Skip to main content

Advertisement

SpringerLink
Log in

Transabdominal and retroperitoneal adrenalectomy: comparative study

  • 2023 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic adrenalectomy is recognized as the "gold standard" approach for benign adrenal tumors. The majority of surgeons opt for laparoscopic transabdominal adrenalectomies (LTA), while retroperitoneoscopic adrenalectomies (RPA) in the prone position have certain advantages for patients. The aim of this study was to compare the effectiveness and safety of the transabdominal and retroperitoneoscopic laparoscopic adrenalectomies.

Materials and methods

Between 2000 and 2021, our clinic performed 472 laparoscopic adrenalectomies. The age 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. Tumor sizes ranged from 1 to 10 cm.

Results

In a study of 316 patients undergoing LTA versus 156 with RPA, the TLA averaged 82.5 min (70–98), while the RPA took 56.4 min (46–62) (P < 0.001). Intraoperative blood loss was 110 cc for the LTA group and 80 cc for the RPA group (P < 0.05) Conversion rates stood at 2.5% for transabdominal and 4.5% for retroperitoneoscopic procedures (P = 0.254). At 24 h post-operation, pain scores were 3.6 and 1.6, respectively (P < 0.001). Time to resume solid oral intake was 15.2 h for TLA and 8 h for RPA, with hospital stays at 4.5 days and 3 days respectively (P < 0.001). Short-term complications occurred in 8.9% of transabdominal and 12.2% of retroperitoneoscopic patients (P = 0.257).

Conclusions

For small tumors, RPA offers advantages over the transabdominal method in surgery time, blood loss, post-op pain, and recovery. These benefits are enhanced for patients with prior abdominal surgeries. However, large tumors present challenges in the retroperitoneal approach due to limited space and anatomical orientation. If complications emerge, surgeons can seamlessly switch to the LTA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fassnacht M, Arlt W, Bancos I, Dralle H, Newell-Price J, Sahdev A, Tabarin A, Terzolo M, Tsagarakis S, Dekkers OM (2016) 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 175(2):G1–G34. https://doi.org/10.1530/EJE-16-0467

    Article  CAS  PubMed  Google Scholar 

  2. Gagner M, Lacroix A, Bolté E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327(14):1033. https://doi.org/10.1056/NEJM199210013271417

    Article  CAS  PubMed  Google Scholar 

  3. Berber E, Tellioglu G, Harvey A, Mitchell J, Milas M, Siperstein A (2009) Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery 146(4):621–626. https://doi.org/10.1016/j.surg.2009.06.057

    Article  PubMed  Google Scholar 

  4. Lezoche E, Guerrieri M, Crosta F, Paganini A, D’Ambrosio G, Lezoche G, Campagnacci R (2008) Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach. Surg Endosc 22(2):522–526. https://doi.org/10.1007/s00464-007-9555-7

    Article  PubMed  Google Scholar 

  5. Mercan S, Seven R, Ozarmagan S, Tezelman S (1995) Endoscopic retroperitoneal adrenalectomy. Surgery 118(6):1071–1075. https://doi.org/10.1016/s0039-6060(05)80116-3. (discussion 1075–1076)

    Article  CAS  PubMed  Google Scholar 

  6. Lee CR, Walz MK, Park S, Park JH, Jeong JS, Lee SH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS (2012) A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol 19(8):2629–2634. https://doi.org/10.1245/s10434-012-2352-0

    Article  PubMed  Google Scholar 

  7. 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 (2016) Minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg (Lond, Engl) 28(Suppl 1):S118–S123. https://doi.org/10.1016/j.ijsu.2015.12.042

    Article  Google Scholar 

  8. Prager G, Heinz-Peer G, Passler C, Kaczirek K, Scheuba C, Niederle B (2004) Applicability of laparoscopic adrenalectomy in a prospective study in 150 consecutive patients. Arch Surg 139(1):46–49. https://doi.org/10.1001/archsurg.139.1.46

    Article  PubMed  Google Scholar 

  9. Gagner M (1996) Laparoscopic adrenalectomy. Surg Clin N Am 76(3):523–537. https://doi.org/10.1016/s0039-6109(05)70459-x

    Article  CAS  PubMed  Google Scholar 

  10. Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A (1997) Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 226(3):238–247. https://doi.org/10.1097/00000658-199709000-00003

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zhang M, Wang H, Guo F, Xue W (2023) Retroperitoneal laparoscopic adrenalectomy versus transperitoneal laparoscopic adrenalectomy for pheochromocytoma: a systematic review and meta-analysis. Wideochirurgia i Inne Techniki Maloinwazyjne 18(1):11–19. https://doi.org/10.5114/wiitm.2022.120419

    Article  PubMed  Google Scholar 

  13. Chen W, Li F, Chen D, Zhu Y, He C, Du Y, Tan W (2013) Retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adrenal tumor: a meta-analysis. Surg Laparosc Endosc Percutan Tech 23(2):121–127. https://doi.org/10.1097/SLE.0b013e3182827b57

    Article  PubMed  Google Scholar 

  14. Arezzo A, Bullano A, Cochetti G, Cirocchi R, Randolph J, Mearini E, Evangelista A, Ciccone G, Bonjer HJ, Morino M (2018) Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for adrenal tumours in adults. Cochrane Database Syst Rev 12(12):1668. https://doi.org/10.1002/14651858.CD011668.pub2

    Article  Google Scholar 

  15. Oh JY, Chung HS, Yu SH, Kim MS, Yu HS, Hwang EC, Oh KJ, Kim SO, Jung SI, Kang TW, Park K, Kwon D (2020) Comparison of surgical outcomes between lateral and posterior approaches for retroperitoneal laparoscopic adrenalectomy: a single surgeon’s experience. Investig Clin Urol 61(2):180–187. https://doi.org/10.4111/icu.2020.61.2.180

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fernández-Cruz L, Saenz A, Benarroch G, Astudillo E, Taura P, Sabater L (1996) Laparoscopic unilateral and bilateral adrenalectomy for Cushing’s syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg 224(6):727–736. https://doi.org/10.1097/00000658-199612000-00008

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mohammadi-Fallah MR, Mehdizadeh A, Badalzadeh A, Izadseresht B, Dadkhah N, Barbod A, Babaie M, Hamedanchi S (2013) Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study. J Laparoendosc Adv Surg Tech A 23(4):362–366. https://doi.org/10.1089/lap.2012.0301

    Article  PubMed  Google Scholar 

  18. 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(2):442–445. https://doi.org/10.1097/01.ju.0000165336.44836.2d

    Article  PubMed  Google Scholar 

  19. 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(6):943–950. https://doi.org/10.1016/j.surg.2006.07.039

    Article  PubMed  Google Scholar 

  20. Barczyński M, Konturek A, Nowak W (2014) Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg 260(5):740–748. https://doi.org/10.1097/SLA.0000000000000982

    Article  PubMed  Google Scholar 

  21. Nigri G, Rosman AS, Petrucciani N, Fancellu A, Pisano M, Zorcolo L, Ramacciato G, Melis M (2013) Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery 153(1):111–119. https://doi.org/10.1016/j.surg.2012.05.042

    Article  PubMed  Google Scholar 

  22. Chai YJ, Kwon H, Yu HW, Kim SJ, Choi JY, Lee KE, Youn YK (2014) Systematic review of surgical approaches for adrenal tumors: lateral transperitoneal versus posterior retroperitoneal and laparoscopic versus robotic adrenalectomy. Int J Endocrinol. https://doi.org/10.1155/2014/918346

    Article  PubMed  PubMed Central  Google Scholar 

  23. Tiberio GA, Solaini L, Arru L, Merigo G, Baiocchi GL, Giulini SM (2013) Factors influencing outcomes in laparoscopic adrenal surgery. Langenbecks Arch Surg 398(5):735–743. https://doi.org/10.1007/s00423-013-1082-5

    Article  PubMed  Google Scholar 

  24. Ottlakan A, Paszt A, Simonka Z, Abraham S, Borda B, Vas M, Teleky B, Balogh A, Lazar G (2020) 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 34(12):5421–5427. https://doi.org/10.1007/s00464-019-07337-1

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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 (2016) Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients. Surg Endosc 30(3):1051–1059. https://doi.org/10.1007/s00464-015-4294-7

    Article  PubMed  Google Scholar 

  26. Shiraishi K, Kitahara S, Ito H, Oba K, Ohmi C, Matsuyama H (2019) Transperitoneal versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: comparative outcomes. Int J Urol 26(2):212–216. https://doi.org/10.1111/iju.13838

    Article  PubMed  Google Scholar 

  27. Broome JT, Solorzano CC (2013) Impact of surgical mentorship on retroperitoneoscopic adrenalectomy with comparison to transperitoneal laparoscopic adrenalectomy. Am Surg 79(2):162–166

    Article  PubMed  Google Scholar 

  28. Treter S, Perrier N, Sosa JA, Roman S (2013) Telementoring: a multi-institutional experience with the introduction of a novel surgical approach for adrenalectomy. Ann Surg Oncol 20(8):2754–2758. https://doi.org/10.1245/s10434-013-2894-9

    Article  PubMed  Google Scholar 

  29. Agcaoglu O, Sahin DA, Siperstein A, Berber E (2012) Selection algorithm for posterior versus lateral approach in laparoscopic adrenalectomy. Surgery 151(5):731–735. https://doi.org/10.1016/j.surg.2011.12.010

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Odessa National Medical University, Valikhovskiy lane, 2, Odesa, Ukraine

    Volodymyr V. Grubnik, Roman S. Parfentiev, Viktor V. Grubnyk, Yurii V. Grubnik & Vladyslav V. Sliepov

Authors
  1. Volodymyr V. Grubnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roman S. Parfentiev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Viktor V. Grubnyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yurii V. Grubnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vladyslav V. Sliepov
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Viktor V. Grubnyk.

Ethics declarations

Disclosures

Viktor V. Grubnyk, Volodymyr V. Grubnik, Yurii V. Grubnik, Vladyslav V Sliepov and Roman S. Parfentiev have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Grubnik, V.V., Parfentiev, R.S., Grubnyk, V.V. et al. Transabdominal and retroperitoneal adrenalectomy: comparative study. Surg Endosc 38, 1541–1547 (2024). https://doi.org/10.1007/s00464-023-10533-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10533-9

Keywords

Search

Navigation