A comparative study of retroperitoneal laparoscopic adrenalectomy via intra and extra perinephric fat approaches

Abstract

Objective To investigate the safety and effectiveness of retroperitoneal adrenalectomy via extra and intra perinephric fat approaches to provide experience and basis for resection of adrenal tumors through the retroperitoneal cavity. Methods The clinical data of 284 patients undergoing retroperitoneal adrenalectomy in our hospital from December 2017 to March 2023 were collected. The basic characteristics of the two groups of patients and the changes in perioperative indicators were retrospectively analyzed. Results A total of 117 patients with intra perinephric fat approach (IPFA) were included,and 167 patients with extra perinephric fat approach (EPFA) were included. Estimated blood loss,operation time and hospitalization expenses were comparable between the two groups.The estimated blood loss in the IPFA group (123.59 ± 50.76ml) was higher than that in the EPFA group (99.10 ± 99.51ml) (p = 0.015),and the operative time in the IPFA group(105.25 ± 42.25min) was longer than that in the EPFA group(81.75 ± 30.45min) (p = 0.000).The hospitalization expenses of IPFA patients(36306.39 ± 7544.25RMB)was more expensive compared with patients receiving EPFA(32122.77 ± 7284.00RMB)(p = 0.000).There were no significant differences between the two groups in terms of tumor size,blood transfusion times and postoperative hospitalization time. Conclusion Retroperitoneal laparoscopic adrenalectomy is a safe and effective procedure that can be performed via extra and intra perinephric fat approaches. IPFA is more than EPFA in terms of estimated blood loss, and the operation time of EPFA is shorter than IPFA. The choice of surgical approach may depend primarily on the experience of the surgeon, the characteristics of adrenal tumor, and the nature of perirenal adipose tissue.