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Single-Layer renal surface vs. standard three-layer approach in retroperitoneal laparoscopic adrenalectomy: surgical
Chuang Fu1, Ruijie Li2, Bo Chang1,3
1Department of Urology, Huaihe hospital of Henan University, Kaifeng, 475000, China.
Objective:
To compare the perioperative outcomes and technical proficiency between the retroperitoneal laparoscopic single-layer renal surface approach (SLRS) and the standard three-layer approach (TLA) for benign adrenal tumors.
Methods:
A retrospective cohort of 117 patients undergoing retroperitoneal laparoscopic adrenalectomy (66 TLA vs. 51 SLRS) was analyzed. Primary outcomes included operative metrics, postoperative recovery (drainage volume, fever incidence, catheter duration), and learning curves. Statistical analyses adjusted for pathological heterogeneity (covariate: cortical adenoma predominance in SLRS). Learning curves were quantified via linear regression slopes and moving-average stabilization thresholds.
Results:
Baseline characteristics were comparable except for pathological distribution (P = 0.034), incorporated as a covariate. SLRS demonstrated a significantly shallower learning curve (slope:-0.52 vs.-1.35 min/case; P = 0.028) and earlier proficiency stabilization (15 vs. 26 cases). Early-phase blood loss was lower with SLRS (33.2 ± 18.1 mL vs. 45.8 ± 24.6 mL; P = 0.012). Postoperatively, SLRS reduced fever incidence (7.8% vs. 12.1%; P = 0.013), 24-hr drain output (58.2 vs. 71.8 mL; P = 0.004), catheter duration (4.71 ± 2.39 vs. 6.27 ± 2.23 days; P < 0.001), and 24-hr pain scores (0.01 ± 0.2 vs. 0.15 ± 0.53; P = 0.045). Paradoxically, SLRS prolonged oral intake initiation (64.67 ± 32.07 vs. 45.36 ± 13.68 h; P < 0.001) and overall hospitalization (24.14 ± 12.48 vs. 20.18 ± 6.71 days; P = 0.03). Control charts confirmed superior procedural stability for SLRS in operative time and blood loss.
Conclusion:
The SLRS approach significantly accelerates postoperative recovery (e.g., reduced fever incidence, drain output, and pain scores) and shortens the learning curve while maintaining operative safety. Notably, SLRS was associated with slightly prolonged hospital stay, potentially linked to extended renal mobilization or institutional perioperative protocols. These findings highlight SLRS as a viable alternative to TLA for enhancing surgical efficiency and early convalescence.
