Lateral transperitoneal and retroperitoneal approaches are both effective for laparoscopic adrenalectomy, according to a recent study published in the BMC Surgery.
Laparoscopic adrenalectomy was first introduced in 1992 by Gagner et al. and has since become a standard treatment for benign adrenal masses. Several minimally invasive approaches have been developed for surgery; among them, lateral transperitoneal and retroperitoneal approaches, are the most frequently performed.
There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approaches for left-sided and right-sided laparoscopic adrenalectomy respectively.
Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For the left side, the transperitoneal approach was used in 132 (103 with tumours < 5 cm and 29 with tumours≥ 5 cm) and retroperitoneal approach in 110 (102 with tumours < 5 cm and 8 with tumours≥ 5 cm). For the right side, the transperitoneal approach was used in 139 (121 with tumours < 5 cm and 18 with tumours≥ 5 cm) and the retroperitoneal approach in 113 (102 with tumours < 5 cm and 11 with tumours≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumours < 5 cm and ≥ 5 cm respectively.
The Results of the study are as follows:
For left-sided tumours < 5 cm, the transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumours≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumours < 5 cm, the transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumours≥ 5 cm, the peri-operative data were comparable.
Thus, the researchers concluded that the Lateral transperitoneal and retroperitoneal approaches are both effective for laparoscopic adrenalectomy. The lateral transperitoneal approach is faster with less blood loss for tumours < 5 cm.
Reference:
Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy by Zhao Liu, et al. published in the BMC Surgery.
https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-021-01422-w