Chonnam Med J.  2009 Aug;45(2):116-121. 10.4068/cmj.2009.45.2.116.

Comparison of Clinical Outcomes between Retroperitoneal Laparoscopic Adrenalectomy and Open Adrenalectomy

• Choi HS
• Shin BS
• Nam DH
• Im CM
• Jung SI
• Kwon DD
• Park K
• Ryu SB

• KMID: 2172271
• DOI: http://doi.org/10.4068/cmj.2009.45.2.116

Abstract

Of all the laparoscopic surgical techniques that have been developed in recent years, laparoscopic adrenalectomy has become one of the most preferred methods for excising adrenal lesions. The purpose of this study was to investigate and compare the results of 2 different approaches to adrenalectomy-retroperitoneal laparoscopic adrenalectomy and open adrenalectomy-through a retrospective review of case reports for 53 patients. Thirty-two retroperitoneal and 21 open laparoscopic adrenalectomies were performed between June 1999 and December 2006. The groups were matched for age (in years; p=0.516) and body mass index (in kg/m2; p=0.269). The mean tumor sizes were 54.0 mm (16~130) and 45.4 mm (13~80) in the retroperitoneal laparoscopic and open adrenalectomy groups, respectively (p=0.086). The affected adrenal glands were successfully removed. An open surgical procedure became necessary in one of the retroperitoneal laparoscopic patients because of severe adhesion to retroperitoneal fat. Retroperitoneal laparoscopic adrenalectomy was found to be better than open adrenalectomy in terms of estimated blood loss (141 vs. 202 ml; p=0.039), duration of postoperative hospitalization (6.2 vs. 8.8 days; p=0.001), time to return to oral intake (1.2 vs. 1.7 days; p=0.005), time to ambulation (1.2 vs. 1.4 days; p=0.013), and time to drain removal (3.7 vs. 4.7 days; p=0.001). No statistically significant difference in operative time (115 vs. 128 minutes; p=0.61) was observed. Laparoscopic adrenalectomy was safe and effective for removal of almost all of the adrenal lesions and was associated with early oral intake, early ambulation, and a low number of hospitalization days.

Keyword

Adrenalectomy; Laparoscopy; Adrenal gland diseases

MeSH Terms

Adrenal Gland Diseases
Adrenal Glands
Adrenalectomy
Body Mass Index
Early Ambulation
Hospitalization
Humans
Intra-Abdominal Fat
Laparoscopy
Operative Time
Retrospective Studies
Walking

Reference

1. Gagner M, Lacroix A, Bolté E. Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med. 1992. 327:1033.

2. Lezoche E, Guerrieri M, Paganini AM, Feliciotti F, Zenobi P, Antognini F, et al. Laparoscopic adrenalectomy by the anterior transperitoneal approach: results of 108 operations in unselected cases. Surg Endosc. 2000. 14:920–925.

3. Kebebew E, Siperstein AE, Duh QY. Laparoscopic adrenalectomy: the optimal surgical approach. J Laparoendosc Adv Surg Tech A. 2001. 11:409–413.

4. Gill IS, Clayman RV, Albala DM, Aso Y, Chiu AW, Das S, et al. Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective. Urology. 1998. 52:566–571.

5. Gill IS, Kavoussi LR, Clayman RV, Ehrlich R, Evans R, Fuchs G, et al. Complications of laparoscopic nephrectomy in 185 patients: a multi-institutional review. J Urol. 1995. 154:479–483.

6. Rassweiler JJ, Seemann O, Frede T, Henkel TO, Alken P. Retroperitoneoscopy: experience with 200 cases. J Urol. 1998. 160:1265–1269.

7. Gill IS. The case for laparoscopic adrenalectomy. J Urol. 2001. 166:429–436.

8. Smith CD, Weber CJ, Amerson JR. Laparoscopic adrenalectomy: new gold standard. World J Surg. 1999. 23:389–396.

9. Jacobs JK, Goldstein RE, Geer RJ. Laparoscopic adrenalectomy. A new standard of care. Ann Surg. 1997. 225:495–501.

10. Jacobsen NE, Campbell JB, Hobart MG. Laparoscopic versus open adrenalectomy for surgical adrenal disease. Can J Urol. 2003. 10:1995–1999.

11. Zeh HJ 3rd, Udelsman R. One hundred laparoscopic adrenalectomies: a single surgeon's experience. Ann Surg Oncol. 2003. 10:1012–1017.

12. Vaughan ED Jr. Walsh PC, Retik AB, Stamey TA, Vaughan ED, Wein AJ, editors. The adrenals. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;3555–3560.

13. Terachi T, Matsuda T, Terai A, Ogawa O, Kakehi Y, Kawakita M, et al. Transperitoneal laparoscopic adrenalectomy: experience with 100 patients. J Endourol. 1997. 11:361–365.

14. Lee WK, Kwon TG, Park YK. Laparoscopic transperitoneal adrenalectomy: clinical experience with 18 cases. Korean J Urol. 2000. 41:1471–1476.

15. Takeda M, Go H, Watanabe R, Kurumada S, Obara K, Takahashi E, et al. Retroperitoneal laparoscopic adrenalectomy for functioning adrenal tumors: comparison with conventional transperitoneal laparoscopic adrenalectomy. J Urol. 1997. 157:19–23.

16. Munch LC, Gill IS, McRoberts JW. Laparoscopic retroperitoneal renal cystectomy. J Urol. 1994. 151:135–138.

17. Gaur DD, Agarwal DK, Purohit KC. Retroperitoneal laparoscopic nephrectomy: initial case report. J Urol. 1993. 149:103–105.

18. Sung GT, Hsu TH, Gill IS. Retroperitoneoscopic adrenalectomy: lateral approach. J Endourol. 2001. 15:505–511.

19. Gasman D, Droupy S, Koutani A, Salomon L, Antiphon P, Chassagnon J, et al. Laparoscopic adrenalectomy: the retroperitoneal approach. J Urol. 1998. 159:1816–1820.

20. Fernandez-Cruz L, Saenz A, Benarroch G, Astudillo E, Taura P, Sabater L. Laparoscopic unilateral and bilateral adrenalectomy for Cushing's syndrome. Transperitoneal and retroperitoneal approaches. Ann Surg. 1996. 224:727–734.

21. Rubinstein M, Gill IS, Aron M, Kilciler M, Meraney AM, Finelli A, et al. Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy. J Urol. 2005. 174:442–445.

22. Gill IS, Clayman RV, McDougall EM. Advances in urological laparoscopy. J Urol. 1995. 154:1275–1294.

23. Heniford BT, Arca MJ, Walsh RM, Gill IS. Laparoscopic adrenalectomy for cancer. Semin Surg Oncol. 1999. 16:293–306.

24. Lee AK, Park KJ, Kim HH, Choi H. Experience of transperitoneal laparoscopic adrenalectomy: initial 4 cases. Korean J Urol. 2000. 41:408–413.

25. Kumar U, Albala DM. Laparoscopic approach to adrenal carcinoma. J Endourol. 2001. 15:339–342.

26. Assalia A, Gagner M. Laparoscopic adrenalectomy. Br J Surg. 2004. 91:1259–1274.

27. Gagner M, Breton G, Pharand D, Pomp A. Is laparoscopic adrenalectomy indicated for pheochromocytomas? Surgery. 1996. 120:1076–1080.

28. Tanaka M, Tokuda N, Koga H, Kimoto Y, Naito S. Laparoscopic adrenalectomy for pheochromocytoma: comparison with open adrena lectomy and comparison of laparoscopic surgery for pheochromocytoma versus other adrenal tumors. J Endourol. 2000. 14:427–431.

29. Fernandez-Cruz L, Taura P, Saenz A, Benarroch G, Sabater L. Laparoscopic approach to pheochromocytoma: hemodynamic changes and catecholamine secretion. World J Surg. 1996. 20:762–768.

30. Li ML, Fitzgerald PA, Price DC, Norton JA. Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery. 2001. 130:1072–1077.