Impact of Posterior Retroperitoneoscopic Adrenalectomy in a Tertiary Care Center: A Paradigm Shift

ANDREAS KIRIAKOPOULOS, MD, EFTHIMIOS POULIOS, MD, DIMITRIOS LINOS, MD. Department of Surgery, Hygeia Hospital, Athens, Greece

Background: Posterior retroperitoneoscopic adrenalectomy substituted its laparoscopic counterpart as the treatment of choice in the management of adrenal tumors in our institution. We present our comparative results between these operative techniques showing the reasons of this change.
Patients: From May 2008 to September 2010 thirty patients (twenty one females and nine males {mean age: 50.3 yrs (21-69)} underwent posterior retroperitoneoscopic adrenalectomy. Operative time, complications, hospital stay, postoperative pain (based on VAS score on days 1 and 3) and cost were compared to thirty selected laparoscopic controls: twenty one females and nine males (mean age: 49.2yrs (25-64), operated between 2006 and 2008. Statistical analysis was based on [chi] 2 test.
Results: Adrenal tumors included nine adenomas associated with Cushing’s syndrome, eight adenomas associated with subclinical Cushing’s syndrome, six pheochromocytomas, four aldosteronomas, two adrenal metastases and one androgen producing tumor. Median tumor size was 4.5 cm (1.5-8.0) for the retroperitoneoscopic group and 5.0 cm (2.4-8.0) for the laparoscopic group. Median operative time was similar between the retroperitoneoscopic and the laparoscopic group {96.1min (60-165) vs 85.6min (60-120), P> 0.05}. Median operative times were significantly reduced after the 20th case {100 min (85-165) vs 70min (60-110), P<0.05}. Mean visual analogue scale pain scores were significantly lower for the retroperitoneoscopic group both on days 1 and 3 {0.7(0-1) vs 3.8(3-6), P<0.05 and 0.2(0-1) vs 3.2(2-6) P<0.05 respectively). Median hospital stay was also better than the laparoscopic group {2.0 days (2-3) vs 3.8 days(3-6)}. There were no complications other than three cases of lateral abdominal swelling and one case of hypoesthesia along the 12th intercostal nerve. The cost of the posterior approach was significantly less than that of the laparoscopic technique.
Conclusions: Posterior retroperitoneoscopic adrenalectomy compared to laparoscopic adrenalectomy was safe, fast, although vastly superior in terms of postoperative pain and hospital stay in this series. Being able to reproduce such excellent operative results along with the impressive patient recovery and the significantly reduced operative cost constituted the retroperitoneal approach the method of choice in minimally invasive adrenal surgery

Session: SS17
Program Number: S100

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