Laparoscopic Adrenalectomy: Posterior Lumbar Approach

Abstract

Twenty-four patients with benign adrenal tumors underwent retroperitoneoscopic adrenalectomy by a posterior lumbar approach. The clinical results were compared with those from the most recent consecutive 24 patients who underwent laparoscopic adrenalectomy by a transperitoneal anterior or lateral approach. The average size of the adrenal tumors removed by the posterior lumbar approach was 23.6 ± 12.6 (SD) mm (range, 8–50 mm). Early visualization of the adrenal vessels afforded clues for localizing the adrenal gland. The average number of trocars required for the posterior lumbar approach was 3.14 ± 0.35, which was significantly less than that for the transperitoneal approach(4.2 ± 0.42). The rate of conversion to open surgery was 4.2% for the former and 12.5% for the latter. The average operating time was significantly shortened to 144 ± 32 min for the posterior lumbar approach, as compared with 234 ± 53 min for the transperitoneal approach(p < 0.01). In conclusion, the posterior lumbar approach allows direct access to the main adrenal vascular supply before the gland has been greatly manipulated. Retroperitoneoscopic adrenalectomy by this approach is technically feasible and is most effective with regard to the simplicity of vascular control. The operating time, perioperative morbidity, and cost were reduced with this approach. This approach meets the technical requirement for retroperitoneoscopic adrenalectomy in most benign adrenocortical tumors. Pheochromocytomas on the right side can be safely removed by the posterior approach if the tumor is smaller than 5 cm in diameter. On the left side, this approach should be limited to smaller pheochromocytomas less than 3 cm in diameter.