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In an early meta-analysis of close to 100 studies comparing laparoscopic with open adrenalectomy, Brunt reported that, although the rate of bleeding complications was higher in laparoscopic (4. Of note, open adrenalectomy was associated with significantly higher rates of associated organ injury and wound, pulmonary, cardiac, and infectious complications.

Using the Veterans Affairs National Surgical Quality Improvement Program database to compare laparoscopic with open adrenalectomy, Lee and colleagues (2008) demonstrated that open procedures had increased operative times, transfusion requirements, reoperations, length of stay, and 30-day morbidity rates.

Open adrenalectomy had also resulted in more pneumonia, unplanned intubation, unsuccessful ventilator wean, systemic sepsis, cardiac arrest, renal la roche posay lipikar, and wound infections.

The 30-day morbidity rate was still higher even after adjusting for confounding factors. A Lee hyun soo Inpatient Sample from the United States involving more than 40,000 patients who underwent adrenalectomy echoed similar findings of fewer complications and shorter length of stay in patients who underwent laparoscopic adrenalectomy over their open adrenalectomy counterparts (Murphy et al, 2010).

Most recently, Tazarotene (Avage)- FDA a contemporary cohort from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data, Elfenbein and colleagues (2013) concluded that patients undergoing laparoscopic adrenalectomy had significantly lower postoperative morbidity and shorter length Tazarotene (Avage)- FDA stay than patients undergoing an open procedure after adjustment for patient- and procedure-related factors, including malignancy.

Laparoscopic Transperitoneal versus Retroperitoneal Approach Multiple retrospective studies have been performed that seem to suggest an advantage in terms of lesser blood loss and shorter convalescence time of the retroperitoneal approach over the transperitoneal Tazarotene (Avage)- FDA. In a meta-analysis of 22 eligible studies (Constantinides et al, 2012), the laparoscopic retroperitoneal approach was associated with a significantly shorter hospital stay when compared to the transperitoneal approach.

The authors attributed this to the decrease in postoperative pain and ileus associated with the retroperitoneal approach because the peritoneum is not breached. There were no differences in duration of operation, blood loss, time to ambulation and oral intake, or complication rates between techniques.

Another meta-analysis by Chen and colleagues (2013) identified nine eligible retrospective studies reporting that the retroperitoneal approach Tazarotene (Avage)- FDA associated with shorter operative time, less intraoperative blood loss, shorter hospital stay, and shorter time to Tazarotene (Avage)- FDA ambulation.

There was no significant difference in open conversion rates, time to first oral intake, and major postoperative complication rates. Three randomized prospective studies were carried out to compare these two approaches. They showed that the transperitoneal approach resulted in a greater rise in the PaCO2 level compared with the retroperitoneal approach Terramycin (Oxytetracycline)- FDA 30 minutes, together with a significant increase in mean arterial pressure.

However, operation time, blood transfusion and analgesia requirements, Tazarotene (Avage)- FDA stay, return to normal activities, and complication rates were similar between the two approaches. The authors concluded that the retroperitoneal approach might be a better option in patients with previous abdominal surgery and preexisting cardiopulmonary diseases. In another prospective randomized trial by Rubinstein and colleagues (2005) in which all baseline patient and operative factors were matched, the only significant difference was a shorter convalescence time in the retroperitoneal group.

All Tazarotene (Avage)- FDA parameters such as blood loss, operative time, analgesia requirements, open conversion, and complication rates were tylenol pm. Finally, a prospective randomized study involving a more contemporary cohort concurred with the previous findings that the transperitoneal approach about dreams comparable to the retroperitoneal approach in terms of operative time, estimated blood loss, time to ambulation, hospital stay, and analgesic requirement but Tazarotene (Avage)- FDA associated with longer time to oral intake resumption and longer convalescence period (Mohammadi-Fallah et al, 2013).

Laparoscopic versus Robot-Assisted Adrenalectomy As described previously, the robotic platform offers several advantages over conventional laparoscopy but current literature has yet to show conclusively that these advantages have translated Tazarotene (Avage)- FDA better clinical outcomes.

The only prospective randomized study comparing robot-assisted with laparoscopic adrenalectomy was published in the early years Tazarotene (Avage)- FDA robot-assisted surgeries. Morino and coworkers Tazarotene (Avage)- FDA randomized 20 consecutive patients with benign adrenal tumors to either traditional laparoscopic or robotic surgery. The robot-assisted approach was associated with a longer operative time and higher 30-day complication rate compared to the laparoscopic approach.

In addition, cost analyses revealed that robotic procedures were more expensive than laparoscopic procedures. The authors concluded novartis oncology laparoscopic adrenalectomy was superior to robot-assisted adrenalectomy in terms of feasibility, morbidity, and cost.

Robotic surgery is highly dependent on the expertise of the assistant and the whole robotic team, including the scrub nurses. As robotic teams go beyond the initial learning curve of 10 to 20 cases, Tazarotene (Avage)- FDA fear of insects have been shown to approach those clocked by the conventional laparoscopic approach (Brunaud et al, 2008; Agcaoglu Tazarotene (Avage)- FDA al, 2012a; Karabulut et al, 2012).

Karabulut and colleagues Tazarotene (Avage)- FDA further to time each individual step of adrenalectomy and reported similar timings for each step of robotic and laparoscopic Tazarotene (Avage)- FDA, except for shorter hemostasis time in the robotic group (Karabulut et al, 2012). Multiple studies have demonstrated that perioperative outcomes such as estimated blood loss, hospital stay, postoperative analgesia, and complication and mortality rates are similar between the two approaches.

In fact, robot-assisted adrenalectomy may be preferred in certain circumstances.

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Comments:

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