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Posterior retroperitoneoscopic adrenalectomy: outcomes and lessons learned from initial 50 cases
Miguel S Cabalag1,2, G Bruce Mann1,3, Alexandra Gorelik4
1Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.
ANZ Journal of Surgery
|January 21, 2014
Summary
Posterior retroperitoneoscopic adrenalectomy (PRA) offers a safe and effective minimally invasive approach for adrenal gland removal. This study of 50 cases demonstrates a short learning curve, minimal pain, and brief hospital stays, supporting PRA as a viable alternative.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Endocrinology
Background:
- Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative to laparoscopic transperitoneal adrenalectomy (LA).
- PRA may offer reduced pain and faster recovery.
- The study audited the initial 50 PRA cases after a change in surgical approach.
Purpose of the Study:
- To evaluate the safety and outcomes of posterior retroperitoneoscopic adrenalectomy (PRA).
- To assess the learning curve associated with PRA.
- To compare PRA outcomes with established minimally invasive techniques.
Main Methods:
- Prospective data collection for 50 consecutive PRAs performed by a single surgeon.
- Recording of patient demographics, tumor characteristics, analgesia, operative times, length of stay, and complications.
- Analysis of data following an initial learning curve period.
Main Results:
- Fifty adrenalectomies were performed in 49 patients, with a median age of 58.5 years.
- Post-learning curve operative times decreased, with minimal post-operative analgesia required (median 0 mg morphine equivalent).
- Median length of stay was 1 day, with 16% same-day discharges and a low complication rate (4 cases).
Conclusions:
- Posterior retroperitoneoscopic adrenalectomy (PRA) is a safe and effective procedure.
- PRA is associated with a relatively short learning curve for surgeons.
- The technique results in minimal post-operative pain and short hospitalizations.
