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Kim, Ryu, and Oh: Initial Experience of Laparoscopic Adrenalectomy with Retroperitoneal Approach
Original Article
Korean Journal of Urology

Korean Journal of Urology 2007; 48(3): 270-275.

Published online: 31 March 2007

DOI: https://doi.org/10.4111/kju.2007.48.3.270

Initial Experience of Laparoscopic Adrenalectomy with Retroperitoneal Approach

Jae Ho Kim, Dong Soo Ryu, Tae Hee Oh

Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (natisururo@yahoo.co.kr)

Received 10 November 2006       Accepted 13 February 2007

Copyright © 2007 The Korean Urological Association

Abstract

Purpose

A laparoscopic adrenalectomy has become the treatment of choice for an adrenal mass. However, there have been few reports on retroperitoneal laparoscopic adrenalectomies (RLA) in Korea. The results of retroperitoneal laparoscopic adrenalectomies were compared with those of a transperitoneal approach to evaluate efficacy of the former approach.

Materials and Methods

Between September 1999 and August 2006, 28 consecutive patients, with surgical adrenal disease, underwent a laparoscopic adrenalectomy via either a retroperitoneal (RLA, n=18) or transperitoneal approach (TLA, n=10). The groups were matched for age (years, p=0.79) and body mass index (kg/m2, p=0.53). The mean tumor sizes were 4.2 (1.6-7.5) and 3.9cm (2.2-7.0) in RLA and TLA groups, respectively (p=0.90).

Results

A RLA was found to be comparable to a TLA in terms of operative time (115 vs. 128 minutes, p=0.61), estimated blood loss (217 vs. 191cc, p=0.92), hospital stay (5.5 vs. 6.1 days, p=0.45), return to diet (0.4 vs. 0.5 days, p=0.68), time to ambulation (0.6 vs. 1.0 days, p=0.11), analgesic requirements (Ketorolac tromethamine, 110 vs. 88mg, p=0.07), time to drain removal (4.2 vs. 5.1 days, p=0.17) and mean specimen weight (24.7 vs. 17.8 g, p=0.14). One case in each group was converted to open surgery for control of bleeding.

Conclusions

A retroperitoneal laparoscopic adrenalectomy is as safe, minimally invasive and effective as the transperitoneal approach for the treatment of adrenal lesions that require surgery.

Keywords: Adrenal glands, Adrenalectomy, Laparoscopy

Figures and Tables

Fig. 1
Trocar site for a retroperitoneal approach (right side). (A) 10mm Hasson trocar, (B) a right side: 5mm trocar is used (left side: 11mm trocar), (C) right side: 11mm (left side: 5mm).
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Fig. 2
Right adrenal vein directly draining into the inferior vena cava.
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Fig. 3
Left adrenal vein is well exposed after traction of the left inferior renal artery.
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Table 1
Patients' characteristics
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RLA: retroperitoneal laparoscopic adrenalectomy, TLA: transperitoneal laparoscopic adrenalectomy, BMI: body mass index. *: analyzed by Mann-Whitney U test, †: analyzed by Fisher's exact test

Table 2
Comparison of the intraoperative parameters between retroperitoneal (RLA, n=18) and transperitoneal (TLA, n=10) laparoscopic adrenalectomies
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EBL: estimated blood loss, RLA: retroperitoneal laparoscopic adrenalectomy, TLA: transperitoneal laparoscopic adrenalectomy

Table 3
Pathological results
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RLA: retroperitoneal laparoscopic adrenalectomy, TLA: transperitoneal laparoscopic adrenalectomy

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