S. C. Oltmann3, D. M. Elfenbein2, R. S. Sippel4, H. Chen1, J. L. Rabaglia3, A. P. Dackiw3, F. E. Nwariaku3, S. A. Holt3, D. F. Schneider4 1University Of Alabama at Birmingham,Surgery,Birmingham, Alabama, USA 2University Of California – Irvine,Surgery,Orange, CA, USA 3University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 4University Of Wisconsin,Surgery,Madison, WI, USA
Introduction:
Adrenalectomy is an infrequent surgical procedure performed by multiple specialties, with multiple technical approaches. The hypothesis of this study is surgical approaches and contraindications are consistent regardless of surgical specialty.
Methods:
Members of the American Association of Endocrine Surgeons (AAES) and of the Endourological Society (EUS) were surveyed using an internet based questionnaire, regarding current practice and attitudes toward adrenalectomy.
Results:
109 AAES members and 146 EUS members completed the survey. AAES performed more adrenalectomies annually, and reported familiarity with a greater number of adrenalectomy techniques (Table). EUS used the robot more frequently, and considered themselves high volume laparoscopic surgeons more often.
Laparoscopic transabdominal adrenalectomy was the top preferred approach for both. AAES preferred retroperitoneoscopic more, and robotic transabdominal approach less.
Contra-indications for transabdominal laparoscopic adrenalectomy varied. AAES was more likely to view known adrenal malignancy(69% vs. 10%, p<0.01), and suspected malignancy(43% vs. 9%, p<0.01) as contraindications, and less likely to view a hostile abdomen(39% vs. 58%, p<0.01) or co-morbidities(4% vs. 18%, p<0.01) as contraindications. Tumor size(45% vs. 52%), and location(35% vs. 27%) were equally considered.
For retroperitoneoscopy, known adrenal malignancy(89% vs. 16%, p<0.01), suspected adrenal malignancy(66% vs. 10%, p<0.01) and BMI(36% vs. 15%, p<0.01) were more often considered a contraindication by AAES. Tumor size(76% vs. 71%), and location(35% vs. 43%) were equally viewed.
Conclusion:
Both surgical specialties perform adrenalectomy with frequency. Attitudes regarding contraindication to a minimally invasive approach vary greatly between AAES and EUS members, most notably regarding malignancy.
