Changing Surgical Approaches for Laparoscopic Adrenalectomy: Single-Surgeon Data of a 6-Year Experience

Abstract

Aim: To evaluate outcomes of laparoscopic adrenalectomy (LA) and laparoendoscopic single-site surgery (LESS) for adrenal masses in the light of changing laparoscopic surgical techniques. Materials and Methods: Seventy-three patients were analyzed retrospectively. There were 2 groups; group 1 included patients who had conventional transperitoneal LA and transperitoneal LESS, and group 2 included patients who had lateral retroperitoneal LA, retroperitoneal LA in prone position, and retroperitoneal LESS. Demographic data, urine 3-methoxy-4-hydroxymandelic acid, normetanephrine, epinephrine, serum cortisol, aldosterone, adrenocorticotropic hormone, American Society of Anesthesiologists score, side and size of mass, conversion to open surgery, complications, estimated blood loss, operation time, pathological results were recorded and analyzed. Results: There was no difference in demographic data and serum parameters between both groups. Tumor size, estimated blood loss, operation time, transfusion rate and hospital stay were less for group 2 (p < 0.05, p = 0.0001). However, the complication rate was similar in both groups; in retroperitoneal prone position, the complication rate was less than for other surgical approaches, but statistically significant results could not be assessed. Conclusions: Even if the diameter of adrenal mass is larger than 6 cm, LA may be considered as the gold standard. The retroperitoneal approach especially in prone position may be a promising treatment method in the near future for adrenalectomy in selected patients.

Impact of Obesity on Perioperative Outcomes of Retroperitoneal Laparoscopic Adrenalectomy

“…However, Epelboym et al [20] found that the retroperitoneal approach wound be safe and feasible for obese patients in their study. The rates of complications seemed to be similar in both retroperitoneal approach and transabdominal approach, and the retroperitoneal LA takes a shorter time and results in lesser blood loss than the transabdominal approach in selected patients operated by experienced surgeons [21,22]. Additionally, Shi et al [23] proposed that retroperitoneal access could have some advantage concerning BMI and avoidance of retraction of intraperitoneal organs.…”

Retrospective comparison of three minimally invasive approaches for adrenal tumors: perioperative outcomes of transperitoneal laparoscopic, retroperitoneal laparoscopic and robot-assisted laparoscopic adrenalectomy

“…Laparoscopic adrenalectomy was first described in 1992 [2]. At present it has routinely replaced the open procedure as the standard treatment for adrenal tumors, with the advantages such as less hemorrhage, shorter hospital stay, and minimally invasive incision [3][4][5]. Conventional laparoscopic adrenalectomy is generally performed by a transperitoneal laparoscopic (TLA) or retroperitoneal laparoscopic (RLA) approach.…”

Comparison of Retroperitoneoscopic and Transperitoneal Laparoscopic Adrenalectomy for Right-Sided Benign Tumors: A Single-Institute Experience

“…Dickson et al [11] recently reported that the retroperitoneal approach results in decreased operative times, blood loss, and postoperative lengths of stay compared to the transperitoneal approach. Arslan et al [17] reported that the retroperitoneal approach is superior to the transperitoneal approachfor small adrenal masses. Lezoche et al [12] concluded that the transperitoneal approach is suitable for the removal of larger adrenal masses and the retroperitoneal approach may represent a better option for obese patients or patients with small lesions.…”