Journal List > Korean J Endocr Surg > v.11(4) > 1060049

M.D., M.D., M.D., M.D., M.D., M.D., M.D., M.D., M.D., and FACS: Initial Experience with Posterior Retroperitoneo-scopic Adrenalectomy for the Adrenal Tumors

Abstract

Purpose:

Posterior retroperitoneoscopic adrenalectomy (PRA) for small adrenal tumors has recently been in the spotlight due to its several benefits. Compelling advantages for endoscopic surgeons include direct, safe, and fast approach to the adrenal gland without trespass to the intraperitoneal organ. This study reports our initial experiences of PRA for the management of adrenal tumors.

Methods:

From December 2009 to August 2011, 63 patients underwent PRA for the management of adrenal tumor. Among these patients, laparoscopic adrenalectomy and robotic adrenalectomy were performed in 54 and nine patients, respectively. We retrospectively reviewed records of all surgical outcomes.

Results:

Of the 54 patients, 22 were male and 32 were female, and mean age was 51.7±14.0 years. Mean body mass index was 24.6±3.6 kg/m2 and mean dimension of the tumors was 2.66±1.36 cm. Six patients were diagnosed with Cushing's disease, 22 patients with primary aldosteronism, seven patients with pheochromocytoma, one patient with metastatic adrenal gland cancer, and 18 patients with nonfunctioning adrenal tumors. Mean operative time was 88.5±27.1 min, mean blood loss was 17.4±37.4 ml, and mean duration to first oral intake was 0.83±0.4 days. Mean number of postoperative analgesics used was 2.28±2.54, and mean postoperative hospital stay was 2.85±1.43 days. There was no open conversion during the operation and no post-operative complication.

Conclusion:

PRA is a safe and fast procedure. In experienced hands, PRA represents one of the ideal approaching methods in the adrenal gland surgery.

REFERENCES

1.Gagner M., Lacroix A., Bolté E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992. 327:1033.
crossref
2.Gill IS. Needlescopic urology: current status. Urol Clin North Am. 2001. 28:71–83.
crossref
3.Zacharias M., Haese A., Jurczok A., Stolzenburg JU., Fornara P. Transperitoneal laparoscopic adrenalectomy: outline of the preoperative management, surgical approach, and outcome. Eur Urol. 2006. 49:448–59.
crossref
4.Moinzadeh A., Gill IS. Laparoscopic radical adrenalectomy for malignancy in 31 patients. J Urol. 2005. 173:519–25.
crossref
5.Del Pizzo JJ. Transabdominal laparoscopic adrenalectomy. Curr Urol Rep. 2003. 4:81–6.
crossref
6.Gill IS., Meraney AM., Thomas JC., Sung GT., Novick AC., Lieberman I. Thoracoscopic transdiaphragmatic adrenalectomy: the initial experience. J Urol. 2001. 165:1875–81.
crossref
7.Mercan S., Seven R., Ozarmagan S., Tezelman S. Endoscopic retroperitoneal adrenalectomy. Surgery. 1995. 118:1071–5.
crossref
8.Berber E., Mitchell J., Milas M., Siperstein A. Robotic posterior retroperitoneal adrenalectomy: operative technique. Arch Surg. 2010. 145:781–4.
9.Li QY., Li F. Laparoscopic adrenalectomy in pheochromocytoma: retroperitoneal approach versus transperitoneal approach. J Endourol. 2010. 24:1441–5.
crossref
10.Rubinstein M., Gill IS., Aron M., Kilciler M., Meraney AM., Finelli A, et al. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005. 174:442–5.
crossref
11.Kang WH., Kim BS., Choi YB. Comparison of laparoscopic transperitoneal versus retroperitoneal adrenalectomy. J Korean Soc Endosc Laparosc Surg. 2010. 13:22–5.
12.Shen WT., Kebebew E., Clark OH., Duh QY. Reasons for conversion from laparoscopic to open or hand-assisted adrenalectomy: review of 261 laparoscopic adrenalectomies from 1993 to 2003. World J Surg. 2004. 28:1176–9.
crossref
13.Tiyadath BN., Sukumar S., Saheed CS., Hattangadi SB. Laparoscopic adrenalectomy –- is it any different in phaeochro-mocytoma and non-phaeochromocytoma? Asian J Surg. 2007. 30:244–9.
14.Zhang XP., Wei JX., Zhang WX., Wang ZY., Wu YD., Song DK. Transperitoneal laparoscopic adrenalectomy for adrenal neoplasm: a report of 371 cases. Ai Zheng. 2009. 28:730–3.
crossref
15.Whittle DE., Schroeder D., Purchas SH., Sivakumaran P., Conaglen JV. Laparoscopic retroperitoneal left adrenalectomy in a patient with Cushing's syndrome. Aust N Z J Surg. 1994. 64:375–6.
crossref
16.Suzuki K., Kageyama S., Hirano Y., Ushiyama T., Rajamahanty S., Fujita K. Comparison of 3 surgical approaches to laparo-scopic adrenalectomy: a nonrandomized, background matched analysis. J Urol. 2001. 166:437–43.
crossref
17.Mazzaglia PJ., Vezeridis MP. Laparoscopic adrenalectomy: balancing the operative indications with the technical advances. J Surg Oncol. 2010. 101:739–44.
crossref
18.Giebler RM., Behrends M., Steffens T., Walz MK., Peitgen K., Peters J. Intraperitoneal and retroperitoneal carbon dioxide insufflation evoke different effects on caval vein pressure gradients in humans: evidence for the starling resistor concept of abdominal venous return. Anesthesiology. 2000. 92:1568–80.
19.Walz MK., Alesina PF., Wenger FA., Deligiannis A., Szuczik E., Petersenn S, et al. Posterior retroperitoneoscopic adrenalectomy–results of 560 procedures in 520 patients. Surgery. 2006. 140:943–8.
crossref
20.Giebler RM., Walz MK., Peitgen K., Scherer RU. Hemodynamic changes after retroperitoneal CO2 insufflation for posterior retroperitoneoscopic adrenalectomy. Anesth Analg. 1996. 82:827–31.
crossref
21.Berber E., Tellioglu G., Harvey A., Mitchell J., Milas M., Siperstein A. Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy. Surgery. 2009. 146:621–5.
crossref
22.Fernández-Cruz L., Saenz A., Benarroch G., Astudillo E., Taura P., Sabater L. Laparoscopic unilateral and bilateral adrenalectomy for Cushing's syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg. 1996. 224:727–34.
23.Rubinstein M., Gill IS., Aron M., Kilciler M., Meraney AM., Finelli A, et al. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005. 174:442–5.
crossref

Fig. 1
Patient position of posterior retroperitoneoscopic adrenalectomy.
kjes-11-287f1.tif
Table 1.
Patient's characteristics (n=54)
  PRA∗
Age±SD 51.7±14.0 (21∼80)
Gender  
Male 22 (40.7%)
Female 32 (59.3%)
BMI±SD 24.6±3.6 (17.3∼35)
Location  
Right side 23 (42.6%)
Left side 31 (57.4%)
Bilateral  
Diagnosis  
Cushing's disease 6 (11.1%)
Aldosteronism 22 (40.7%)
Pheochromocytoma 7 (13.0%)
Metastatic cancer 1 (1.9%)
Non-functioning tumor 18 (33.3%)

PRA = posterior retroperitoneoscopic adrenalectomy.

Table 2.
Operative outcomes of PRA (n=54)
  PRA∗
Mean peration time (min)±SD 88.5±27.1 (47∼143)
Blood loss (ml)±SD 17.4±37.4 (0∼150)
First oral intake (day)±SD 0.83±0.4 (0∼2)
Postoperative analgesics use 2.28±2.54 (0∼11)
(number)±SD  
Postoperative hospital stay 2.85±1.43 (1∼8)
(day)±SD  
Mean tumor size±SD 2.66±1.36 (0.7∼7.0)

PRA = posterior retroperitoneoscopic adrenalectomy.

Fig. 2
Mean operation times and mean tumor sizes according to the 3 consecutive periods.
kjes-11-287f2.tif
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