The aims of the present study were to (1) analyse preoperative computed tomography (CT) parameters, (2) investigate whether obesity and CT parameters affect surgical outcomes in patients undergoing LESS lateral retroperitoneal adrenalectomy, and (3) further establish the optimal cutoff point of CT parameters for tolerable operating time.
Between January 2010 and August 2016, patients who underwent LESS adrenalectomy through the retroperitoneal approach in our hospitals were included. Patients’ demographic data, preoperatively measured CT parameters (the depth and horizontal width to the adrenal gland in the axial view of abdominal CT, the vertical height in the coronal view of CT, and the angle of the depth and horizontal width), and intraoperative (operative time and blood loss) and postoperative (hospital stay and complications) parameters were retrospectively reviewed. Linear regression was performed to determine factors that potentially affect surgical outcomes.
In 116 patients, depth was the only CT parameter associated with surgical outcomes. Large depth (P = 0.005; 95% CI 1.739–9.256) and high BMI (P = 0.012; 95% CI 0.357–2.851) were factors significantly associated with longer operative time. The area under the ROC curve for the depth was 0.69 (P = 0.002), and the cutoff point 10.48 cm may be the tolerable operating time.
Our results suggest a depth limit of 10.48 cm for the optimal prediction of operating time less than 90 min; although obese patients and deeper adrenal glands had longer operative time, LESS adrenalectomy could be performed in the obese patients without increased blood loss, prolonged hospital stay, or increased pain.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Hirasawa Y, Miyajima A, Hattori S, Miyashita K, Kurihara I, Shibata H, Kikuchi E, Nakagawa K, Oya M (2014) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic adrenalectomy: a comparison of surgical outcomes and an analysis of a single surgeon’s learning curve. Surg Endosc 28:2911–2919
Wang L, Wu Z, Li M, Cai C, Liu B, Yang Q, Sun Y (2013) Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies. J Endourol 27:743–750
Inoue S, Ikeda K, Kobayashi K, Kajiwara M, Teishima J, Matsubara A (2014) Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy. Can Urol Assoc J 8:E20–E25
Fazeli-Matin S, Gill IS, Hsu TH, Sung GT, Novick AC (1999) Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery. J Urol 162:665–669
Varela E (2009) Retroperitoneoscopic adrenalectomy for pheochromocytoma in morbidly obese. Obes Surg 19:1180–1182
Aksoy E, Taskin HE, Aliyev S, Mitchell J, Siperstein A, Berber E (2013) Robotic versus laparoscopic adrenalectomy in obese patients. Surg Endosc 27:1233–1236. https://doi.org/10.1007/s00464-012-2580-1
Shen ZJ, Chen SW, Wang S, Jin XD, Chen J, Zhu Y, Zhang RM (2007) Predictive factors for conversion of laparoscopic adrenalectomy: a 13-year review of 456 cases. J Endourol 21:1333–1337
Agha A, Breitenbuch P, Gahli N, Piso P, Schlitt HJ (2008) Retroperitoneoscopic adrenalectomy: lateral versus dorsal approach. J Surg Oncol 97:90–93
Zonča P, Bužga M, Ihnát P, Martínek L (2015) Retroperitoneoscopic adrenalectomy in obese patients: is it suitable? Obes Surg 25(7):1203–1208
Hu Q, Hang Z, Ho Y, Sun C, Xu K, Xia G, Ding Q (2015) Impact of obesity on perioperative outcomes of retroperitoneal laparoscopic adrenalectomy. Urol Int 95(3):361–366
Smith CD, Weber CJ, Merson JR (1999) Laparoscopic adrenalectomy: a new gold standard. World J Surg 23:389
Constantinides VA, Christakis I, Touska P, Palazzo FF (2012) Systematic review and meta-analysis of retroperitoneoscopic versus laparoscopic adrenalectomy. Br J Surg 99:1639–1648
Wang L, Cai C, Liu B, Yang Q, Wu Z, Xiao L, Yang B, Chen W, Xu Z, Song S, Sun Y (2013) Perioperative outcomes and cosmesis analysis of patients undergoing laparoendoscopic single-site adrenalectomy: a comparison of transumbilical, transperitoneal subcostal, retroperitoneal subcostal approaches. Urology 82:358–364
Rane A, Cindolo L, Schips L, De Sio M, Autorino R (2012) Laparoendoscopic single site (LESS) adrenalectomy: technique and outcomes. World J Urol 30:597–604
Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, Moinzadeh A, Ukimura O, Desai MM, Kaouk J, Bravo E (2005) Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol 174:442–445
Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD (2008) Single port access adrenalectomy. J Endourol 22:1573–1576
Muth A, Taft C, Hammarstedt L, Björneld L, Hellström M, Wängberg B (2013) Patient-reported impacts of a conservative management programme for the clinically inapparent adrenal mass. Endocrine 44:228–236
Economopoulos KP, Phitayakorn R, Lubitz CC, Sadow PM, Parangi S, Stephen AE, Hodin RA (2016) Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy? Surgery 159(1):240–248
Hasegawa M, Miyajima A, Jinzaki M, Maeda T, Takeda T, Kikuchi E, Shibata H, Oya M (2013) Visceral fat is correlated with prolonged operative time in laparoendoscopic single-site adrenalectomy and laparoscopic adrenalectomy. Urology 82:1312–1318
Zonča P, Cambal M, Labas P, Jacobi CA (2012) Retroperitoneoscopic adrenalectomy with dorsal approach. Rozhl Chir 91:235–240
Chang HC, Yang HC, Chang HY, Yeh CJ, Chen HH, Huang KC, Pan WH (2017) Morbid obesity in Taiwan: prevalence, trends, associated social demographics, and lifestyle factors. PLoS ONE 12(2):e0169577
Lin YC, Yen LL, Chen SY, Kao MD, Tzeng MS, Huang PC, Pan WH (2003) Prevalence of overweight and obesity and its associated factors: findings from National Nutritional and Health Survey in Taiwan, 1993-1996. Prev Med 37–24:233–241
Kazaure HS, Roman SA, Sosa JA (2011) Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy. World J Surg 35:1287–1295
All authors (Yu-Chen Chen, Hsiang-Ying Lee, Ming-Chen Paul Shih, Yung-Shun Juan, Hao-Wei Chen, Wen-Jeng Wu, Yu-Tsang Wang and Ching-Chia Li) declare that they have no funding.
Yu-Chen Chen, Hsiang-Ying Lee, Ming-Chen Paul Shih, Yung-Shun Juan, Hao-Wei Chen, Wen-Jeng Wu, Yu-Tsang Wang and Ching-Chia Li declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chen, YC., Lee, HY., Shih, MC.P. et al. Effect of preoperative computed tomography parameters and obesity on surgical outcomes of laparoendoscopic single-site adrenalectomy. Surg Endosc 34, 4781–4787 (2020). https://doi.org/10.1007/s00464-019-07254-3
- Treatment outcome
- Computed tomography