Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases.

Area of Science:

• Minimally invasive surgery
• Endocrine surgery
• Urology

Background:

• Minimally invasive adrenalectomy is preferred for benign adrenal pathology.
• The retroperitoneal space is the natural location for adrenal glands, yet transperitoneal laparoscopic approaches are more common.
• Endoscopic retroperitoneal adrenalectomy (ERA) offers an alternative minimally invasive technique.

Purpose of the Study:

• To evaluate the effectiveness and outcomes of endoscopic retroperitoneal adrenalectomy (ERA).
• To assess ERA's safety and efficacy in treating various adrenal pathologies.
• To compare unilateral and bilateral ERA procedures.

Main Methods:

• A retrospective review of 111 endoscopic retroperitoneal adrenalectomies (ERAs) performed between January 1994 and December 1999.
• Analysis of clinical characteristics, surgical outcomes, complications, and follow-up data.
• Inclusion of patients with diverse adrenal conditions, including Cushing syndrome, Conn's adenoma, and pheochromocytoma.

Main Results:

• The study included 95 patients undergoing 111 ERAs (79 unilateral, 16 bilateral) for various adrenal conditions.
• Median operative time for unilateral ERA was 114 minutes with 65 mL blood loss; bilateral ERA took 214 minutes with 121 mL blood loss.
• The conversion rate to open surgery was 4.5%, complication rate was 11%, and mortality rate was 0.9%. Median hospital stay was 2 days (unilateral) and 5 days (bilateral).

Conclusions:

• Endoscopic retroperitoneal adrenalectomy (ERA) is a safe and effective minimally invasive procedure for benign adrenal tumors.
• ERA is particularly recommended for benign adrenal tumors smaller than 6 cm.
• The study demonstrates low recurrence rates (0.9%) at a median follow-up of 14 months.