Comparison of laparoscopic transabdominal lateral versus posterior retroperitoneal adrenalectomy

Background. For the past 14 years,.we have been performing laparoscopic adrenalectomy via the lateral transabdommal as well as the posterior retropertioneal, approach. The ann of this study is to describe Patient selection criteria for each approach with comparison of perioperative outcomes Methods. In. patients with smaller tumors, low body mass index (BMI), history of previous abdominal] operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterion approach. Data regarding clinical patholog, tumor size, BMI, estimated. blood loss (EBL), operating time (OT). morbidity, mortality. and duration of stay rove analyzed retrospectively. Data, are, expressed as mean +/- standard error of the mean (SEM). Results. One hundred. seventy-two laparoscopic adrenalectomy procedures were performed in 159 patients between 1994 and 2008. The lateral approach was used in 69 patients (light side. 39%, left side: 55% bilateial 6 %) and the posterior approach in 90 patients (right side: 42 %, left side 48 %, bilateral 10 %). The incidence of prior abdommal surgery was greater in. the posterior group (26 % vs 19%.. NS) The lateral approach. Was used in 9% (3/34) of aldosteronoma, 38% (9124) of Cushing's disease.syndrome, 47% (18/38) of nonsecretnig cortical adenoma, 66% (23/35) of pheochromocytoma 41 % (7/17) of malignant lesions and 73% (8/11) of others. Thirty percent of the bilateral ladrenalectomes were performed via lateral and 70 % via posterior approach. Two patients in the posterior approach were, converted to the laparoscopic lateral approach, and 2 patients in the lateral approach WPM converted to open. Overall, patient age and sex were similar between groups. BMI Was higher in patients undergoing addrenalectomy via lateral vs posterior approach (32.4 vs 28.4; P = 005). Tumor size was larger than 6 cm in 11 (16%) and 1 (1%) of the patients in the lateral and posterior groups, respectively. On univariate anlaysis., mean OT for laterial and posterior approaches was sondar for unilateral cases (157 +/- 7 vs 138 +/- 6 min, respectively; P = NS). This was also true on multivariate analysis when corrected for patient selection factors. EBL was 35 +/- 7 mL for lateral versus 25 +/- 6.mL for Posterior approach (P = .05) The duration of stay in lateral and posterior approaches was 1 day in 56% vs 82%, 2 days in 29% vs 13%. and more than 2 days in 15% vs 5% of the patients, respectively. Two patients in the laterial groups died postopertively because of cardiac and putmonary causes,. and 2 patients it? the posterior group developed temporary neuralgia Conclusion. This series compares 2 differnet approaches for laparoscopic adrenalectomy Our study shows that the lateral and pasterior techniques have a similar peri-operative outcome when patients are selected for each option based on certain criteria. (Surgery 2009.146.621-6