Effectiveness of transperitoneal and trans-retroperitoneal laparoscopic adrenalectomy versus open adrenalectomy

Purpose: This study compared the effectiveness of laparoscopic adrenalectom y, using either a transperitoneal or trans-retroperitoneal approach, with t hat of open adrenalectomy in patients with benign adrenal tumors. Methods: From February 1995 to April 2000, laparoscopic adrenalectomy was p erformed on 31 patients with adrenal tumors, including 16 aldosteronomas, 1 0 Gushing's adenomas, three nonfunctioning tumors, and two pheochromocytoma s. A lateral trans-retroperitoneal approach was used for the first 16 patie nts and a lateral transperitoneal approach was used for tile last 15 patien ts. Twenty-one patients who received open adrenalectomy during the same per iod served as a control group. Comparisons were made between laparoscopy an d open groups, and between transperitoneal and trans-retroperitoneal groups . Results: Conversion to open adrenalectomy was necessary in two cases - both in the trans-retroperitoneal group during the first 2 years of the study p eriod. No other intraoperative complications occurred and blood transfusion was not used. Compared with the open group, the laparoscopic group had les s blood loss (71 vs 124 mt), resumed oral feeding earlier (28 vs 60 hr), re quired less postoperative narcotics (45 vs 120 mg meperidine), and had shor ter postoperative hospital stays (4.9 vs 7.6 days) (all P < 0.05). The mean operative time was longer in the laparoscopic group (203 vs 123 min, p < 0 .001). There were no significant differences between the transperitoneal an d trans-retroperitoneal laparoscopy groups in any of tile studied parameter s, except that the operative time was longer in the trans-retroperitoneal l aparoscopy group (244 vs 166 minutes, p < 0.01). Conclusions: Decreased blood loss, less postoperative pain, earlier resumpt ion of oral feeding, and shorter hospital stays were achieved in patients u ndergoing laparoscopic adrenalectomy. These findings indicate that laparosc opic adrenalectomy is the treatment of choice for benign adrenal tumors. Th e transperitoneal approach yielded shorter operative time than the trans-re troperitoneal approach, because it offered a clearer view and familiar land marks.