Laparoscopic adrenalectomy: transperitoneal vs retroperitoneal approaches

To compare the results between transperitoneal and retroperitoneal approaches.

Between 17 January 1992 and 31 December 1997, 76 patients (31 men and 45 women, 37 right and 37 left, mean 46.7 years old) with adrenal tumors including 37 primary aldosteronism. 19 Cushing's syndrome, 15 non-functioning adrenal tumors, and five pheochromocytomas, underwent laparoscopic removal operations in one hospital. Fifty-seven open adrenalectomies were also included.

Fifty-two patients by transperitoneal laparoscopic approach, and the other 24 patients by retroperitoneal laparoscopic approach were compared.

Mean operative time, operative blood loss, time to oral intake, and ambulation of transperitoneal approach were 203 min, 115.6 mL, 1.9 days, and 1.4 days. In patients operated on by the retroperitoneal approach, these factors were 257 min, 141.6 mL, 1.1 days, and 1.4 days. There was no significant difference in any item between the two groups. In patients operated on by open procedure, these factors were 143 min, 214 mL, 2.5 days, and 2.4 days. Operating time of the open surgery group was significantly shorter than either of the other two groups, and all of the other three items of open surgery group were significantly greater than either of the other two groups. Open surgery was required in two of 76 patients treated by endoscopic procedure due to inadvertent injury of the anomalous adrenal vein during the transperitoneal approach, and pancreatic injury during the retroperitoneal approach. During and after the operation, no significant complication was observed.

Both transperitoneal and retroperitoneal laparoscopic adrenalectomies are feasible for adrenal tumors.