A Comparative Study for the Surgical Outcomes of Laparoscopic Adrenalectomies (Transperitoneal Approach vs. Posterior Retroperitoneal Approach) for Small Adrenal Tumors

Sang-Wook Kang, MD, Jong Ju Jeong, MD, Woong Youn Chung, MD. Department of Surgery, Yonsei University College of Medicine

Backgrounds: With the development of endoscopic instruments and minimally invasive techniques, the laparoscopic adrenalectomy has been the gold standards for the surgical treatment of small adrenal tumors. Several approaching routes for laparoscopic adrenalectomy such as transperitoneal (TPA), lateral retroperitoneal or posterior retroperitoneal accesses (PRA) are being used according to the surgeon’s preference. PRA has several superior benefits comparing to the others in terms of direct and short access to the target organ, no trespass and irritation of intraperitoneal space, no need of retracting adjacent organs, and safety and ease for learning this method. Recently, we have experienced PRA for several cases of small adrenal tumor. In this study, detailed methods and preliminary results will be introduced.
Patients and Method: From Jan. 2009 to July. 2010, a total of 58 patient had been performed adrenalectomies in the endocrine surgery department. Among them, open adrenlaectomy and robotic adrenalectomy were performed in 5 and 10 patients, respectively. Forty-three patients had undergone laparoscopic adrenalectomy, and transperitoneal approach (TPA) and PRA were conducted in 26 and 17 patients, respectively. We have evaluated and compared the clinico-pathologic data and surgical outcomes of the two groups retrospectively.
Results: There were no significant differences between the two groups in terms of age, sex, lesion side, the volume of blood loss, and tumor size. Cushing syndrome, primary aldosteronism, pheochromocytoma, and non-functioning adrenal tumor were in 3, 4, 8, and 11 patients in TPA group and 2, 7, 2, and 6 patients in PRA group, respectively. Mean operative time of PRA was shorter than that of TPA (TPA : 116.2 ± 52.5 Vs. PRA : 87.2 ± 27.6min., p = 0.043). Average time to oral intake and postoperative hospital stay of PRA also showed shorter results comparing to the TPA (TPA : 1.19 ± 0.49 Vs. PRA : 0.88 ± 0.33 days, p = 0.028. TPA : 5.96 ± 3.56 Vs. PRA : 3.00 ± 1.37days, p = 0.002, respectively). The mean numbers of analgesics use for pain control was fewer in the PRA group (TPA : 3.81 ± 3.23 Vs. PRA : 1.29 ± 1.21 times, p = 0.001). There was no conversion to open surgery and postoperative complications.
Conclusions: In our initial experiences, the posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. Ordinal anatomical dissection in the bloodless planes provides a clear operative field and avoids inadvertent injury to surrounding organs and major vessels. Thus, it decreases the complication rate with a significantly short operative time. In experienced hands, this method can be an ideal approach in adrenal surgery.

Session: Emerging Technology Poster
Program Number: ETP007
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