Contemporary Experience of Posterior Retroperitoneoscopic Adrenalectomy in the US

Abstract

BACKGROUND: As the incidence of adrenalectomy increases steadily, so does the use of minimally invasive approaches like posterior retroperitoneoscopic adrenalectomy (PRA). To date, the largest studies of PRA have been from abroad, and we sought to provide a contemporary US update on the outcomes after PRA. METHODS: A retrospective chart review was conducted on all PRAs performed at a single tertiary care institution between 2013 and 2020. Patient demographic characteristics, indication for operation, operative details, and postoperative course were abstracted. Outcomes of interest included 30-day mortality, conversion to open or transabdominal approach, postoperative complication, and 30-day readmission. RESULTS: A total of 249 PRAs were performed between 2013 and 2020. The population was 54.2% women and mean (SD) age was 54.1 (14.1) years. Most lesions (60.6%) were left-sided, and the most common diagnosis was nonfunctioning adenoma (39.4%), followed by pheochromocytoma (21.3%) and aldosteronoma (16.6%). Mean (SD) tumor size was 3.2 cm (range 0.5 to 9.4 cm). Median operative length was 110 minutes (range 30 to 319 minutes). Overall, the complication rate was 6.4%. Nine patients (3.6%) had a minor postoperative complication (Clavien-Dindo I to III) and 5 patients (2.0%) had a major postoperative complication (Clavien-Dindo IV to V), including 1 mortality (0.4%). There were 2 conversions of approach (0.8%). The majority of patients (58.2%) were discharged on postoperative day 1, and 92.0% were discharged by postoperative day 3. The 30-day readmission rate was 1.6%. CONCLUSIONS: Current practice demonstrates that PRA is an extremely safe approach, with a complication rate < 7% and mortality rate < 1%. In addition, the vast majority of patients are able to return home in an expedient manner.

The Modified Retroperitoneal Laparoscopic Adrenalectomy effectively resolves adhesive periadrenal fat and achieves superior outcomes

“…[20,21] According to current evidence, RLA has been proven to be a highly secure method, with a complication rate below 7% and mortality rate less than 1% in the United States. [22] The surgeon's experience, adrenal tumor characteristics, and nature of the perinephric fat were likely to be key factors in uencing the decision. [23] In the hands of appropriately selected patients, it serves as an indispensable tool in the armamentarium of endocrine surgeons.…”

An effective method for preoperative distinguishing Gastric duplication cysts and Adrenal cysts in children

“…Currently, transperitoneal or retroperitoneal approaches can be used in surgery for masses in the adrenal region [21]. Since the surgical sites of GDC are in the abdominal cavity near the greater curvature of the stomach, a retroperitoneal approach is not conducive to exposing the cyst.…”

Adrenalectomy for Pheochromocytoma: Complications and Predictive Factors of Intraoperative Hemodynamic Instability

“…The surgical techniques followed the principles already reported in the literature with surgeons striving to control and clip the adrenal vein as early as possible, before mobilizing the adrenal gland. 14,15 One experienced surgeon and two surgeons in their learning curve performed all the surgical procedures in one center while two experienced surgeons performed the vast majority of adrenalectomies in the other center. Surgeon’s experience was categorized as high (ie, >20 adrenalectomies) vs limited (<20 adrenalectomies) for each procedure.…”