Right Adrenal Vein: Posterior Retroperitoneoscopic Or Laparoscopic Anterior Approach?

Andreas Kiriakopoulos, MD, Dimitrios Linos, MD


Background: Right adrenal vein ligation comprises the most serious and challenging step of right adrenalectomy that always taxes the abilities of the surgical team in relation to various tumor and patient characteristics. We present our comparative results between posterior and laparoscopic approaches

Patients and Methods: From May 2008 to September 2012 fourteen patients (ten females and four males {mean age: 43.5 yrs (26-62)} underwent right posterior retroperitoneoscopic adrenalectomy. Surgeon’s subjective effort of adrenal vein dissection and ligation (scaled from 1-better to 5-worse), operative time, complications and postoperative pain (VA pain score on days 1 and 3) were compared to fourteen selected laparoscopic controls: six females and seven males (mean age: 49.2yrs (25-64).

Results: Adrenal tumors included 3 adenomas associated with Cushing’s syndrome, 3 adenomas associated with subclinical Cushing’s syndrome, 4 pheochromocytomas, 2 aldosteronomas, one adrenal metastases and one myelolipoma. Median tumor size was 3.75 cm (1.9-6.2) for the retroperitoneoscopic group and 4.0 cm (1.7-8.0) for the laparoscopic group. Due to anatomic reasons (posterior take off of the adrenal vein from the vena cava) and the inherent advantage of direct access to the retroperitoneal space, the retroperitoneoscopic approach affords excellent view and more straightforward control of the adrenal vein. Laparoscopic right adrenal vein ligation poses significantly more strain of the surgical team. Median operative time was similar between the retroperitoneoscopic and the laparoscopic group {90 min (45-150) vs 85 min (60-120), P> 0.05}. Mean visual analogue 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). No serious complications were noted in both procedures.

Conclusions: Right posterior retroperitoneoscopic adrenalectomy compared to anterior laparoscopic adrenalectomy was equally safe and fast, although vastly superior in terms of postoperative pain and patient recovery in this series. On technical grounds, the direct posterior access affords an impressive control of the right adrenal vein and easily constitutes the approach of choice for this most significant step of right adrenalectomy.

Session: Poster Presentation

Program Number: P660

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