The Comparison Of Transperitoneal With Ipsilateral Retroperitoneal Approaches In The Laparoscopic Adrenalectomy

Objective To compare the difference of the transperitoneal with the ipsilateral retroperitoneal approaches in the laparoscopic adrenalectomy.Methods The data of 589 cases with adrenal gland neoplasms and undergoing laparoscopic adrenalectomy were retrospectively analyzed, who included 255 patients with right adrenal gland neoplasms (of which 174 cases undergoing transperitoneal laparoscopic adrenalectomy and 81 cases undergoing retroperitoneal laparoscopic adrenalectomy, respectively as the A group and B group)and 334 patients with left adrenal gland neoplasms (of which 242 cases undergoing transperitoneal laparoscopic adrenalectomy and 92 cases undergoing retroperitoneal laparoscopic adrenalectomy, respectively as the C group and D group).The parameters of the transperitoneal approaches were compared with ipsilateral retroperitoneal, including the operation time, blood loss volume, the time to first oral intake, postoperative hospital stay,intraoperative complication and conversion rate.Results The mean operation time and the blood loss volume of A group was (55.6±12.4) min and (63.3±21.5)ml, significantly lower than those of B group(59.3±10.2min and 73.2±26.7ml,P<0.05),however, there were no significant difference in the time to first oral intake, postoperative hospital stay,intraoperative complication and conversion rate between both groups.Moreover, The mean time to first oral intake and postoperative hospital stay of C group was 1.5±0.3 days and 5.9±1.7 days, significantly higher than those of D group(1.4±0.6 days and 5.4±1.9 days,P<0.05), but, the significant difference were no found in the operation time, blood loss volume, intraoperative complication and conversion rate between C group and D group. (59.3±10.2) min for group A and group B respectively.Conclusions The right laparoscopic adrenalectomy is relatively safe by the transperitoneal opproach, however, the recovery after the operation is relatively quick by the retroperitoneal approaches in the the left laparoscopic adrenalectomy. The appropriate approach depends on the tumor size, character, location and the experience of the surgeon.