Young Jun Chai(1), MD, Soon Young Tae(1), MD, Heeseung Lee(1), MD, Yong Joon Suh(1), MD, Jung-Woo Woo(1), MD, Se Hyun Paek(1), MD, Su-jin Kim(1), MD, Jun Young Choi(2), MD, Kyu Eun Lee(1), MD, PhD, Yeo-Kyu Youn(1), MD, PhD. (1)Department of Surgery,Seoul National University Hospital and College of Medicine,Seoul,Korea, Division of Surgery,Thyroid Center,Seoul National University Cancer Hospital,Seoul,Korea, (2)Department of Surgery, Seoul National University Bundang Hospital.
Background. Among several minimally invasive adrenalectomy techniques, laparoscopic transperitoneal adrenalectomy (LTA) has been the standard method for benign adrenal gland tumors; however, recently posterior retroperitoneoscopic adrenalectomy (PRA) has been performed widely. This study presents the outcome of these two approaches performed by a single surgeon in retrospective and consecutive patient cohorts.
Methods. Thirty-eight patients underwent LTA from 2009 to 2011, and 22 patients underwent PRA from in 2012. Of these, 29 patients in the LTA group and 19 in the PRA group met selection criteria (unilateral benign tumor, pheochromocytoma ≤ 5 cm, and the other benign tumors ≤ 7 cm) and were enrolled. The medical records of these 48 patients were reviewed and compared retrospectively.
Results. No significant differences were observed in operation time, postoperative analgesics use, first oral intake, hospital stay, or complication rate between the two groups. The PRA group showed less blood loss (p = 0.017), a lower highest systolic blood pressure during surgery (p = 0.041), and a lower pain score in the second and third postoperative day (p = 0.006, p = 0.002, respectively). In the right adrenalectomy, operation time was significantly shorter in the PRA group (p = 0.009) but similar in the left adrenalectomy (p = 0.380).
Conclusions. PRA was performed safely and showed a better outcome than LTA in terms of blood loss and postoperative pain. PRA is a challengeable operative technique for an endocrine surgeon who is experienced in the transperitoneal approach.