Comparison of Descending and Ascending Approaches for Vascular Control in Transperitoneal Laparoscopic Adrenalectomy

Aim: This study aims to evaluate the descending and ascending approaches in laparoscopic adrenalectomy, focusing on their impact on surgical outcomes. Methods: This retrospective study included patients who underwent transperitoneal laparoscopic adrenalectomy for indications other than pheochromocytoma between 2018 and 2025. Patients were divided into two groups: those who underwent the descending approach (Group D) and those who underwent the ascending approach (Group A). Preoperative, intraoperative, and postoperative data were collected, including age, the American Society of Anesthesiology scores, tumor characteristics, operative time, blood loss, blood pressure variations, and hospital stay duration. Statistical analyses were performed using SPSS 25.0, with P < .05 considered statistically significant. Results: A total of 63 patients were analyzed (Group D: 30, Group A: 33). The mean operative time was significantly shorter in Group D (92 versus 110 minutes, P = .027). Blood loss was lower in Group D (80 versus 120 mL, P = .022), with a smaller hemoglobin decrease (1.2 versus 1.8 g/dL, P = .025). There was no significant difference in intraoperative blood pressure fluctuations, hospital stay, or major complications. Conclusions: The descending approach may offer advantages in reducing operative time and blood loss in laparoscopic adrenalectomy. However, both techniques remain viable options with comparable complication rates. Further studies are needed to confirm these findings in larger cohorts.