[Laparoscopic adrenalectomy: a prospective study comparing transperitoneal and retroperitoneal approaches].

OBJECTIVES

A prospective protocol was used to compare transperitoneal and retroperitoneal laparoscopic access for treatment of adrenal lesions.

METHODS

Forty patients (19 male and 21 female) were submitted to laparoscopic adrenalectomy. Patients were operated by two surgeons. Twenty cases for each type of access (transperitoneal and retroperitoneal) were selected for analysis. Operative time, blood loss, time to oral intake, dose of analgesic, surgical complications, conversions, hospital stay and return to normal activities were compared for both approaches.

RESULTS

All procedures were successfully completed. Operative mean time and time to oral intake were 3.6 h and 24 h for the transperitoneal and 2.5 h and 12 h for the retroperitoneal approach (p<0.05). There were no differences in blood loss, analgesia, hospital stay and time for return to normal activities. Complications were observed in two patients in the transperitoneal approach (retroperitoneal bleeding and pancreatitis) and there were three events in the retroperitoneal approach (hipercarbia, peritoneal laceration and pneumonia). No conversions occurred in this cohort of patients.

CONCLUSION

Laparoscopic adrenalectomy is a safe and efficient treatment for an adrenal mass of up to 10 cm. There are no relevant differences between the transperitoneal and retroperitoneal approach. Choice of the laparoscopic approach rests upon particular aspects of each case or upon the surgeon's preference.