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Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift

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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.

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Disclosures

Andreas Kiriakopoulos, Konstantinos P. Economopoulos, Efthimios Poulios, and Dimitrios Linos have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, “Hygeia”’ Hospital, 4 Erythrou Stavrou Street and Kifissias Avenue, Marousi, 15123, Athens, Greece

    Andreas Kiriakopoulos, Konstantinos P. Economopoulos, Efthimios Poulios & Dimitrios Linos

  2. University of Athens, School of Medicine, Athens, Greece

    Konstantinos P. Economopoulos & Dimitrios Linos

Authors
  1. Andreas Kiriakopoulos
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  2. Konstantinos P. Economopoulos
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  3. Efthimios Poulios
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  4. Dimitrios Linos
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Corresponding author

Correspondence to Andreas Kiriakopoulos.

Additional information

Presented at the SAGES 2011 Annual Meeting, March 30–April 2, 2011, San Antonio, TX.

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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

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  • DOI: https://doi.org/10.1007/s00464-011-1762-6

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