Comparative analysis of transabdominal and retroperitoneal approaches in adrenalectomy

Abstract

Laparoscopic adrenalectomy has been recognised as the «gold standard» approach for benign adrenal tumours. The majority of surgeons opt for transabdominal laparoscopic adrenalectomies, while retroperitoneoscopic adrenalectomies in the prone position, which were pioneered by Waltz, offer certain advantages for patients. Objective — to compare the effectiveness and complication rates of transabdominal and retroperitoneoscopic laparoscopic adrenalectomies. Materials and methods. Between 2000 and 2021, our clinic performed 472 laparoscopic adrenalectomies. The age of the patients ranged from 19 to 79 years, with a mean age of 50.5±10.2 years. The patient pool consisted of 315 women and 157 men. The primary indications for operation were as follows: incidentaloma (32.5%), pheochromocytoma (30.2%), aldosteronoma (19%), corticosteroma (10.3%), myelolipoma (3.0%), and metastatic cancer (5.0%). Tumour sizes ranged from 1 to 10 cm. Results. A total of 316 patients underwent transabdominal adrenalectomies: 206 patients had right adrenalectomies and 110 patients had left adrenalectomies. A total of 156 patients underwent retroperitoneoscopic adrenalectomies. Seven patients required a conversion to a transabdominal approach, including three patients with tumours exceeding 6 cm in size and four patients with tumours ranging from 4 to 6 cm. The conversion rate amounted to 4.9%. The retroperitoneoscopic approach showed certain advantages for patients with small tumours, including shorter surgery duration, lower operative blood loss, diminished postoperative pain intensity, a lower incidence of shoulder‑tip pain, a faster transition to oral intake, and shorter hospital stays. Conclusions. Both approaches were equally safe. In patients with small tumours, retroperitoneoscopic adrenalectomies outperformed the transabdominal approach in terms of shorter surgery duration, lower blood loss, lower postoperative pain, faster recovery, and favourable cosmetic results. In patients with large tumours, the transabdominal approach demonstrated better outcomes, with lower complication and conversion rates.