Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications

Abstract

In the last decades, minimally invasive transperitoneal laparoscopic adrenalectomy has become the standard of care for surgical resection of the adrenal gland tumors. Recently, however, adrenalectomy by a mininvasive retroperitoneal approach has reached increasingly popularity as alternative technique. Short hospitalization, lower postoperative pain and decrease of complications and a better cosmetic resolution are the main advantages of these innovative techniques. In order to determine the better surgical management of adrenal neoplasms, the Authors analyzed and compared the feasibility and the postoperative complications of minimally invasive adrenalectomy approaches. A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, comparing laparoscopic transperitoneal adrenalectomy versus retroperitoneoscopic adrenalectomy. Many studies support that posterior retroperitoneal adrenalectomy is superior or at least comparable to laparoscopic transperitoneal adrenalectomy in operation time, pain score, blood loss, hospitalization, complications rates and return to normal activity. However, laparoscopic transperitoneal adrenalectomy is up to now a safe and standardized procedure with a shorter learning curve and a similar low morbidity rate, even for tumors larger than 6 cm. Nevertheless, further studies are needed to objectively evaluate these techniques, excluding selection bias and bias related to differences in surgeons' experiences with this approaches.

A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

“…Thanks to technological progress, laparoscopic adrenalectomy is becoming more common in the treatment of tumors > 6 cm [10]. Tumors of more than 12 cm in diameter and malignant lesions infiltrating other tissues should be operated using conventional approaches [3,7].…”

“…Among the most common methods are the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA) [10]. The method used depends mainly on the surgeon's preference and contraindications, if any, for a particular approach in the patient.…”

Laparoscopic adrenalectomy as an effective approach to massive bilateral pheochromocytomas

“…The obtained outcomes of the two compared techniques were similar; however, thanks to the avoidance of pneumoperitoneum and the direct approach to the gland, PRA was associated with shorter operative time, less postoperative pain score and meaningfully shorter hospitalisation, with an equitable morbidity rate. Despite the described benefits, PRA may demand some difficulties especially with tumours larger than 8 cm in diameter, considering the smaller working space and implying substantial technical experience due to the change to a reverse angle approach 20. Accordingly, additional studies are needed to compare these two approaches and define which one should be settled as superior.…”

Evaluation of a large adrenal carcinoma with 3D reconstruction of computed tomography images: A case report and literature review

“…As laparoscopic surgeries are widely used, it is critical to obtain clear and detail image information about the size, number, location of the tumor lesion and the adhesion status between the tumor and the adjacent organs, vascular distribution and metastasis before surgery. Typically for adrenal surgery, the retroperitoneal space is limited for laparoscopic surgeries [13,17,18]. It is a challenge to resect large retroperitoneal neoplasms via retroperitoneal approach [17,18] because it's more likely to affect and damage adjacent organs and tissues.…”

“…Typically for adrenal surgery, the retroperitoneal space is limited for laparoscopic surgeries [13,17,18]. It is a challenge to resect large retroperitoneal neoplasms via retroperitoneal approach [17,18] because it's more likely to affect and damage adjacent organs and tissues. In this case, we successfully removed a large adrenal cancer tumor with the aid of dynamic 3D video.…”