Endoscopic adrenalectomy: is there an optimal surgical approach? Results of a single Center case control study

Background. The choice in between the laparoscopic lateral transabdominal (LTA) or the posterior\r\nretroperitoneoscopic (PRA) approach for adrenalectomy is usually based on surgeon s preference, rather\r\nthan on objective arguments. We compared the intraoperative and postoperative outcomes of LTA and\r\nPRA to determine whether there is a preferable approach.\r\nMethods. Thirty-eight consecutive patients successfully underwent PRA for benign adrenal tumors #6\r\ncm. A case-control study including 38 patients who successfully underwent LTA was performed.\r\nOperative time, intraoperative ventilatory parameters (CO2 production [VCO2], whole body oxygen\r\nconsumption, arterial partial pressure of carbon dioxide [PaCO2], and arterial partial pressure of oxygen\r\n[PaO2]), final histology, complications, postoperative stay, analgesic requirement, time to regain normal\r\nbowel function, and time to return to work were recorded and compared between the 2 groups.\r\nResults. The 2 groups did not differ in terms of operative time, analgesic requirement, time to first flatus,\r\ncomplication rate, duration of postoperative stay, or final histology. Patients in the LTA group showed\r\nsignificantly lower PaCO2, PaO2, and VCO2 at the end of the operation. Patients in the PRA group\r\nexperienced a significantly faster return to work.\r\nConclusion. No procedure can be considered preferable overall. In cases of bilateral adrenalectomy and\r\nprevious abdominal surgery, PRA may offer some advantages. Surgeon s preference and experience will\r\ncontinue to guide this choice.