Introduction: There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for right-sided laparoscopic adrenalectomy. The aim of this study was to determine whether there is any difference between right-sided transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA). Material and Methods: Our surgery database was reviewed to identify patients who underwent right-sided laparoscopic adrenalectomy with a retroperitoneal or transperitoneal approach since 2000. Fifty-five patients were enrolled (31 RLA and 24 TLA). Patient characteristics, as well as operative and perioperative details, were compared between the two groups. Results: There was no difference in patient characteristics between the groups. There was a statistically significant difference (p = 0.02) in blood loss (31.7 ± 16.4 vs. 56.9 ± 65.5 ml) between RLA and TLA when the patient's BMI was >26. There was no significant difference in operative time, conversion to open surgery, length of hospitalization, or time to oral intake between the groups. Conclusions: Right-sided laparoscopic adrenalectomy can be performed safely and effectively via either RLA or TLA. Surgeons can adopt either approach with confidence depending on their preference if they are familiar with that approach.

Keywords:
Transperitoneal, Retroperitoneal, Laparoscopic, Adrenalectomy
1.
Ganger M, Lacroix A, Bolte E: Laparoscopic adrenalectomy in Cushing's syndrome and pheochromocytoma. N Engl J Med 1992;327:1033.
2.
Guazzoni G, Montorsi F, Bocciardi A, Da Pozzo L, Rigatti P, Lanzi R, et al: Transperitoneal laparoscopic versus open adrenalectomy for benign hyperfunctioning adrenal tumors: a comparative study. J Urol 1995;153:1597-1600.
3.
Winfield HN, Hamilton BD, Blavo EL, Novick AC: Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy. J Urol 1998;160:325-329.
4.
Gagner M, Lacroix A, Prinz RA, Bolte E, Albata D, Potvin C, et al: Early experiences with laparoscopic approach for adrenalectomy. Surgery 1993;114:1120-1125.
5.
Wang HS, Li CC, Chou YH, Wang CJ, Wu WJ, Huang CH: Comparison of laparoscopic adrenalectomy with open surgery for adrenal tumors. Kaohsiung J Med Sci 2009;25:438-444.
6.
Mercan S, Seven R, Ozarmagan S, Tezelman S: Endoscopic retroperitoneal adrenalectomy. Surgery 1995;118:1071-1076.
7.
Fernandez Cruz L, Saenz A, Benarroch G, Astudillo E, Taura P, Sabater L: Laparoscopic unilateral and bilateral adrenalectomy for Cushing's syndrome: transperitoneal and retroperitoneal approaches. Ann Surg 1996;224:727-734.
8.
Naya Y, Nagata M, Ichilawa T, Amakasu M, Omura M, Nishikawa T, et al: Laparoscopic adrenalectomy: comparison of transperitoneal and retroperitoneal approaches. BJU Int 2002;90:199-204.
9.
Ramacciato G, Nigri GR, Petrucciani N, Santo VD, Piccoli M, Buniva P, et al: Minimally invasive adrenalectomy: a multicenter comparison of transperitoneal and retroperitoneal approaches. Am Surg 2011;77:409-416.
10.
Giger U, Vonlanthen R, Michel JM, Krähenbühl L: Trans- and retroperitoneal endoscopic adrenalectomy: experience in 26 consecutive adrenalectomies. Dig Surg 2004;21:28-32.
11.
Dickson PV, Alex GC, Grubbs EG, Ayala-Ramirez M, Jimenez C, Evans DB, et al: Posterior retroperitoneoscopic adrenalectomy is a safe and effective alternative to transabdominal laparoscopic adrenalectomy for pheochromocytoma. Surgery 2011;150:452-458.
12.
Lezoche E, Guerrieri M, Feliciotti F, Paganini AM, Perretta S, Baldarelli M, et al: Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc 2002;16:96-99.
13.
Papalia R, Simone G, Leonardo C, Loreto A, Coppola R, Guaglianone S, et al: Laparoscopic transperitoneal right adrealectomy for ‘large‘ tumors. Urol Int 2008:437-440.
14.
Takeda M, Go H, Watanabe R, Kurumada S, Obara K, Takahashi E, et al: Retroperitoneal laparoscopic adrenalectomy for functioning adrenal tumors: comparison with conventional transperitoneal laparoscopic adrenalectomy. J Urol 1997;157:19-23.
15.
Chee C, Ravinthiran T, Cheng C: Laparoscopic adrenalectomy: experience with transabdominal and retroperitoneal approaches. Urology 1998;51:29-32.
16.
Blake D: Hamilton: Laparoscopic adrenalectomy: transperitoneal and retroperitoneal approaches; in Bishoff JT, Kavoussi LR (eds): Atlas of Laparoscopic Retroperitoneal Surgery. Philadelphia, Saunders, 2000, pp 191-208.
17.
Arslan M, Akin Y, Ates M, Degirmenci T, Kozacioglu Z, Ors B, et al: Changing surgical approaches for laparoscopic adrenalectomy: single-surgeon data of a 6-year experience. Urol Int 2013;91:304-309.
18.
Agha A, Hornung M, Iesalnieks I, Glockzin G, Schlitt HJ: Single-incision retroperitoneoscopic adrenalectomy and single-incision laparoscopic adrenalectomy. J Endourol 2010;24:1765-1770.
19.
Ito K, Yoshii T, Shinmoto H, Kanbara T, Sumitomo M, Kaji T, Tanaka Y, Asano T: Laparoscopic enucleation of macronodules in a patient with ACTH-independent macronodular adrenal hyperplasia7 years after unilateral adrenalectomy: consideration of operative procedure. Urol Int 2013;90:253-258.
20.
Gagner M, Pomp A, Heniford BT, Pharand D, Lacroix A: Laparoscopic adrenalectomy: lessons learned from 100 consecutive procedures. Ann Surg 1997;226:238-246.
21.
Shen WT, Sturgeon C, Clark OH, Duh QY, Kebebew E: Should pheochromocytoma size influence surgical approach? A comparison of 90 malignant and 60 benign pheochromocytoma. Surgery 2004;136:1129-1137.
22.
Greco F, Hoda MR, Rassweiler J, Fahlenkamp D, Neisius DA, Kutta A, et al: Laparoscopic adrenalectomy in urological centres - the experience of the German Laparoscopic Working Group. BJU Int 2011;108:1646-1651.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.