ORLANDO, FL USA (UroToday.com) - Over the past 20 years there has been a shift in the surgical management of adrenal lesions from open to different minimally invasive techniques: multi-port conventional laparoscopy, robotics and laparo-endoscopic single-site (LESS) surgery. Now urologists have an armamentarium of surgical techniques to manage adrenal masses, and in this study, Hak and colleagues evaluated the current international trends in the surgical management of adrenal masses.
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This was a study composed of 18 international academic centers and their patients who underwent minimally invasive adrenalectomy from 2008 to 2013. This was a retrospective study, and patients were categorized by different minimally-invasive treatments for adrenalectomy: conventional laparoscopy (CL), robotics, LESS and mini-lap (ML).
In total, 867 adrenalectomies were performed from all centers. Multi-port laparoscopy was the most commonly performed procedure (55%), and LESS, robotics and mini-lap were performed in 30%, 8% and 6% respectively. Asia contributed the most patients in this study with 51%, and Europe 40%, USA 6% and South America 3%. Overall, the lesions were benign in 75-90%, with tumor size of 3-4 cm and patient ages ranging from 50-55 years for all techniques. There was, however, no difference in the peri-operative outcomes for transfusion, Clavien ≥ IIIa complications and 30 day readmission rates. Finally, there is an overall increase in the number of adrenalectomies from 2008 to 2013 for all techniques, but there has been a steady decrease in the usage of multi-port laparoscopy from 100% in 2008 to 47.7% in 2013. LESS has replaced most of the adrenalectomies performed multi-port from 0% in 2008 to 32.6% in 2013 at a rate of 6.5% per year. Robotics and mini-lap has only gained minimal adoption in this cohort from 2008 to 2013 at 1.5% and 2.2% per year, respectively.
Over time, the authors noted there has been an increase in adrenalectomies from all modalities. Multi-port laparoscopy and LESS are the most commonly utilized techniques, whereas mini-lap and robotics have been slower in growth.
Presented by Hak J. Lee, MD at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
San Diego, CA USA
Written by Zhamshid Okhunov, MD, University of California (Irvine), and medical writer for UroToday.com