Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?

Abstract

PurposeThere has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the “classic” laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.MethodsA retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches.ResultsBoth mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0–200) vs. 50 (0–1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches.ConclusionsApplication of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.

Adrenal Metastasis of Hepatocellular Carcinoma in Patients following Liver Resection or Liver Transplantation: Experience from a Tertiary Referral Center

“…But we also owed a certain lack of experience with those patients during the former time. In nowadays, due to further development and experience with laparoscopic adrenalectomies in benign dignities, it should be performed whenever possible and retroperitoneoscopic adrenalectomy may serve as a good alternative in case of severe adhesion [ 26 ]. Alternatively to metastasectomy, a variation of nonsurgical treatment options like PEI, TACE, radiation, and radiofrequency ablation were also reported and recent chemotherapeutic protocols achieved palliative control of adrenal metastasis [ 27 – 31 ].…”

Multicentre study evaluating the surgical learning curve for posterior retroperitoneoscopic adrenalectomy

“…Furthermore, there is no need to reposition patients with an indication for bilateral adrenalectomy. Despite several published reports showing shorter duration of surgery, less blood loss, decreased postoperative pain, faster recovery and improved cost‐effectiveness, most surgeons still perform lateral transperitoneal adrenalectomy (LTA).…”

Risk factors for haemodynamic instability and its prolongation during laparoscopic adrenalectomy for pheochromocytoma

“…14,22 Previous studies demonstrated that retroperitoneal LA for pheochromocytoma was associated with shorter operative times, less blood loss and shorter hospital stays than transperitoneal LA. [23][24][25] The retroperitoneal approach had an operative time of 50.8-102 min, while that of the transperitoneal approach was 77.3-173.3 min. However, Vorselaars et al 26 identified a disadvantage of the retroperitoneal approach; 101 retroperitoneal LA and 240 transperitoneal LA were compared and the risk of mean arterial pressure less than 60 mmHg was found to be greater with the retroperitoneal approach (66% vs. 43%; p = .035).…”