Korean J Urol.  2007 Mar;48(3):270-275. 10.4111/kju.2007.48.3.270.

Initial Experience of Laparoscopic Adrenalectomy with Retroperitoneal Approach

• Kim JH
• Ryu DS
• Oh TH

• KMID: 1997124
• DOI: http://doi.org/10.4111/kju.2007.48.3.270

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.

Keyword

Adrenal glands; Adrenalectomy; Laparoscopy

MeSH Terms

Adrenal Glands
Adrenalectomy*
Body Mass Index
Diet
Hemorrhage
Humans
Korea
Laparoscopy
Length of Stay
Operative Time
Tromethamine
Walking
Tromethamine

Figure

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  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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