title: Retroperitoneal laparoscopic adrenalectomy for functioning adrenal tumors: comparison with conventional transperitoneal laparoscopic adrenalectomy.
abstract: OBJECTIVE
  We attempted to confirm the possibility and feasibility of laparoscopic adrenalectomy via the retroperitoneal approach, and to compare results of the transperitoneal and retroperitoneal approaches.
  
  
  METHODS
  Three men and 8 women (mean age 39.6 years) with functioning adrenocortical tumors (primary aldosteronism in 5 and Cushing's syndrome in 6) underwent laparoscopic adrenalectomy via the retroperitoneal approach using a balloon dissection technique and a newly developed ultrasonic aspirator. Results were compared to those of 27 cases of transperitoneal laparoscopic adrenalectomy.
  
  
  RESULTS
  Although the retroperitoneal approach was successful in all 5 patients with primary aldosteronism, it succeeded in only 2 of the 6 cases of Cushing's syndrome. In 3 Cushing's syndrome cases the retroperitoneal approach was changed to the transperitoneal laparoscopic approach due to difficulty in exploration. Open laparotomy was required in 1 case of left Cushing's syndrome because of an inadvertent pancreatic injury. Subcutaneous emphysema developed in 6 patients without hypercapnia or prolonged postoperative symptoms. Mean operative time and blood loss, and time to oral intake and ambulation were 248.3 minutes, 151.4 ml., and 1.55 and 2 days, respectively. There was no difference between retroperitoneal and conventional transperitoneal laparoscopic adrenalectomy in regard to these factors or to convalescence.
  
  
  CONCLUSIONS
  Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.
authors.affiliation: Department of Urology, Niigata University School of Medicine, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Takeda
authors.forename: H
authors.initials: H
authors.lastname: Go
authors.forename: R
authors.initials: R
authors.lastname: Watanabe
authors.forename: S
authors.initials: S
authors.lastname: Kurumada
authors.forename: K
authors.initials: K
authors.lastname: Obara
authors.forename: E
authors.initials: E
authors.lastname: Takahashi
authors.forename: T
authors.initials: T
authors.lastname: Komeyama
authors.forename: T
authors.initials: T
authors.lastname: Imai
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000295:instrumentation / Q000379:methods*; D000328:Adult; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space