The adoption of the endoscopic retroperitoneal approach to the adrenal gland - Conversion factors and learning points

Introduction: Minimally invasive adrenalectomy includes lapamscopic transperitoneal (LA) and retroperitoneoscopic (RP) approaches. This study reviewed the local adrenalectomy practice to identify characteristics and outcomes between patients undergoing adrenalectomy via LA, RP, and RP requiring conversion (RPC). Methods: Adrenalectomies documented in a prospective surgical database were reviewed. Demographics, diagnosis, surgical approach/conversion, body mass index (BMI), radiographic body measurements (RBM), tumor size, operative time (OT), length of stay (LOS), and 30-day post-operative emergency (ED) visits were collected. Results: 203 adrenalectomies were reviewed from 2015 to 2020. The RP group had the shortest OT (124 +/- 54 min, p = 0.281 vs LA, p < 0.001 vs RPC) and LOS (1.6 +/- 1.0 days, p < 0.001 vs LA and RPC). There was an 18% conversion rate from RP to LA, and in one case to laparotomy. The RPC group had greater BMI, OT, LOS, and ED visits than LA and RP. The RPC group had less favorable RBM (p < 0.001). On multivariate analysis, RBM impacted OT, LOS, and ED visits (p < 0.05). Discussion: The RP approach had shorter OT and LOS. BMI and RBM may increase risk of conversion, OT, LOS, and ED visits. Preoperative RBM may aid in appropriate patient selection for a RP approach.

Automated summary

This study reviewed the practice of adrenalectomy and found that retroperitoneoscopic approach had shorter operative time and length of stay. Body mass index and radiographic body measurements may increase the risk of conversion, operative time, length of stay, and emergency department visits. Preoperative radiographic body measurements may help in selecting appropriate patients for a retroperitoneoscopic approach.