Comparative analysis of transabdominal and retroperitoneal approaches in adrenalectomy
DOI:
https://doi.org/10.30978/GS-2023-3-8Keywords:
retroperitoneoscopic adrenalectomy, transabdominal adrenalectomy, minimally invasive adrenal surgery, adrenalectomyAbstract
Laparoscopic adrenalectomy has been recognised as the «gold standard» approach for benign adrenal tumours. The majority of surgeons opt for transabdominal laparoscopic adrenalectomies, while retroperitoneoscopic adrenalectomies in the prone position, which were pioneered by Waltz, offer certain advantages for patients.
Objective — to compare the effectiveness and complication rates of transabdominal and retroperitoneoscopic laparoscopic adrenalectomies.
Materials and methods. Between 2000 and 2021, our clinic performed 472 laparoscopic adrenalectomies. The age of the patients ranged from 19 to 79 years, with a mean age of 50.5±10.2 years. The patient pool consisted of 315 women and 157 men. The primary indications for operation were as follows: incidentaloma (32.5%), pheochromocytoma (30.2%), aldosteronoma (19%), corticosteroma (10.3%), myelolipoma (3.0%), and metastatic cancer (5.0%). Tumour sizes ranged from 1 to 10 cm.
Results. A total of 316 patients underwent transabdominal adrenalectomies: 206 patients had right adrenalectomies and 110 patients had left adrenalectomies. A total of 156 patients underwent retroperitoneoscopic adrenalectomies. Seven patients required a conversion to a transabdominal approach, including three patients with tumours exceeding 6 cm in size and four patients with tumours ranging from 4 to 6 cm. The conversion rate amounted to 4.9%. The retroperitoneoscopic approach showed certain advantages for patients with small tumours, including shorter surgery duration, lower operative blood loss, diminished postoperative pain intensity, a lower incidence of shoulder‑tip pain, a faster transition to oral intake, and shorter hospital stays.
Conclusions. Both approaches were equally safe. In patients with small tumours, retroperitoneoscopic adrenalectomies outperformed the transabdominal approach in terms of shorter surgery duration, lower blood loss, lower postoperative pain, faster recovery, and favourable cosmetic results. In patients with large tumours, the transabdominal approach demonstrated better outcomes, with lower complication and conversion rates.
References
Agcaoglu O, Sahin DA, Siperstein A, Berber E. Selection algorithm for posterior versus lateral approach in laparoscopic adrenalectomy. Surgery. 2012 May;151(5):731-5. http://doi.org/10.1016/j.surg.2011.12.010. Epub 2012 Jan 18. PMID: 22261293.
Arezzo A, Bullano A, Cochetti G, Cirocchi R, Randolph J, Mearini E, Evangelista A, Ciccone G, Bonjer HJ, Morino M. Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults. Cochrane Database Syst Rev. 2018 Dec 30;12(12):CD011668. http://doi.org/10.1002/14651858.CD011668.pub2. PMID: 30595004; PMCID: PMC6517116.
Barczyński M, Konturek A, Nowak W. Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg. 2014 Nov;260(5):740-7; discussion 747-8. http://doi.org/10.1097/SLA.0000000000000982. PMID: 25243546.
Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A. Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery. 2009 Oct;146(4):621-5; discussion 625-6. http://doi.org/10.1016/j.surg.2009.06.057. PMID: 19789020.
Broome JT, Solorzano CC. Impact of surgical mentorship on retroperitoneoscopic adrenalectomy with comparison to transperitoneal laparoscopic adrenalectomy. Am Surg. 2013 Feb;79(2):162-6. PMID: 23336655.
Brunaud L, Nguyen-Thi PL, Mirallie E, Raffaelli M, Vriens M, Theveniaud PE, Boutami M, Finnerty BM, Vorselaars WM, Rinkes IB, Bellantone R, Lombardi C, Fahey T 3rd, Zarnegar R, Bresler L. Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients. Surg Endosc. 2016 Mar;30(3):1051-9. http://doi.org/10.1007/s00464-015-4294-7. Epub 2015 Jun 20. PMID: 26092019.
Chai YJ, Kwon H, Yu HW, Kim SJ, Choi JY, Lee KE, Youn YK. Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy. Int J Endocrinol. 2014;2014:918346. http://doi.org/10.1155/2014/918346. Epub 2014 Dec 17. PMID: 25587275; PMCID: PMC4281398.
Chen W, Li F, Chen D, Zhu Y, He C, Du Y, Tan W. Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutan Tech. 2013 Apr;23(2):121-7. http://doi.org/10.1097/SLE.0b013e3182827b57. PMID: 23579504.
Conzo G, Tartaglia E, Gambardella C, Esposito D, Sciascia V, Mauriello C, Nunziata A, Siciliano G, Izzo G, Cavallo F, Thomas G, Musella M, Santini L. Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg. 2016 Apr;28 Suppl 1:S118-23. http://doi.org/10.1016/j.ijsu.2015.12.042. Epub 2015 Dec 18. PMID: 26708860.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. http://doi.org/10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.
Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors. Eur J Endocrinol. 2016 Aug;175(2):G1-G34. http://doi.org/10.1530/EJE-16-0467. PMID: 27390021.
Fernández-Cruz L, Saenz A, Benarroch G, Astudillo E, Taura P, Sabater L. Laparoscopic unilateral and bilateral adrenalectomy for Cushing’s syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg. 1996 Dec;224(6):727-34; discussion 734-6. http://doi.org/10.1097/00000658-199612000-00008. PMID: 8968227; PMCID: PMC1235468.
Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med. 1992 Oct 1;327(14):1033. http://doi.org/10.1056/NEJM199210013271417. PMID: 1387700.
Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A. Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg. 1997 Sep;226(3):238-46; discussion 246-7. http://doi.org/10.1097/00000658-199709000-00003. PMID: 9339930; PMCID: PMC1191015.
Gagner M. Laparoscopic adrenalectomy. Surg Clin North Am. 1996 Jun;76(3):523-37. http://doi.org/10.1016/s0039-6109(05)70459-x. PMID: 8669012.
Lee CR, Walz MK, Park S, Park JH, Jeong JS, Lee SH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol. 2012 Aug;19(8):2629-34. http://doi.org/10.1245/s10434-012-2352-0. Epub 2012 Apr 20. PMID: 22526902.
Lezoche E, Guerrieri M, Crosta F, Paganini A, D’Ambrosio G, Lezoche G, Campagnacci R. Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Surg Endosc. 2008 Feb;22(2):522-6. http://doi.org/10.1007/s00464-007-9555-7. Epub 2007 Aug 19. PMID: 17705067.
Mohammadi-Fallah MR, Mehdizadeh A, Badalzadeh A, Izadseresht B, Dadkhah N, Barbod A, Babaie M, Hamedanchi S. Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study. J Laparoendosc Adv Surg Tech A. 2013 Apr;23(4):362-6. http://doi.org/10.1089/lap.2012.0301. PMID: 23573882.
Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013 Jan;153(1):111-9. http://doi.org/10.1016/j.surg.2012.05.042. Epub 2012 Aug 30. PMID: 22939744.
Oh JY, Chung HS, Yu SH, Kim MS, Yu HS, Hwang EC, Oh KJ, Kim SO, Jung SI, Kang TW, Park K, Kwon D. Comparison of surgical outcomes between lateral and posterior approaches for retroperitoneal laparoscopic adrenalectomy: A single surgeon’s experience. Investig Clin Urol. 2020 Mar;61(2):180-187. http://doi.org/10.4111/icu.2020.61.2.180. Epub 2020 Feb 5. PMID: 32158969; PMCID: PMC7052412.
Ottlakan A, Paszt A, Simonka Z, Abraham S, Borda B, Vas M, Teleky B, Balogh A, Lazar G. Laparoscopic transperitoneal and retroperitoneal adrenalectomy: a 20-year, single-institution experience with an analysis of the learning curve and tumor size [lap transper and retroper adrenalectomy]. Surg Endosc. 2020 Dec;34(12):5421-5427. http://doi.org/10.1007/s00464-019-07337-1. Epub 2020 Jan 17. PMID: 31953726; PMCID: PMC7644518.
Prager G, Heinz-Peer G, Passler C, Kaczirek K, Scheuba C, Niederle B. Applicability of laparoscopic adrenalectomy in a prospective study in 150 consecutive patients. Arch Surg. 2004 Jan;139(1):46-9. http://doi.org/10.1001/archsurg.139.1.46. PMID: 14718275.
Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, Moinzadeh A, Ukimura O, Desai MM, Kaouk J, Bravo E. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005 Aug;174(2):442-5; discussion 445. http://doi.org/10.1097/01.ju.0000165336.44836.2d. PMID: 16006861.
Shiraishi K, Kitahara S, Ito H, Oba K, Ohmi C, Matsuyama H. Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: Comparative outcomes. Int J Urol. 2019 Feb;26(2):212-216. http://doi.org/10.1111/iju.13838. Epub 2018 Nov 14. PMID: 30430653.
Tiberio GA, Solaini L, Arru L, Merigo G, Baiocchi GL, Giulini SM. Factors influencing outcomes in laparoscopic adrenal surgery. Langenbecks Arch Surg. 2013 Jun;398(5):735-43. http://doi.org/10.1007/s00423-013-1082-5. Epub 2013 Apr 30. PMID: 23624880.
Treter S, Perrier N, Sosa JA, Roman S. Telementoring: a multi-institutional experience with the introduction of a novel surgical approach for adrenalectomy. Ann Surg Oncol. 2013 Aug;20(8):2754-8. http://doi.org/10.1245/s10434-013-2894-9. Epub 2013 Mar 20. PMID: 23512076.
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. Posterior retroperitoneoscopic adrenalectomy-results of 560 procedures in 520 patients. Surgery. 2006 Dec;140(6):943-8; discussion 948-50. http://doi.org/10.1016/j.surg.2006.07.039. PMID: 17188142.
Zhang M, Wang H, Guo F, Xue W. Retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for pheochromocytoma: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne. 2023 Mar;18(1):11-19. http://doi.org/10.5114/wiitm.2022.120419. Epub 2022 Oct 19. PMID: 37064558; PMCID: PMC10091911.
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