Laparoscopic Adrenalectomy: Comparison of Lateral Transperitoneal and Lateral Retroperitoneal Approaches

Abstract

Laparoscopic adrenalectomy has become the method of choice of removal of most of adrenal lesions. This study investigated and compared the results of 2 different approaches of laparoscopic adrenalectomy, through retrospective review of 40 patients. Within this study period between 1995 and 2004, there were 20 lateral retroperitoneal and 20 lateral transperitoneal laparoscopic adrenalectomies performed. There was no significant difference in demographic variables between the 2 groups. Operative time, days to diet and ambulation, hospital stay, rate of conversion and complication did not differ significantly between the 2 approaches. No recurrence was detected upon mean follow-up period of 15.9 months. Learning curves showed gradual decrease in operation time in both approaches, reflecting maturation of techniques. In conclusion, both lateral transperitoneal and lateral retroperitoneal laparoscopic adrenalectomy are safe and effective. There is no difference in outcome between 2 approaches.

Subcostal Port Placement for Lateral Transperitoneoscopic Adrenalectomy: Assessment of Surgical Efficacy

“…Several approaches have been developed to reach and remove the adrenal glands [6][7][8]; of these, the LTP approach is the most popular technique for laparoscopic adrenalectomy [9]. However, as neither a standard approach to the adrenal region nor reliable criteria to select the most suitable route have been defined, a consensus has not been reached regarding the appropriate port placements for the previously reported LTP approach [10][11][12][13]. Because a model has shown the optical axis-to-target view (OATV) angle [17], alteration in angle of vision or the angle between the optical axis of the endoscope and the instruments' plane can influence surgical performance and altering the port configuration may possibly affect the outcomes [18,19].…”

“…Many surgeons choose a triangle port configuration in which the camera port is placed at or near the umbilicus with working ports around the adrenal region [10][11][12]. In such cases, if a patient is placed in the supine position, the abdominal organs must be widely mobilised to reach the area of the adrenal gland.…”

“…However, no standard lateral transperitoneal approach to the adrenal region has ever been defined. The approach varies among reports [10][11][12][13], as port placement is determined by the surgeon's preference based on individual experience. We first applied a triangular port configuration involving camera access just lateral to the edge of the rectus sheath at the level of the umbilicus; however, the visibility of the videoscope is less desirable, as it might be impaired by a sagging bowel.…”

Over 10 Years of Experience in the Laparoscopic Treatment of Adrenal Lesions via Lateral Transperitoneal Approach

“…Among possible accesses to the adrenal gland, the most often lateral transperitoneal approach is used (4,(10)(11)(12)(13)(14). It enables intraperitoneal diagnostic, visualization and the assessment of the inferior vena cava.…”

Flank approach versus anterior sub-mesocolic access in left laparoscopic adrenalectomy: a prospective randomized study

“…In 1992, Gagner reported three cases of laparoscopic adrenalectomy performed by lateral approach with the patient in the lateral decubitus position: the so-called lateral flank approach. Since then several reports have appeared on LA performed according to the minimally invasive technique by the flank, anterior, or posterior approach, with each author advocating the advantages and disadvantages inherent to their approach [3,10,22,23]. The posterior approach is routinely employed only in few centres, due to the fact that the anatomical landmarks are not easy to identify.…”