Minimally Invasive Adrenalectomy – Choosing the Appropriate Approach for the Patient

Ariel Schweitzer, MD, Ibrahim Matter, MD, Gideon Sroka. Bnai-Zion Medical Center

Background: minimally invasive adrenalectomy can be performed either by the laparoscopic (LA) or the retroperitoneoscopic (PRA) approaches. Both have been shown to be safe and effective. Nevertheless, there are no clear guidelines to choose a better approach for a specific patient. The purpose of this study was to assist in defining the indications for each approach.

Methods: A retrospective analysis of all patients who went through adrenalectomy in our department, between January 2012 and August 2015. Imaging, perioperative, and pathological parameters, were compared between the different approaches. Data is presented as mean±SD.

Results: LA was performed in 29 patients with 31 tumors, PRA in 16 with 18 tumors and 1 patients was operated in open approach. Size of the lesions was 53±23mm (LA), 28±9mm (PRA), and 135mm (open). Blood loss was negligible in PRA. Length of stay (LOS) was 5.2±4.7, 2.9±1.6, and 8 days respectively. There were no major complications.

Conclusion: Patients with benign appearing tumors of <5cm would benefit from PRA, and more so if they've had previous upper abdominal surgery, or if they need bilateral intervention. In patients with tumors >10cm with high suspicion for malignancy the open approach should be strongly considered. The rest of the lesions should be resected laparoscopically.

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