Comparison of Posterior Retroperitoneoscopic Adrenalectomy Versus Lateral Transperitoneal Laparoscopic Adrenalectomy for Adrenal Tumors: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo discuss the differences in the effectiveness and security for adrenal tumors by posterior retroperitoneoscopic adrenalectomy (PRA) and lateral transperitoneal laparoscopic adrenalectomy (LTA).MethodsWe systematically searched PubMed, Embase, Scopus database and Cochrane Library, and the date was from above database establishment to November 2020. Stata 16 was used for calculation and statistical analyses.ResultsNine studies involving eight hundred patients were included. The following differences were observed in favor of PRA vs LTA: less operative time (MD: −22.5; 95% CI −32.57 to −12.45; P=0.000), Fewer estimated blood loss (MD: −15.17; 95% CI −26.63 to −3.72; P=0.009), lower intensity of postoperative pain (MD: −0.56; 95% CI, −1.05 to −0.07; P=0.026), shorter length of hospital stay (MD: −1.15; 95% CI −1.94 to −0.36; P=0.04). No differences were shown in conversion rate (OR 2.07; 95%CI 0.71 to 6.03; P=0.181) and complications (OR 0.85;95% CI 0.46 to 1.56; P=0.597).ConclusionsPosterior retroperitoneoscopic adrenalectomy was clinically superior to lateral transperitoneal laparoscopic adrenalectomy for adrenal tumors in operative time, estimated blood loss, length of hospital stay, and postoperative pain. Only in term of conversion rate and complications, both were similar

Synchronized Laparoscopic Bilateral Adrenalectomy for Pheochromocytoma in Multiple Endocrine Neoplasia Syndrome: A Case Report

“…The main benefits of the laparoscopic technique are short hospital stay, low complication rate, and quick recovery. Compared to the posterior retroperitoneal approach, more time for changing the patient’s position, longer duration of surgery, prolonged hospital stays, and more postoperative pain are all disadvantages of the lateral approach ( 13 ). In contrast, it seems that there is no difference or superiority between the two approaches in the high BMI patients due to intricate dissection of the perirenal fat; similar results are reported by Kozłowski et al and Chai et al ( 11 , 14 ).…”

Benefits of transitioning from transperitoneal laparoscopic to retroperitoneoscopic adrenalectomy – a single center experience

“…Histopathological ndings were evaluated in both groups, separately: in the RPA collective the most common ndings were adrenal cortical adenoma (56), pheochromocytoma (25), adrenal cortical hyperplasia (7) and adrenal cortical cancer (2). In the LTA group the most ndings were adrenal cortical adenoma (57), pheochromocytoma (39), adrenal cortical hyperplasia (11)…”

The Mount Sinai Clinical Pathway for the Diagnosis and Management of Hypercortisolism due to Ectopic ACTH Syndrome

“…Retroperitoneal laparoscopic adrenalectomy can also be performed through a lateral flank or posterior lumbar approach. The posterior lumber approach provides better visualization of the vessels of the adrenal gland, while the lateral flank approach provides more space for manipulation of the gland during adrenalectomy [ 60 ]…”