Ariel Shwitzer, MD, Ibrahim Matter, MD, Gideon Sroka. Department of General Surgery, Bnai-Zion Medical Center
Background: For the last two decades, laparoscopic adrenalectomy (LA) has been the standard procedure for small benign adrenal tumors. Retroperitoneoscopic adrenalectomy (RPA) is an increasingly performed procedure, with some possible advantages. The purpose of this study is to compare between the two approaches and assist in defining their indications.
Methods: This study is a retrospective analysis of all patients who went through LA and RPA in our department, between January 2012 and July 2014. In December 2013 we began using the RPA approach as well. Perioperative and pathological parameters were compared between the two groups. Data is presented as mean±SD.
Results: LA was performed in 21 patients and RPA in 16 with 18 tumors. Patient’s age was the same (56±14y). There were more females in the RPA (75% vs. 57%). ASA group was higher in the RTA (2.7±0.5 vs. 1.9±0.5). 50% of the RPA group had previous laparotomies vs. 19% in the LA group. Size of the lesion was significantly larger in the LA group (56±29mm vs. 44±25mm). Operative time was the same (91±45min. RTA vs. 88±46min. LA). There was significantly more blood loss in the LA group (143±350cc vs. 3±1.6cc). LOS was shorter in 2.5days in the RPA (3.0±1.6 vs. 5.6±5.4 in the LA). The use of opiates and return to bowel function were not found to be different between groups. More tumors in the LA group were non-secreting (57% vs. 31%). Perioperative morbidity was negligible and there was no mortality.
Conclusion: RPA is safe, has short learning curve for surgeons with experience in LA, and has faster recovery. It should be considered in patients with lesions up to 5-6cm, those with previous laparotomies, and those who need bilateral adrenalectomies. Future prospective randomized trials should compare the two approaches in lesions with same characteristics.