Evaluating liver function test alterations in laparoscopic right adrenalectomy with different retractors

Area of Science:

• Minimally Invasive Surgery
• Hepatobiliary Surgery
• Endocrine Surgery

Background:

• Laparoscopic adrenalectomy (LA) is preferred over open surgery for adrenal disorders.
• Right laparoscopic adrenalectomy (RLA) often requires liver retraction, with limited research on its impact.
• Liver injury during retraction in RLA specifically remains understudied.

Purpose of the Study:

• To evaluate the impact of two different retractors on liver function tests (LFTs) during RLA.
• To assess the clinical significance of LFT changes after RLA.
• To compare outcomes between 5-blade (FB) and full ring (GF) retractors in RLA.

Main Methods:

• Retrospective study of 87 LA patients (01/01/2010–04/30/2024).
• Patients divided into RLA (n=42) and left LA (LLA) (n=45) groups.
• RLA patients further subgrouped by retractor: FB (n=22) and GF (n=20).
• Comparison of clinicopathological data, operative outcomes, and LFTs.

Main Results:

• RLA groups showed significantly higher postoperative AST, ALT, and ALP than LLA (p<0.001, p<0.001, p=0.001).
• No significant difference in LFTs or outcomes between FB and GF retractors.
• Positive correlation between AST and lesion size (rho=0.31, p=0.045).
• Longer hospital stay for functional vs. nonfunctional adrenal pathologies (p<0.001).

Conclusions:

• RLA procedures result in elevated LFTs compared to LLA.
• FB and GF retractors demonstrate similar safety and efficacy in RLA.
• While LFTs increase, no significant clinical impact or difference between retractors was observed.
• Caution is advised for potential liver injury during RLA.