Differences in left and right laparoscopic adrenalectomy.

BACKGROUND AND OBJECTIVES: The classic belief is that right-sided laparoscopic adrenalectomy is technically more difficult to perform than left-sided. The purpose of this study was to determine whether objective outcomes are different for the right- versus left- sided operation. METHODS: A retrospective review of 163 laparoscopic adrenalectomies was performed to compare outcomes. Variables extracted included age, demographics, body mass index (BMI), laterality, indication, operative time, estimated blood loss (EBL), gland size, complications, open conversion rates, and length of stay. RESULTS: Of the adrenalectomies performed, 109 were on the left and 54 on the right. Age, BMI, and indication were similar for each group. The mean EBL on the left side was 113 mL (range, 2 to 3000) and 84 mL (range, 10 to 700) for the right (P=0.85). The mean operative time on the left side was 187 minutes (range, 62 to 475) and on the right was 156 minutes (range, 50 to 365) (P=0.02). There was no difference in complication or conversion rate. CONCLUSIONS: There was no difference in complication or conversion rates between each side, and we observed a trend toward lower blood loss for the right side. Although we report generally similar outcomes, the mean operative time for a right-sided laparoscopic adrenalectomy was significantly less (31 minutes) than the left side.

Accuracy and implications of percutaneous renal biopsy in the management of renal masses.

INTRODUCTION: Percutaneous renal biopsy in patients with renal masses is increasing. We investigated the accuracy of percutaneous renal mass biopsy results in patients undergoing evaluation of solid renal masses. METHODS: A retrospective review was performed of patients in the Kaiser Permanente Southern California Region who underwent computed tomography or ultrasound-guided percutaneous renal biopsy of a solid renal mass between January 2005 and December 2009. Patients were stratified by size of mass (≤ 4 cm vs > 4 cm). Initial biopsy results were correlated with final pathology specimens after extirpation. RESULTS: Medical records of 126 patients (129 renal units with 132 biopsies) were reviewed. Initial diagnostic biopsies revealed 87 (66%) malignant, 38 (29%) benign, and 7 (5%) nondiagnostic lesions. Sixty-three patients (50%) ultimately underwent extirpative surgery (23 partial and 40 radical nephrectomies). Of these patients, the diagnostic accuracy of the initial percutaneous renal mass biopsy was 76%, with an overall sensitivity and specificity of 75.4% and 100%, respectively. The biopsy concordance to final histologic tumor subtype was 93%. Larger tumor size (odds ratio [OR], 2.20; 95% confidence interval [CI], 0.55 to 8.88) and increasing number of biopsies (OR, 2.50; 95% CI, 0.59 to 10.69) were associated with increasing accuracy of a biopsy result to predict cancer; however, these associations were not statistically significant. CONCLUSION: Percutaneous renal mass biopsy is diagnostically accurate and has good sensitivity, specificity, and concordance with final pathologic renal cell carcinoma subtype. This diagnostic modality can assist in management of select renal masses as treatment options are expanding.