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Posterior Retroperitoneoscopic Versus Laparoscopic Transperitoneal Adrenalectomy: A Systematic Review by an Updated
Paschalis Gavriilidis1,2, Christian Camenzuli3, Anna Paspala4
1Department of Endocrine and Thyroid Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 OHS, UK. pgavrielidis@yahoo.com.
World Journal of Surgery
|August 29, 2020
Summary
Posterior retroperitoneoscopic adrenalectomy (PRA) is associated with less blood loss, earlier oral intake, and shorter hospital stays compared to laparoscopic transperitoneal adrenalectomy (LTA). This makes PRA a valuable option for endocrine surgeons.
Area of Science:
- Minimally invasive surgical techniques in endocrinology.
- Comparative analysis of surgical approaches for adrenalectomy.
Background:
- Two primary minimally invasive adrenalectomy methods exist: laparoscopic transperitoneal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA).
- This study provides an updated meta-analysis comparing LTA and PRA using randomized controlled trials (RCTs) and non-randomized comparative trials (NRTs).
Purpose of the Study:
- To compare the efficacy and outcomes of laparoscopic transperitoneal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA).
- To evaluate key surgical and post-operative parameters between the two minimally invasive adrenalectomy techniques.
Main Methods:
- Systematic search of comparative LTA and PRA studies.
- Data extraction included demographics, operative time, estimated blood loss (EBL), conversion rates, post-operative pain, oral intake, ambulation, morbidity, hospital length of stay (HLOS), and mortality.
- Meta-analysis employed Mantel-Haenszel methods with fixed- and random-effect models, assessing study quality and heterogeneity.
Main Results:
- The analysis included 12 studies (3 RCTs, 9 NRTs) with 775 patients (44% PRA, 56% LTA).
- PRA was associated with smaller tumor sizes (0.78 cm less, p=0.003).
- Significant differences favored PRA: reduced EBL (18 ml less, p=0.006), earlier oral intake (3.4 h sooner, p=0.009), and shorter HLOS (0.84 days shorter, p=0.001).
Conclusions:
- Posterior retroperitoneoscopic adrenalectomy (PRA) demonstrates advantages in reduced blood loss, earlier post-operative oral intake, and shorter hospital stays.
- Despite being performed for smaller tumors, PRA offers significant benefits.
- PRA is a valuable tool for endocrine surgeons in appropriately selected patients.
