Systematic Review of Surgical Approaches for Adrenal Tumors: Lateral Transperitoneal versus Posterior Retroperitoneal and Laparoscopic versus Robotic Adrenalectomy.

Young Jun Chai,June Young Choi,Yeo-Kyu Youn,Kyu Eun Lee,Su-Jin Kim,Hyeong Won Yu,Hyungju Kwon

doi:10.1155/2014/918346

Abstract

Background. Laparoscopic lateral transperitoneal adrenalectomy (LTA) has been the standard method for resecting benign adrenal gland tumors. Recently, however, laparoscopic posterior retroperitoneal adrenalectomy (PRA) has been more popular as an alternative method. This systematic review evaluates current evidence on adrenalectomy techniques, comparing laparoscopic LTA with PRA and laparoscopic adrenalectomy with robotic adrenalectomy. Methods. PubMed, Embase, and ISI Web of Knowledge databases were searched systematically for studies comparing surgical outcomes of laparoscopic LTA versus PRA and laparoscopic versus robotic adrenalectomy. The studies were evaluated according to the PRISMA statement. Results. Eight studies comparing laparoscopic PRA and LTA showed that laparoscopic PRA was superior or at least comparable to laparoscopic LTA in operation time, blood loss, pain score, hospital stay, and return to normal activity. Conversion rates and complication rates were similar. Six studies comparing robotic and laparoscopic adrenalectomy found that outcomes and complications were similar. Conclusion. Laparoscopic PRA was more effective than LTA, especially in reducing operation time and hospital stay, but there was no evidence showing that robotic adrenalectomy was superior to laparoscopic adrenalectomy. Cost reductions and further technical advances are needed for wider application of robotic adrenalectomy.

Highlights

Open transperitoneal adrenalectomy has been the gold standard of treatment for adrenal disease
In most of the studies, malignant tumors were considered a contraindication for laparoscopic surgery; lateral transperitoneal adrenalectomy (LTA) or posterior retroperitoneal adrenalectomy (PRA) was successfully performed in patients with no evidence of invasion on preoperative imaging or when the lesion was an isolated metastasis [20, 21]
Patients were deemed eligible for PRA if their tumors were less than 8 cm in diameter, size criteria were more liberal for LTA

Summary

Introduction

Open transperitoneal adrenalectomy has been the gold standard of treatment for adrenal disease. Invasive adrenalectomy results in less blood loss, earlier ambulation, shorter hospital stay, and faster return to normal activity [6]. These advantages were made possible by accumulated experience, advanced laparoscopic techniques, and better understanding of adrenal gland anatomy. Laparoscopic lateral transperitoneal adrenalectomy (LTA) has been the standard method for resecting benign adrenal gland tumors. This systematic review evaluates current evidence on adrenalectomy techniques, comparing laparoscopic LTA with PRA and laparoscopic adrenalectomy with robotic adrenalectomy. Laparoscopic PRA was more effective than LTA, especially in reducing operation time and hospital stay, but there was no evidence showing that robotic adrenalectomy was superior to laparoscopic adrenalectomy. Cost reductions and further technical advances are needed for wider application of robotic adrenalectomy

Methods

Results

Conclusion