Yao-Chou Tsai1,2, Chung-Hsien Chen3, Ya-Hui Hu4, Leay-Kiaw Er4, Che-Hsiung Wu5, Shih-Chieh Chueh6,7, Victor Chia-Hsiang Lin8,9. 1. Department of Surgery, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan. 2. Department of Urology, Medical College, Tzu Chi University, Hualien, Taiwan. 3. Department of Urology, E-Da Hospital, No. 1 E-da Road, Yan-Chau District, Kaohsiung, Taipei, Taiwan. 4. Division of Endocrine and Metabolism, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan. 5. Division of Nephrology, Taipei Tzuchi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan. 6. Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA. 7. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. 8. Department of Urology, E-Da Hospital, No. 1 E-da Road, Yan-Chau District, Kaohsiung, Taipei, Taiwan. tsai0523@ms29.url.com.tw. 9. School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan. tsai0523@ms29.url.com.tw.
Abstract
BACKGROUND: Laparoendoscopic single-site (LESS) adrenalectomy is a novel challenging technique which is still under clinical evaluation. Initial reports have revealed its superiority in patient convalescence. In addition, it has been reported that some patient or anatomic factors might affect the ergonomics of LESS adrenalectomy. The aim of this study is to investigate the possible factors that might affect procedural efficiency and patient convalescence in LESS adrenalectomy. METHODS: Between October 2009 and July 2015, 105 consecutive adult patients with benign adrenal tumors, who underwent LESS retroperitoneal adrenalectomy were enrolled in this study. All the relevant peri-operative parameters were prospectively collected for later analysis. By using stepwise linear regression and stepwise selection of these peri-operative parameters, those that might affect the operative efficiency and patient convalescence were analyzed. RESULTS: Finally, 78 patients who completed follow-up and were eligible for stepwise linear regression were enrolled for final analysis. For parameters affecting operative efficiency, the fitted model revealed that patients with a pre-operative diagnosis of pheochromocytoma, a higher BMI, and an associated co-morbidity of heart disease are associated with a longer operative time. In addition, the fitted model revealed that patients with a lower post-operative pain score, a delayed oral intake, and a diagnosis of non-functioning adrenal tumor were associated with a lengthier period before returning to normal activity. CONCLUSION: A higher BMI is the only anatomic factor that affects procedural efficiency in LESS adrenalectomy. In addition, post-operative pain score, time to oral intake, and a diagnosis of non-functioning adrenal tumor are the factors affecting patient convalescence.
BACKGROUND: Laparoendoscopic single-site (LESS) adrenalectomy is a novel challenging technique which is still under clinical evaluation. Initial reports have revealed its superiority in patient convalescence. In addition, it has been reported that some patient or anatomic factors might affect the ergonomics of LESS adrenalectomy. The aim of this study is to investigate the possible factors that might affect procedural efficiency and patient convalescence in LESS adrenalectomy. METHODS: Between October 2009 and July 2015, 105 consecutive adult patients with benign adrenal tumors, who underwent LESS retroperitoneal adrenalectomy were enrolled in this study. All the relevant peri-operative parameters were prospectively collected for later analysis. By using stepwise linear regression and stepwise selection of these peri-operative parameters, those that might affect the operative efficiency and patient convalescence were analyzed. RESULTS: Finally, 78 patients who completed follow-up and were eligible for stepwise linear regression were enrolled for final analysis. For parameters affecting operative efficiency, the fitted model revealed that patients with a pre-operative diagnosis of pheochromocytoma, a higher BMI, and an associated co-morbidity of heart disease are associated with a longer operative time. In addition, the fitted model revealed that patients with a lower post-operative pain score, a delayed oral intake, and a diagnosis of non-functioning adrenal tumor were associated with a lengthier period before returning to normal activity. CONCLUSION: A higher BMI is the only anatomic factor that affects procedural efficiency in LESS adrenalectomy. In addition, post-operative pain score, time to oral intake, and a diagnosis of non-functioning adrenal tumor are the factors affecting patient convalescence.
Entities:
Keywords:
Adrenalectomy; Convalescence; Ergonomics; LESS
Authors: Martin K Walz; Piero F Alesina; Frank A Wenger; Anastasios Deligiannis; Eduard Szuczik; Stephan Petersenn; Andreas Ommer; Harald Groeben; Klaus Peitgen; Onno E Janssen; Thomas Philipp; Hartmut P H Neumann; Kurt W Schmid; Klaus Mann Journal: Surgery Date: 2006-12 Impact factor: 3.982
Authors: Jens-Uwe Stolzenburg; Panagiotis Kallidonis; Holger Till; Martin Burchardt; Thomas R Herrmann; Evangelos N Liatsikos Journal: World J Urol Date: 2009-12 Impact factor: 4.226
Authors: G B Thompson; C S Grant; J A van Heerden; R T Schlinkert; W F Young; D R Farley; D M Ilstrup Journal: Surgery Date: 1997-12 Impact factor: 3.982