The Modified Retroperitoneal Laparoscopic Adrenalectomy effectively resolves adhesive periadrenal fat and achieves superior outcomes

Abstract

Purpose: The Mayo adhesive probabilityscore affects adrenalectomy outcome. To determine whether modified three-layered retroperitoneal laparoscopic adrenalectomy overcomes periadrenal fat adhesion compared to classic three-layered retroperitoneal laparoscopic adrenalectomy to achieve better surgical outcomes. Materials and Methods: Patients who underwent retroperitoneal laparoscopic adrenalectomy were divided into two groups from January 2016 to December 2022. Baseline characteristics and perioperative data were analyzed, and statistical significance was defined as p<0.05. Linear regression analysis was used for data that met certain conditions, such as linearity, normality, and independence. Binary logistic regression analysis was employed for binary classification of the dependent variables. Results: A total of 731 patients underwent retroperitoneal laparoscopic adrenalectomy, and 651 patients had adequate data for the adhesive probability score assessment. Of these patients, 247 were in the modified group and 404 were in the classic group, and baseline characteristics were comparable between the two groups (p>0.05). The modified group exhibited superior outcomes in terms of the operating time, duration, postoperative hospital stay, estimated blood loss, and complications. Notably, there were 16 cases of unplanned adrenalectomy in the classic group, whereas no such cases occurred in the modified group. Further analysis revealed that periadrenal stranding may be the underlying cause of this discrepancy. Conclusions: The modified three-layered retroperitoneal laparoscopic adrenalectomy effectively overcame the impact of adhesive periadrenal fat compared with the classic approach. We recommend the use of modified three-layered retroperitoneal laparoscopic adrenalectomy for patients with adhesive periadrenal fat.