A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach

Abstract

diovascular and respiratory diseases, or those with obesity [1]. However, novel methods may prolong operative time when employed by trainee surgeons.During surgical procedures, the proper exposure of paired adrenal glands is challenging due to their small size, fragility and localization in the retroperitoneal area (deep inside the adipose tissue). Classical interventions require extensive incisions through integuments that are disproportionately large compared to the size of the glands [3].Surgery has recently made immense progress towards the minimization of invasiveness. Surgical trauma and the rate of complications have been limited significantly. As a result, decreased postoperative pain, shorter hospital stay, faster recovery, reduced mortality, improved cosmetic effect and decreased hospital costs have been observed [1,2]. Various studies conducted worldwide confirm the safety and efficacy of interventions that employ novel methods also in patients diagnosed with car- AbstractBackground. Laparoscopic adrenalectomy is the gold standard for the surgical treatment of benign adrenal masses. It is most commonly performed using the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA). The choice of the method depends on contraindications for a particular approach in an individual case and surgical experience. The objective of the article is to compare two approaches, LTA and PRA, in view of our own experience and literature review. Objectives. The objective of the article is to compare two approaches, LTA and PRA, in view of our own experience and literature. Material and Methods. The assessment involved morphological characteristics of tumors, indications for PRA and LTA, operative time, perioperative blood loss and postoperative complications. Results. Seventy-seven of the examined 104 laparoscopic adrenalectomies were performed retroperitoneally; 27 -transperitoneally. The mean size of tumors in PRA was 4.6 cm and in LTA 6.2 cm. The mean total operative time was 91.8 min in the case of PRA and 153.1 min in LTA. No differences in the amount of blood loss between the two approaches were recorded. The average hospitalization post PRA lasted 2.03 days and post LTA 2.67 days. Conclusions. Laparoscopic adrenalectomy proves to be an effective and safe surgical technique both in the case of LTA and PRA. The technique to be used should be suited to surgical team's experience, patient's general condition and tumor size and location. In our experience, the most advantageous approach in the case of tumors of less than 7 cm is PRA (Adv Clin Exp Med 2016, 25, 5, 829-835).

Laparoscopic Versus Open Adrenalectomy: a Retrospective Comparative Study

“…Adrenal tumors which need surgical intervention are broadly classified into functional or nonfuctional. In our study, supported by other studies ( 1 , 5 , 7 - 9 ) , the majority of operated tumors were non-functional. Younger patients were found to be more likely to have functional tumors, but in contrary to what reported by Wooten and King ( 10 ), we found that males were more likely than females to have functional adrenal tumors.…”

“…Propper exposure requires extensive incisions much larger than their size. Because of this, LA represented an attractive alternative to open approach since first report of LA in 1992 ( 3 , 5 , 6 ). Adrenal tumors which need surgical intervention are broadly classified into functional or nonfuctional.…”

Meta-analysis of two approaches to Laparoscopic Adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach

“…Of 592 retrieved studies, 573 articles were excluded for different reasons.Finally, 19 studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] were included in our analysis. Table 1 lists the basic characteristics of the included studies in the meta-analysis,and Table 2 shows the clinical and pathologic characteristics of the included studies.The two groups were similar in age (MD -4.03, 95% CI -8.82 to 0.76, P = 0.10), BMI (MD 0.17, 95% CI -0.53 to 0.87, P = 0.64), proportion of right sided (OR 0.91, 95% CI 0.74 to 1.12, P = 0.35), proportion of bilateral lesions (OR 1.21, 95% CI 0.52 to 2.80, P = 0.65),and previous abdominal surgery (OR 0.91, 95% CI 0.59 to 1.43, P = 0.70),as shown in Fig.4A-E.…”

The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

“…Nevertheless, PRA requires much higher pressure of CO 2 insufflation as compared to LTA (25 vs. 12 mm Hg). As a consequence, renal veins and inferior vena cava during right-sided PRA are compressed for as long as 30-150 minutes, depending on the difficulty of the operation and the surgeon's experience [13][14][15]. In some patients after adrenalectomy Ass.…”