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Endoscopic adrenalectomy: Is there an optimal operative approach? Results of a single-center case-control study
Celestino Pio Lombardi1, Marco Raffaelli, Carmela De Crea
1Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
Background:
The choice in between the laparoscopic lateral transabdominal (LTA) or the posterior retroperitoneoscopic (PRA) approach for adrenalectomy is usually based on surgeon's preference, rather than on objective arguments. We compared the intraoperative and postoperative outcomes of LTA and PRA to determine whether there is a preferable approach.
Methods:
Thirty-eight consecutive patients successfully underwent PRA for benign adrenal tumors
Results:
The 2 groups did not differ in terms of operative time, analgesic requirement, time to first flatus, complication rate, duration of postoperative stay, or final histology. Patients in the LTA group showed significantly lower Paco(2), Pao(2), and Vco(2) at the end of the operation. Patients in the PRA group experienced a significantly faster return to work.
Conclusion:
No procedure can be considered preferable overall. In cases of bilateral adrenalectomy and previous abdominal surgery, PRA may offer some advantages. Surgeon's preference and experience will continue to guide this choice.
