Abstract
Background
Posterior retroperitoneoscopic adrenalectomy has substituted its anterior laparoscopic counterpart as the treatment of choice in the management of adrenal tumors at the authors’ institution. The authors present their comparative results between these operative techniques, demonstrating the reasons for this change.
Methods
From May 2008 to September 2010, 30 patients underwent posterior retroperitoneoscopic adrenalectomy. Operative time, complications, hospital stay, postoperative pain, and cost were compared with those of 30 selected laparoscopic control subjects treated from 2005 to 2010. Statistical analysis was based on Chi-square, the Mann–Whitney U test, the independent-samples t-test, and the Wilcoxon matched pairs test, as appropriate.
Results
The median tumor size was 3.8 cm (range, 1.5–8.0 cm) in the retroperitoneoscopic group and 4.9 cm (range, 2.4–8.0 cm) in the laparoscopic group. The median operative time was similar between the two groups (90.0 min; range, 60–165 min vs. 77.5 min; range, 55–120 min; P = 0.138). It was, however, significantly reduced after the 20th case (97.5 min; range, 80–165 min vs. 70 min; range, 60–110 min; P < 0.001) in the retroperitoneoscopic group. The median visual analog pain scores were significantly lower in the retroperitoneoscopic group on both the first and the third postoperative days, respectively (1; range, 0–1 vs. 4; range, 3–6; P < 0.001 and 0; range, 0–1 vs. 3; range, 2–6; P < 0.001). The median postoperative hospital stay also was shorter in the retroperitoneoscopic group (2 days; range, 2–3 days vs. 4 days; range, 3–6 days; P < 0.001). The cost of the posterior approach was significantly less than that of the laparoscopic technique (P < 0.001).
Conclusions
Posterior retroperitoneoscopic adrenalectomy compared with laparoscopic adrenalectomy was safe, fast, and vastly superior in terms of postoperative pain and hospital stay in this series. Because of the ability to reproduce such excellent operative results, the impressive patient recovery, and the significantly reduced operative cost, the authors suggest that the retroperitoneoscopic approach should become the method of choice in minimally invasive adrenal surgery.
Similar content being viewed by others
References
Walz MK, Alesina PF, Wenger FA, Deligiannis A, Szuczik E, Petersenn S, Ommer A, Groeben H, Peitgen K, Janssen OE, Philipp T, Neumann HP, Schmid KW, Mann K (2006) Posterior retroperitoneoscopic adrenalectomy: results of 560 procedures in 520 patients. Surgery 140:943–948 discussion 8–50
Walz MK, Peitgen K, Hoermann R, Giebler RM, Mann K, Eigler FW (1996) Posterior retroperitoneoscopy as a new minimally invasive approach for adrenalectomy: results of 30 adrenalectomies in 27 patients. World J Surg 20:769–774
Baba S, Miyajima A, Uchida A, Asanuma H, Miyakawa A, Murai M (1997) A posterior lumbar approach for retroperitoneoscopic adrenalectomy: assessment of surgical efficacy. Urology 50:19–24
Gasman D, Droupy S, Koutani A, Salomon L, Antiphon P, Chassagnon J, Chopin DK, Abbou CC (1998) Laparoscopic adrenalectomy: the retroperitoneal approach. J Urol 159:1816–1820
Hanssen WE, Kuhry E, Casseres YA, de Herder WW, Steyerberg EW, Bonjer HJ (2006) Safety and efficacy of endoscopic retroperitoneal adrenalectomy. Br J Surg 93:715–719
Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, Moinzadeh A, Ukimura O, Desai MM, Kaouk J, Bravo E (2005) Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol 174:442–445 discussion 445
Terachi T, Yoshida O, Matsuda T, Orikasa S, Chiba Y, Takahashi K, Takeda M, Higashihara E, Murai M, Baba S, Fujita K, Suzuki K, Ohshima S, Ono Y, Kumazawa J, Naito S (2000) Complications of laparoscopic and retroperitoneoscopic adrenalectomies in 370 cases in Japan: a multi-institutional study. Biomed Pharmacother 54(Suppl 1):211s–214s
Walz MK, Peitgen K, Krause U, Eigler FW (1995) Dorsal retroperitoneoscopic adrenalectomy: a new surgical technique. Zentralbl Chir 120:53–58
Martin K, Walz MK (2005) Posterior retroperitonescopic adrenalectomy. In: Linos DA, van Heerden JA (eds) Adrenal glands: diagnostic aspects and surgical therapy. Springer-Verlag, Heidelberg
Proye CA, Huart JY, Cuvillier XD, Assez NM, Gambardella B, Carnaille BM (1993) Safety of the posterior approach in adrenal surgery: experience in 105 cases. Surgery 114:1126–1131
Russell CF, Hamberger B, van Heerden JA, Edis AJ, Ilstrup DM (1982) Adrenalectomy: anterior or posterior approach? Am J Surg 144:322–324
Fernandez-Cruz L, Benarroch G, Torres E, Astudillo E, Saenz A, Taura P (1993) Laparoscopic approach to the adrenal tumors. J Laparoendosc Surg 3:541–546
Gagner M, Lacroix A, Prinz RA, Bolte E, Albala D, Potvin C, Hamet P, Kuchel O, Querin S, Pomp A (1993) Early experience with laparoscopic approach for adrenalectomy. Surgery 114:1120–1124 discussion 1124–1125
Linos DA, Stylopoulos N, Boukis M, Souvatzoglou A, Raptis S, Papadimitriou J (1997) Anterior, posterior, or laparoscopic approach for the management of adrenal diseases? Am J Surg 173:120–125
Duh QY, Siperstein AE, Clark OH, Schecter WP, Horn JK, Harrison MR, Hunt TK, Way LW (1996) Laparoscopic adrenalectomy: comparison of the lateral and posterior approaches. Arch Surg 131:870–875 discussion 875—876
Gaur DD (1995) Retroperitoneal surgery of the kidney, ureter, and adrenal gland. Endosc Surg Allied Technol 3:3–8
Mandressi A, Buizza C, Antonelli D (1993) Retro-extraperitoneal laparoscopic approach to excise retroperitoneal organs, kidney, and adrenal gland. Min Invasive Ther 2:213
Yoneda K, Shiba E, Watanabe T, Akazawa K, Shimazu K, Takamura Y, Kim S, Tsukamoto F, Tanji Y, Taguchi T, Noguchi S (2000) Laparoscopic adrenalectomy: lateral transabdominal approach vs posterior retroperitoneal approach. Biomed Pharmacother 54(Suppl 1):215s–219s
Tai CK, Li SK, Hou SM, Fan CW, Fung TC, Wah MK (2006) Laparoscopic adrenalectomy: comparison of lateral transperitoneal and lateral retroperitoneal approaches. Surg Laparosc Endosc Percutan Tech 16:141–145
Disclosures
Andreas Kiriakopoulos, Konstantinos P. Economopoulos, Efthimios Poulios, and Dimitrios Linos have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX.
Rights and permissions
About this article
Cite this article
Kiriakopoulos, A., Economopoulos, K.P., Poulios, E. et al. Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift. Surg Endosc 25, 3584–3589 (2011). https://doi.org/10.1007/s00464-011-1762-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1762-6