"Totally no Tube" laparoscopic technique in the management of adrenal diseases: a safe and efficient practice

Laparoscopic adrenal surgery has become a common procedure for some adrenal diseases. The necessity of surgery-related tubes, such as abdominal drainage tubes, urinary catheters and endotracheal tubes, is controversial. These devices may induce regional tissue inflammation and cause discomfort. In this study, we evaluated the safety and the feasibility of "Totally No Tube (TNT)" transperitoneal laparoscopic technique in adrenal surgery.

From January 2021 to December 2023, a total of 67 patients who underwent TNT laparoscopic adrenal surgery were reviewed, and 78 patients who underwent conventional laparoscopic adrenal surgery were included as the control group. Retrospective analysis was conducted on indicators such as the anesthesia and operation time, intraoperative blood loss, postoperative hospital stay, postoperative visual analogue scale scores, Quality of Recovery-40 score, time to first ambulation after surgery, total hospitalization cost, and postoperative complications in both groups.

All 145 patients underwent surgery experienced no grade II-IV complications. The TNT group showed significantly shorter postoperative hospital stay, lower postoperative pain score, better QoR-40 score, earlier ambulation after surgery, lower total hospitalization cost, and fewer specific postoperative complications. There were no significant differences in anesthesia time, operation time, and intraoperative blood loss between these two groups.

TNT transperitoneal laparoscopic adrenal surgery is safe and well tolerated when strict selection criteria are followed. It is associated with a similar rate of postoperative complications compared to the conventional laparoscopic approaches. Concurrently, it offers advantages such as less postoperative discomfort, greater satisfaction with recovery from surgery, and lower healthcare expenditure.