The safety and efficiency of retroperitoneal laparoscopic adrenalectomy via extra and intra perinephric fat approaches: a retrospective clinical study

Xuejian Wang,Xinqing Zhu,Lina Wang,Deyong Yang,Changli Liu,Sony Nahayo,Junqiang Liu,Aozhang Ji,Jianbo Wang,Xishuang Song,Weiwei Fan

doi:10.1186/s12893-019-0648-8

Abstract

BackgroundThis retrospective clinical study is to evaluate the safety and efficiency of two different approaches in retroperitoneal laparoscopic adrenalectomy and provide experience and basis for the treatment of adrenal tumors through retroperitoneal approach.MethodsFrom July 2015 to February 2018, 112 patients with adrenal lesions underwent retroperitoneal laparoscopic adrenalectomy (RLA) using a 3-port method. Among them, 56 patients underwent RLA via the extra perinephric fat approach (EPFA), 56 patients underwent RLA via the intra perinephric fat approach (IPFA). Clinical data, including preoperative, operative and postoperative management were recorded.ResultsAll surgeries were successfully completed, and there was no single patient who died during these surgeries. There was no statistically significant difference between the two groups in blood loss, postoperative complications, vena cava injury, renal cortex injury, peripheral organ injury, and post operation hospital stay. Peritoneum injury occurred more frequently in the EPFA group when compared with the IPEA group (p = 0.042). The average surgery time of the IPEA group is significantly shorter when compared with that of the EPEA group (p < 0.001). Due to serious saponification of the perinephric fat and heavy adhesion to renal fascia, three cases in IPFA group were converted to the EPFA surgery.ConclusionRLA is a safe and effective procedure both via extra perinephric fat and intra perinephric fat approaches. IPEA is superior to EPEA in terms of peritoneal injury and duration. The choice may mainly depend on the experience of the surgeon, the characteristics of the adrenal tumor and the nature of the perinephric fat.

Highlights

This retrospective clinical study is to evaluate the safety and efficiency of two different approaches in retroperitoneal laparoscopic adrenalectomy and provide experience and basis for the treatment of adrenal tumors through retroperitoneal approach
Peritoneum injury occurred more frequently in the extra perinephric fat approach (EPFA) group when compared with the IPEA group (p = 0.042)
There were two renal cortex injury which occurred in the IPEA group, and no renal cortex injury occurred in the EPFA group, when compared with each other, there was no obviously statistically significance (p = 0.135)

Summary

Introduction

This retrospective clinical study is to evaluate the safety and efficiency of two different approaches in retroperitoneal laparoscopic adrenalectomy and provide experience and basis for the treatment of adrenal tumors through retroperitoneal approach. Laparoscopic adrenalectomy has become the golden standard approach for small benign adrenal tumors [1, 2]. This minimally invasive method shows obvious advantages over the traditional open surgery in perioperative complications and patient recovery [3]. Transperitoneal laparoscopic adrenalectomy is considered as a classic approach in adrenal surgery. In retroperitoneal approach, compared with the transperitoneal approach, the anatomic position of adrenal gland is concealed, the space of retroperitoneal cavity is relatively narrow and the anatomic marks are fewer and not obvious [7]. How to expose, separate and dissect the adrenal tumor through the optimal surgical route has

Methods

Results

Discussion

Conclusion