Gasless single-port retroperitoneal laparoscopic adrenalectomy: a novel option for adrenal tumors

Laparoscopic adrenalectomy is the primary treatment for most adrenal tumors. However, gasless single-port retroperitoneal laparoscopic adrenalectomy (GL-SPRLA) is rarely documented, and its safety and effectiveness need further investigation. To address this, we introduced an improved GL-SPRLA technique using a novel peritoneal spreader (PerS) that eliminates the need for CO₂ insufflation while maintaining the benefits of minimally invasive surgery.

This single-center retrospective study compared GL-SPRLA (n=58) with conventional single-port retroperitoneal laparoscopic adrenalectomy (SPRLA) (n=106) for adrenal tumors (<4 cm) at Sun Yat-sen University Cancer Center [2021-2023]. All procedures were performed by the same surgeon via retroperitoneal approach. We systematically compared demographic characteristics, intraoperative parameters, postoperative outcomes, and follow-up results. Statistical analysis was performed with Student's t-test, χ² test and multivariable regression adjusting for potential confounders.

All 58 GL-SPRLA procedures were successfully completed using a novel gasless device that replaces carbon dioxide. Compared to SPRLA, GL-SPRLA showed comparable operative time, complication rates, and postoperative hospital stay (P>0.05), but showed smaller perioperative changes in pCO₂ and pH in a physiologic subcohort, along with a 12.7% cost reduction (P<0.001), and zero conversions to multi-port versus 14.2% in SPRLA (P=0.001). There were no Clavien-Dindo grade 3-4 complications in either group, and neither tumor recurrence nor metastasis occurred at 12 months.

GL-SPRLA may be a feasible minimally invasive option for selected patients with small adrenal tumors, with potential advantages in avoiding CO₂ insufflation and reducing hospitalization costs, and requires confirmation in prospective multicenter studies.