Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gagner M, Lacroix A, Bolté E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327(14):1033

    Article  CAS  PubMed  Google Scholar 

  2. Monn MF, Calaway AC, Mellon MJ, Bahler CD, Sundaram CP, Boris RS (2015) Changing USA national trends for adrenalectomy: the influence of surgeon and technique. BJU Int 115(2):288–294

    Article  PubMed  Google Scholar 

  3. Lee J, El-Tamer M, Schifftner T et al (2008) Open and laparoscopic adrenalectomy: analysis of the National Surgical Quality Improvement Program. J Am Coll Surg 206(5):953–959

    Article  PubMed  Google Scholar 

  4. Liao CH, Lai MK, Li HY, Chen SC, Chueh SC (2008) Laparoscopic adrenalectomy using needlescopic instruments for adrenal tumors less than 5 cm in 112 cases. Eur Urol 54(3):640–646

    Article  PubMed  Google Scholar 

  5. Brandao LF, Autorino R, Zargar H et al (2014) Robot-assisted laparoscopic adrenalectomy: step-by-step technique and comparative outcomes. Eur Urol 66(5):898–905

    Article  PubMed  Google Scholar 

  6. Rane A, Cindolo L, Schips L, De Sio M, Autorino R (2012) Laparoendoscopic single site (LESS) adrenalectomy: technique and outcomes. World J Urol 30(5):597–604

    Article  PubMed  Google Scholar 

  7. Murphy MM, Witkowski ER et al (2010) Trends in adrenalectomy: a recent national review. Surg Endosc 24(10):2518–2526

    Article  PubMed  Google Scholar 

  8. Villar JM, Moreno P, Ortega J et al (2010) Results of adrenal surgery. Data of a Spanish National Survey. Langenbecks Arch Surg 395(7):837–843

    Article  PubMed  Google Scholar 

  9. Greco F, Hoda MR, Rassweiler J et al (2011) Laparoscopic adrenalectomy in urological centres—the experience of the German Laparoscopic Working Group. BJU Int 108(10):1646–1651

    Article  PubMed  Google Scholar 

  10. Park HS, Roman SA, Sosa JA (2009) Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty? Arch Surg 144(11):1060–1067

    Article  PubMed  Google Scholar 

  11. Simhan J, Smaldone MC, Canter DJ et al (2012) Trends in regionalization of adrenalectomy to higher volume surgical centers. J Urol 188(2):377–382

    Article  PubMed  Google Scholar 

  12. Chang SL, Kibel AS, Brooks JD, Chung BI (2015) The impact of robotic surgery on the surgical management of prostate cancer in the USA. BJU Int 115(6):929–936

    Article  PubMed  Google Scholar 

  13. Autorino R, Zargar H, Kaouk JH (2014) Robotic-assisted laparoscopic surgery: recent advances in urology. Fertil Steril 102(4):939–949

    Article  PubMed  Google Scholar 

  14. Brandao LF, Autorino R, Laydner H et al (2014) Robotic versus laparoscopic adrenalectomy: a systematic review and meta-analysis. Eur Urol 65(6):1154–1161

    Article  PubMed  Google Scholar 

  15. Stefanidis D, Goldfarb M, Kercher KW, Hope WW, Richardson W, Fanelli RD, Society of Gastrointestinal and Endoscopic Surgeons (2013) SAGES guidelines for minimally invasive treatment of adrenal pathology. Surg Endosc 27(11):3960–3980

    Article  PubMed  Google Scholar 

  16. Zacharias M, Haese A, Jurczok A, Stolzenburg JU, Fornara P (2006) Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome. Eur Urol 49(3):448–459

    Article  PubMed  Google Scholar 

  17. Ishida M, Miyajima A, Takeda T, Hasegawa M, Kikuchi E, Oya M (2013) Technical difficulties of transumbilical laparoendoscopic single-site adrenalectomy: comparison with conventional laparoscopic adrenalectomy. World J Urol 31(1):199–203

    Article  PubMed  Google Scholar 

  18. Wang L, Wu Z, Li M et al (2013) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 27(6):743–750

    Article  PubMed  Google Scholar 

  19. Autorino R, White WM, Gettman MT et al (2012) Public perception of “scarless” surgery: a critical analysis of the literature. Urology 80(3):495–502

    Article  PubMed  Google Scholar 

  20. Hora M, Ürge T, Stránský P et al (2014) Laparoendoscopic single-site surgery adrenalectomy—own experience and matched case-control study with standard laparoscopic adrenalectomy. Wideochir Inne Tech Maloinwazyjne 9(4):596–602

    PubMed  PubMed Central  Google Scholar 

  21. Autorino R, Kim FJ, Rassweiler J et al (2012) Mini-laparoscopy, laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery-assisted laparoscopy: novice surgeons’ performance and perception in a porcine nephrectomy model. BJU Int 110(11 Pt C):E991–E996

    Article  PubMed  Google Scholar 

  22. Porpiglia F, Autorino R, Cicione A et al (2014) Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol 28(8):951–957

    Article  PubMed  Google Scholar 

  23. Chen W, Li F, Chen D, Zhu Y, He C, Du Y, Tan W (2013) Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutan Tech 23(2):121–127

    Article  PubMed  Google Scholar 

  24. Goonewardene SS, Brown M, Challacombe BJ. Adrenalectomy: a retroperitoneal procedure. BJU Int. 2015 July 27. doi:10.1111/bju.13245. (Epub ahead of print)

  25. Ahmed K, Ibrahim A, Wang TT, Khan N, Challacombe B, Khan MS, Dasgupta P (2012) Assessing the cost effectiveness of robotics in urological surgery - a systematic review. BJU Int 110(10):1544–1556

    Article  PubMed  Google Scholar 

Download references

Authors’ contributions

Autorino, Darweesh, and Porpiglia are responsible for protocol/project development. Chueh, Hyun, Miyajima, Kyriazis, Puglisi, Fiori, Yang, Fei, Altieri, Chang Jeong, Branco, Chen, Ferro, Berardinelli, Liao, and Brandao collected the data. Lee, Pavan, and Autorino analyzed and managed the data. Pavan Autorino, Lee, and Darweesh drafted the manuscript Porpiglia, Sun, Greco, Cindolo, Fornara, Schips, De Cobelli, Chen, Haber, He, Oya, Liatsikos, Challacombe, and Kaouk was involved in critical revision.

Author information

Author notes

    Authors and Affiliations

    1. University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA

      Nicola Pavan & Riccardo Autorino

    2. Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy

      Nicola Pavan

    3. Department of Urology, University of California San Diego Health System, La Jolla, CA, USA

      Hak Lee & Ithaar Darweesh

    4. Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy

      Francesco Porpiglia & Cristian Fiori

    5. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China

      Yinghao Sun, Bo Yang & Guo Fei

    6. Department of Urology, Romolo Hospital, Rocca di Neto, Italy

      Francesco Greco & Vincenzo Altieri

    7. Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

      S. Jeff Chueh, Georges-Pascal Haber, Luis Brandao & Jihad Kaouk

    8. Department of Urology, Samsung Medical Center, Seoul, Italy

      Deok Hyun Han & Byong Chang Jeong

    9. Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy

      Luca Cindolo, Francesco Berardinelli & Luigi Schips

    10. Department of Urology, European Institute of Oncology, Milan, Italy

      Matteo Ferro & Ottavio De Cobelli

    11. Xiangya Hospital Central South University, Changsha, China

      Xiang Chen, Zhi Chen & Yao He

    12. Department of Urology, Cruz Vermelha Hospital, Curitiba, Brazil

      Anibal Branco

    13. Department of Urology, Martin-Luther-University, Halle Saale, Germany

      Paolo Fornara

    14. Department of Urology, Medical College, National Taiwan University, Taipei City, Taiwan

      Chun-Hou Liao

    15. Department of Urology, Keio University School of Medicine, Tokyo, Japan

      Akira Miyajima & Mototsugu Oya

    16. Department of Urology, University of Patras, Patras, Greece

      Iason Kyriazis & Evangelos Liatsikos

    17. Guy’s and St Thomas’ Hospitals, London, UK

      Marco Puglisi & Benjamin Challacombe

    Authors
    1. Nicola Pavan
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Riccardo Autorino
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Hak Lee
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Francesco Porpiglia
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Yinghao Sun
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Francesco Greco
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. S. Jeff Chueh
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Deok Hyun Han
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Luca Cindolo
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Matteo Ferro
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Xiang Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Anibal Branco
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Paolo Fornara
      View author publications

      You can also search for this author in PubMed Google Scholar

    14. Chun-Hou Liao
      View author publications

      You can also search for this author in PubMed Google Scholar

    15. Akira Miyajima
      View author publications

      You can also search for this author in PubMed Google Scholar

    16. Iason Kyriazis
      View author publications

      You can also search for this author in PubMed Google Scholar

    17. Marco Puglisi
      View author publications

      You can also search for this author in PubMed Google Scholar

    18. Cristian Fiori
      View author publications

      You can also search for this author in PubMed Google Scholar

    19. Bo Yang
      View author publications

      You can also search for this author in PubMed Google Scholar

    20. Guo Fei
      View author publications

      You can also search for this author in PubMed Google Scholar

    21. Vincenzo Altieri
      View author publications

      You can also search for this author in PubMed Google Scholar

    22. Byong Chang Jeong
      View author publications

      You can also search for this author in PubMed Google Scholar

    23. Francesco Berardinelli
      View author publications

      You can also search for this author in PubMed Google Scholar

    24. Luigi Schips
      View author publications

      You can also search for this author in PubMed Google Scholar

    25. Ottavio De Cobelli
      View author publications

      You can also search for this author in PubMed Google Scholar

    26. Zhi Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    27. Georges-Pascal Haber
      View author publications

      You can also search for this author in PubMed Google Scholar

    28. Yao He
      View author publications

      You can also search for this author in PubMed Google Scholar

    29. Mototsugu Oya
      View author publications

      You can also search for this author in PubMed Google Scholar

    30. Evangelos Liatsikos
      View author publications

      You can also search for this author in PubMed Google Scholar

    31. Luis Brandao
      View author publications

      You can also search for this author in PubMed Google Scholar

    32. Benjamin Challacombe
      View author publications

      You can also search for this author in PubMed Google Scholar

    33. Jihad Kaouk
      View author publications

      You can also search for this author in PubMed Google Scholar

    34. Ithaar Darweesh
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Riccardo Autorino.

    Ethics declarations

    Ethical standards

    All patients included in this study signed an informed consent. The authors do not have any conflict of interest to disclose. Dr. Nicola Pavan is a SIU (Italian Society of Urology)-AUA (American Urological Association) research fellow for 2014–2015.

    Additional information

    Nicola Pavan and Riccardo Autorino have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Pavan, N., Autorino, R., Lee, H. et al. Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology. World J Urol 34, 1473–1479 (2016). https://doi.org/10.1007/s00345-016-1791-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00345-016-1791-9

    Keywords

    Search

    Navigation