I Hemodynamic Instability and Conversion in Adrenalectomy for Management

Study Overview
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Brief Summary
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Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high intraoperative hemodynamic instability (HI) and conversion risk. This study aimed to compare the incidence and risk factors of perioperative HI and conversion between left-sided (LLA) and right-sided (RLA) transabdominal laparoscopic adrenalectomy (TLA).

Detailed Description
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Pheochromocytoma (PHEO) is an adrenomedullary chromaffin cell tumour that releases catecholamines . The general population incidence of PHEO is 0.05%-0.1%; however, it is higher in the hypertensive population. Clinical presentation ranges from asymptomatic to sudden death . Emerging technologies have evolved to include minimally invasive laparoscopic adrenalectomy(LA), which has become the preferred method in adrenal disease surgery with lower surgical morbidity and mortality. Gagner et al. were the first to discuss transperitoneal laparoscopic adrenalectomy (TLA) . The LA technique includes many different transabdominal and retroperitoneal approaches, while many surgeons prefer TLA because of its familiar anatomy and large working space . However, PHEO surgery is still challenging for surgeons and anesthesiologists because it has been proven to be associated with hemodynamic instability(HI) and presents with sudden hypertension or tachycardia or severe and prolonged hypotension after tumour removal . Trained surgeons and anesthesiologists optimize the results and minimize HI . Numerous other risk factors for HI have been reported in the literature . The diversity might be due to unstandardized anesthesiological and surgical management and different HI definitions. There are no absolute contraindications for laparoscopic adrenalectomy; however, as many as 20% of patients require conversion to an open. Variations in patient outcomes during laparoscopic right adrenalectomy(LRA) or laparoscopic left adrenalectomy(LLA) for managing pheochromocytoma resection have never been evaluated specifically in terms of incidence and risk factors of perioperative HI (intraoperative and postoperative) and conversion rate in a large cohort of patients.

Official Title
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A Retrospective Comparative Analysis of Perioperative Hemodynamic Instability and Conversion in Transabdominal Laparoscopic Adrenalectomy for Pheochromocytoma: Side-specific Factors.

Conditions
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adrenalDisease

Intervention / Treatment
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* Procedure: laparoscopic adrenalectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - patients >18 years, both sex with unilateral PHEO of any size who underwent TLA Exclusion Criteria: . Patients with first-line open adrenalectomy, other surgical procedures during TLA, partial adrenalectomy, bilateral PHEOS, bleeding diathesis, skeletal deformity, pregnancy, previous homolateral abdominal surgery, missing data, uncertain preoperative diagnosis, hereditary PHEO, or recurrent PHEO

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| laparoscopic right adrenalectomy<br>laparoscopic right adrenalectomy for pheochromocytoma | Procedure: laparoscopic adrenalectomy<br>* laparoscopic adrenalectomy for pheochromocytoma<br>|
| laparoscopic left adrenalectomy<br>laparoscopic left adrenalectomy for pheochromocytoma | Procedure: laparoscopic adrenalectomy<br>* laparoscopic adrenalectomy for pheochromocytoma<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| hemodynamic instability | incidence of hemodynamic instability | intraoperative and immediate postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| conversion rate | incidence of conversion | intraoperative |