[The choice between transperitoneal and retroperitoneal adrenalectomy. A prospective study].
BACKGROUND
The aim of this prospective study was to evaluate the optimal surgical approach to endoscopic adrenalectomy.


METHODS
Between March 1997 and February 2003, we performed 221 endoscopic adrenalectomies in 202 patients (right side 83, left side 100, bilateral 19), with an conversion rate of 2,5%. In 197 patients endoscopic adrenalectomy was carried out via retropertioneal approach 128 times and via transperitoneal approach 88 times.


RESULTS
Endoscopic adrenalectomy was performed in 98% of the total number patients. No statistically significant influence ( P=0.05) was found for the parameters intraoperative blood loss, rate of postoperative complications, or duration of hospitalization in regard to the procedure. The operative time and learning curve were significantly longer with the retroperitoneal approach. Multivariate analysis identified surgical approach, tumor size (5 cm), and body mass index (25) as independent factors for operative time.


CONCLUSIONS
The lateral transperitoneal approach is the optimal procedure for endoscopic adrenalectomy.
Kneist
W
W
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Klinikum der Johannes Gutenberg-Universität, Mainz.
Vetter
G
G
Kann
P
P
Jaursch-Hancke
C
C
Heintz
A
A
Hommel
G
G
Junginger
T
T
D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D003480:Cushing Syndrome / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D015999:Multivariate Analysis; D010673:Pheochromocytoma / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D013997:Time Factors