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Updated: Sep 20, 2025
Laparoscopic Posterior Radical Antegrade Modular Pancreatosplenectomy for Distal Pancreatic Carcinoma
Published on: December 29, 2023
The modified retroperitoneal laparoscopic adrenalectomy overcomes adhesive periadrenal fat and achieves superior
Minxiong Hu1,2, Wenchao Cai1,2, Yupeng Chen3
1Shengli Clinical College of Fujian Medical University, 134 Dongjie, Gulou District, Fuzhou City, Fujian Province, 350001, China.
Objectives:
Mayo adhesive probability (MAP) score affects the outcomes of adrenaletomy. Aimed to determine whether the modified retroperitoneal laparoscopic adrenalectomy (MRLA) overcomes periadrenal fat adhesion compared to Classical retroperitoneal laparoscopic adrenalectomy (CRLA) to achieve better surgical outcomes.
Patients And Methods:
Patients admitted from January 2016 to December 2022 were retrospectively analyzed and systematically categorized into two distinct cohorts: the MRLA group and the CRLA group, based on specific criteria.The main surgical techniques modified of MRLA is third separation level: between the edge of adrenal gland and the peripheral renal fat. The baseline characteristics and perioperative data, e.g., age, gender, BMI, tumor position, tumor size (cm), MAP score, P distance (cm), perinephric stranding, and periadrenal stranding, estimated blood loss, Operating time, were analyzed, with statistical significance defined as p < 0.05. We analyzed the differences between groups using the t test. For measurement data that didn't follow normal distribution, we described the concentration and dispersion trended using M (Q25, Q75) and analyzed the differences between groups using the M-U test. For data that met certain conditions like being linear, normal and independent, we used linear regression analysis. For binary classification of dependent variables, we used binary logistic regression analysis.
Results:
A total of 731 patients underwent adrenaletomy, and 651 patients had adequate data, were available for MAP score assessment. Of these patients, 247 were in the MRLA group, whereas 404 were in the CRLA group, baseline characteristics weren't found to be different between the two groups (p > 0.05). The MRLA group exhibited superior outcomes in terms of operating time, duration, postoperative hospital stay, estimated blood loss, and complications, in comparison to the CRLA group. Further analysis revealed that periadrenal stranding could be the underlying cause for this discrepancy.
Conclusions:
The MRLA effectively overcame the impact of adhesive periadrenal fat (APAF) compared to CRLA. We recommend to employ the MRLA for patients with preoperative CT images indicating periadrenal fat adhesion.
Insights
Modified retroperitoneal laparoscopic adrenalectomy (MRLA) offers better surgical outcomes by overcoming periadrenal fat adhesion compared to classical retroperitoneal laparoscopic adrenalectomy (CRLA). This technique is recommended for patients with preoperative indications of fat adhesion.
Area of Science:
- Urology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Adhesive periadrenal fat (APAF) poses challenges in adrenalectomy, potentially impacting surgical outcomes.
- The Mayo Adhesive Probability (MAP) score is used to assess the degree of periadrenal fat adhesion.
- Classical retroperitoneal laparoscopic adrenalectomy (CRLA) may be less effective in managing significant APAF.
Purpose of the Study:
- To evaluate if modified retroperitoneal laparoscopic adrenalectomy (MRLA) can overcome APAF more effectively than CRLA.
- To compare surgical outcomes between MRLA and CRLA in patients undergoing adrenalectomy.
- To determine the impact of APAF on surgical outcomes and the efficacy of MRLA.
Main Methods:
- Retrospective analysis of 731 patients undergoing adrenalectomy from January 2016 to December 2022.
- Patients were categorized into MRLA (n=247) and CRLA (n=404) groups based on surgical technique.
- Statistical analysis, including t-tests, M-U tests, and regression analyses, was used to compare baseline characteristics and perioperative data.
Main Results:
- No significant differences in baseline characteristics were observed between the MRLA and CRLA groups (p > 0.05).
- The MRLA group demonstrated significantly superior outcomes, including shorter operating times, reduced estimated blood loss, and fewer complications compared to the CRLA group.
- Periadrenal stranding was identified as a potential factor contributing to the observed differences in outcomes.
Conclusions:
- MRLA is effective in overcoming the challenges posed by APAF during adrenalectomy.
- MRLA offers improved surgical outcomes compared to CRLA, particularly in patients with preoperative evidence of periadrenal fat adhesion.
- MRLA is recommended for adrenalectomy in patients with preoperative CT findings suggestive of APAF.
