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difficulty ; adrenalectomy ; laparoscopy ; safety
Abstract:
Introduction: Although minimally invasive surgery of adrenal glands has become more common, there is still a discussion on some of its aspects.The aim of the study was to identify the factors influencing difficulty, safety and short-term results of laparoscopic transperitoneal adrenalectomy (LTA).Material and methods. The retrospective analysis covered material of550 patients who underwent LTA. We compared the results of treatment depending on the size of the tumor and histologic type. Endpoints of the study were duration of surgery, conversion rate, intraoperative blood loss, need for blood transfusion, intraoperative and postoperative complication rate.Results. Mean operative time in pheochromocytoma group was significantly longer than in group of other tumors, similarly intraoperative blood loss was significantly higher in pheochromocytoma group. Complications did not differ significantly between the two groups. In the case of malignant tumors, 90.3% of them were removed from the laparoscopic access. Complications occurred in 11.5% of patients. Median operative time in the group of tumor with diameter <6cm was significantly shorter than in tumors with diameter =>6cm. The median intraoperative blood loss was significantly lower, respectively, the two groups did not differ significantly in terms of complications. Complication rate in group of tumors with a diameter =>4cm and < ; 4cm was 2 (3.6%) and 4 (5.2%), respectively (p = 0.67). In the group of tumors with diameter <4cm, 1.8% malignant lesions occurred and 7.2% potential malignant. In the group of tumors with diameter => 4cm 7.8% tumors were malignant, and in 4 cases - potentially malignant.Conclusions. LTA is a safe method and is associated with low risk of morbidity and minimal mortality. The results of treatment does not depend on the experience of a single surgeon, but the entire team involved in perioperative care.
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Rembiasz, Kazimierz ; Pędziwiatr, Michał