Laparoscopic approach to the adrenal masses: single-center experience of five years. The Medical Bulletin of Sisli Etfal Hospital, 2020, 54(1), рр. 52–57. https://doi.org/10.14744/SEMB.2019.40225

9. Lorenz K., Langer P., Niederle B., Alesina P., Holzer K., Nies Ch., Musholt Th., Goretzki P.E., Rayes N., Quinkler M., Waldmann J., Simon D., Trupka A., Ladurner R., Hallfeldt K.,Zielke A.,Saeger D.,Pöppel Th.,Kukuk G.,Hötker A., Schabram P., Schopf S., Dotzenrath C., Riss P., Steinmüller Th., Kopp I., Vorländer C., Walz M. K., Bartsch D.K. Surgical therapy of adrenal tumors: Guidelines from the German Association of Endocrine Surgeons (CAEK). Langenbeck’s archives of surgery, 2019, 404(4), рр. 385–401. https://doi.org/10.1007/s00423-019-01768-z

10. Rowe S.P., Lugo-Fagundo C., Ahn H., Fishman E.K., Prescott J.D. What the radiologist needs to know: the role of preoperative computed tomography in selection of operative approach for adrenalectomy and review of operative techniques. Abdominal radiology, 2019, 44(1), рр. 140–153. https://doi.org/10.1007/s00261-018-1669-y

11. Azoury S.C., Nagarajan N., Young A., Mathur A., Prescott J.D., Fishman E K., Zeiger M.A. Computed tomography in the management of adrenal tumors: does size still matter? Journal of computer assisted tomography, 2017, 41(4), рр. 628–632. https://doi.org/10.1097/RCT.0000000000000578