Benefits of transitioning from transperitoneal laparoscopic to retroperitoneoscopic adrenalectomy-a single center experience.

Background: Since 2017, switching from laparoscopic transabdominal adrenalectomy (LTA), posterior retroperitoneoscopic adrenalectomy (RPA) is used as standard procedure in this institution. Aim of this retrospective study was to compare both techniques regarding operative time, length of stay and safety of the procedures.

Methods: All patients operated in our institution for adrenal tumors were prospectively documented in the EUROCRINE-database and retrospectively analyzed. Sex, age, body mass index (BMI), indication, operative time, conversion and complication rates, hospital stay and tumor-size were analyzed by Z-score, chi-square test, t-test, Mann-Whitney U test and Pearson correlation.

Results: A total of 105 RPAs and 132 LTAs were performed in an 8-year period. No difference was seen in age, sex and tumor localization. Adenoma (n=113) and pheochromocytoma (n=64) were the most common histopathological findings. Compared to the LTA group, the RPA group had significantly shorter operative time with a median of 50 (15-380) vs. 125 (25-420) min (P<0.001) and shorter hospital stay with a median of 3 vs. 9 days (P<0.001). The decrease of the median operative time in RPA group, visualizing the learning curve of the procedure, was from 60 min (2017) to 45 min (2020). Four conversions from RPA to open adrenalectomy had to be performed due to bleeding or adhesions, whereas 9 LTA procedures had to be converted due to bleeding (n=2), unclear anatomy (n=1), adhesions (n=1), difficult access (n=1) or planned conversion (n=4).

Conclusions: RPA could be safely introduced with reduced operative times and shorter length of hospital stay compared to LTA.