Equivalent Pain and Opioid Use Between Transabdominal and Retroperitoneal Adrenalectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Urology

Background:

• Laparoscopic transabdominal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA) are established, safe, and effective surgical techniques for adrenal gland removal.
• A direct comparative analysis of postoperative pain and opioid consumption between LTA and PRA is crucial for optimizing surgical decision-making.

Purpose of the Study:

• To directly compare postoperative pain and opioid utilization between laparoscopic transabdominal adrenalectomy (LTA) and posterior retroperitoneoscopic adrenalectomy (PRA).
• To evaluate the impact of surgical approach on patient-reported pain, opioid use, length of stay, and readmission rates.

Main Methods:

• A retrospective analysis of adult patients who underwent laparoscopic adrenalectomy between 2015 and 2021 at a tertiary care center.
• Key outcomes including perioperative opioid use and patient-reported pain scores were analyzed using multivariate linear regression, comparing LTA and PRA approaches.
• Additional data collected included post-discharge pain, prescription refills, length of stay, and 30-day readmission rates.

Main Results:

• The study included 88 LTA and 39 PRA procedures, with a patient population averaging 54 years of age, 58% female, and 75% with functional adrenal tumors.
• No statistically significant differences were observed in pain scores at rest (4.4 LTA vs. 4.5 PRA) or during activity (4.7 LTA vs. 5.6 PRA).
• Median opioid use was 110.3 MME for LTA versus 91.0 MME for PRA (P=0.16), with multivariate analysis showing no significant difference between the approaches (-9.3 MME).

Conclusions:

• Posterior retroperitoneoscopic adrenalectomy (PRA) does not offer a significant advantage over laparoscopic transabdominal adrenalectomy (LTA) regarding postoperative pain or opioid consumption.
• Both LTA and PRA demonstrate comparable clinical outcomes, suggesting that the selection of surgical approach should be individualized based on patient-specific factors.
• The findings contrast with some prior studies, highlighting the need for careful consideration of patient characteristics in surgical planning for adrenalectomy.