Page 30 - Journal of Laparoscopic Surgery

Ekta Paw et al.
A more novel indication for laparoscopic adrenalectomy version 21 was used for analysis. Data where appropriate
is that of the adrenal incidentaloma. With the increasing are presented as percentages. Normality of data was
availability of imaging, there has been an increase in the determined using the Shapiro-Wilk Test, with data being
proportion of adrenal lesions diagnosed incidentally. non-parametric, Man–Whitney tests and Kruskal Wallis
Adrenalectomy has been recommended for tumors greater Test were employed to determine differences between
16
than 4 cm due to the risk of malignancy. The slightly two groups and more than two groups respectively.
increased use of partial adrenalectomy for small adrenal Association between categorical data was determined
tumors has raised questions about whether asymptomatic using the chi-squared test, with a p value of < 0.05
tumors should be resected. 17-19 considered as statistically significant.
The overall objective of this study was to retrospectively Ethics for both sites included in this study (Townsville
evaluate the laparoscopic treatment of adrenal tumors in Hospital and Mater Hospital Townsville) was obtained
Townsville, Queensland for the last 10 years. Specifically, we from the Human Research Ethics Committee for each
determined how many laparoscopic adrenalectomies were site. All data were collected in a de-identified manner
performed; what percentage of these belonged to particular
pathological groups (aldosteronoma, pheochromocytoma, RESULTS
Cushing’s’ disease, adrenal metastasis, incidentaloma, Over the last decade, 97 adrenalectomies were performed
cyst) and what the complication rate was in this area on 44 (45%) males and 53 (55%) females with a mean age
(including conversion to open). We also examined whether of 54.5. The oldest patient was 89 years old, and the young-
operative time decreased with surgeon experience and est was 22. The breakdown of pathologies is reported in
whether the laparoscopic approach is appropriate for Table 1, showing that the most common pathology was
tumors > 6 cm, metastases, pheochromocytomas, and the non-secretory adenoma. Total 40% of cases were
incidentalomas < 4 cm. The indications for surgery were incidentalomas. Approximately, 92% of cases had no com-
collected (incidentaloma or symptomatic) and the number plication. The most common complication was damage to
of partial adrenalectomies.
other organs (4.1%), with open conversion, intraoperative
bleeding and postoperative bleeding only occurring once
MATERIALS AND METHODS
each (~1.0%). There was one instance of high blood pres-
De-identified data were collected of all laparoscopic sure and heart rate intraoperatively during manipulation
adrenalectomies performed in one geographic area for of a pheochromocytoma.
the last decade. Cases which were converted to open were Statistical analysis as detailed above showed that
included in the study and the data collected included the most significant decrease in operative time was
patient demographics (age, gender), length of stay, comparing 2005–2009 (p < 0.0001). Significant decreases
complications, pathology (benign or malignant tumor) were also seen when comparing 2005–2008 operative
and operative time. Operative time was considered as times to 2010–2011 (p < 0.005), 2012-2013 (p < 0.01) and
a knife to skin time until time to end of the closure. 2014–2015 (p < 0.005).
Both suspected pathology (preoperative diagnosis) and On examination of tumour pathology reports, 36.4%
definitive pathology as per final report were collected. were < 4 cm size; 28.4% were 4–6 cm size; and 33% > 6 cm
Tumors which were discovered as an incidental finding size. Total 13% of tumors < 4 cm had complications as did
on imaging were determined to be incidentalomas. Data 10% of tumors > 6 cm, with 4 to 6 cm having only 4%.
was collected from electronic medical records, physical The only case of open conversion was in the > 6 cm
charts, and pathology reports. group. Incidentalomas and pheochromocytomas had
Microsoft Excel was used to collate data, and statistical the same rate of complication as this general group of
software Statistical Package for the Social Sciences (SPSS) adrenalectomies. Metastases had a 14% complication

Table 1: Breakdown of pathology
Pathology Number of cases Percentage of total cases (%)
Non-secretory adenoma 34 35.1
Aldosterone secreting adenoma 18 18.6
Adrenal metastases 17 17.5
Pheochromocytomas 13 13.4
Other † 11 11.3
Simple cyst 4 4.1
Adrenal cortical carcinoma 3 3
† Other pathologies: schwannoma (2), multinodular adrenal cortical hyperplasia, adrenal hemorrhage, ganglioneuroma, hemangioma and myelolipoma
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