SIU 2017: Laparoscopic Adrenalectomy: Posterior Retroperitoneoscopic or Transperitoneal Approach?

Lisbon, Portugal ( Laparoscopic adrenalectomy (LA) has been a technique under development and remains a challenging procedure. There are multiple approaches described in the literature, including lateral transperitoneal, anterior transperitoneal, lateral retroperitoneal and posterior retroperitoneal. However, it has not yet been determined what the best approach is. 

In this study, the group from Argentina compared the posterior retroperitoneal approach (PRA) to lateral transperitoneal approach (LTA) in a single institution series. This was a prospective study in 22 patients undergoing 24 adrenalectomies over a 1.5 year period; 12 in each arm. The median follow-up was 6.5 months, which indicates primarily perioperative outcomes assessment. While the patients were relatively similar in terms of demographics, this was a very small cohort. 

Patients undergoing LTA had a 42 minute longer operative time compared to PRA. While oncologic outcomes were the same in both arms (all patients achieved “cure”), there were also no differences in perioperative outcomes – hospital stay, bleeding and complications. There was 1 bleeding episode in the LTA arm, but none in the PRA arm – though this was surprisingly not statistically significant.

However, as can be imagined, a series such as this is inherent to significant bias. It is unclear what selection criteria led to which patients received which approach. Unfortunately, due to the small volume, it is hard to draw any conclusions regarding the results.

Despite its flaws, laparoscopic retroperitoneal adrenalectomy is technically feasible. Further study is required to state is safe and effective.

Presented by: José Ignacio Nolazco
Affiliation: Hospital Italiano de Buenos Aires

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal
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