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Improving Minimally Invasive Adrenalectomy: Selection of Optimal Approach and Comparison of Outcomes

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Abstract

Introduction

Minimally invasive adrenalectomy is commonly performed by either a transperitoneal laparoscopic (TLA) or posterior retroperitoneoscopic (PRA) approach. Our group described the technique for robot-assisted PRA (RAPRA) in 2010. Few studies are available that directly compare outcomes between the available operative approaches. We reviewed our results for minimally invasive adrenalectomy using the three different approaches over a 10-year period.

Methods

Between January 2005 and April 2015, 160 minimally invasive adrenalectomies were performed. Clinicopathologic data were prospectively collected and retrospectively analyzed. The primary endpoints evaluated were operative time, blood loss, length of stay (LOS), and morbidity.

Results

The study included 67 TLA, 76 PRA, and 17 RAPRA procedures. Tumor size for PRA/RAPRA was smaller than for patients undergoing TLA (2.38 vs 3.6 cm, p ≤ 0.0001). Procedure time was shorter for PRA versus TLA (133.3 vs 152.8 min, p = 0.0381), as was LOS (1.85 vs 2.82 days, p = 0.0145). Procedure time was longer in RAPRA versus TLA/PRA (177 vs 153/133 min, p = 0.008), but LOS was significantly decreased (1.53 vs 2.82/1.85 days, p = 0.004).

Conclusions

Minimally invasive adrenalectomy is associated with expected excellent outcomes regardless of approach. In our series, the posterior approach is associated with decreased operative time and LOS. Robotic technology provides potential advantages for the surgeon at the expense of more complex setup requirements and costs. Further study is required to demonstrate clear benefit of one surgical approach. Utilization of the entire spectrum of available operative techniques can allow for selection of the optimal approach based on individual patient factors.

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Acknowledgments

The authors wish to acknowledge Cortney Y. Lee, MD, Benjamin R. Sigmond, MD, and Courtney E. Quinn, MD for their contributions in the technical development and data collection, and provision of clinical care for a large number of patients in the study.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Baylor Scott & White Health, MS-01-730C, 2401 S. 31st Street, Temple, TX, 76508, USA

    Terry C. Lairmore, Jessica Folek & Samuel K. Snyder

  2. Department of Surgery, Baylor Scott & White Hillcrest, 100 Hillcrest Medical Blvd, Waco, TX, 76712, USA

    Cara M. Govednik

Authors
  1. Terry C. Lairmore
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  2. Jessica Folek
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  3. Cara M. Govednik
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  4. Samuel K. Snyder
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Correspondence to Terry C. Lairmore.

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Lairmore, T.C., Folek, J., Govednik, C.M. et al. Improving Minimally Invasive Adrenalectomy: Selection of Optimal Approach and Comparison of Outcomes. World J Surg 40, 1625–1631 (2016). https://doi.org/10.1007/s00268-016-3471-8

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  • DOI: https://doi.org/10.1007/s00268-016-3471-8

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