title: Endoscopic adrenalectomy: an analysis of the transperitoneal and retroperitoneal approaches and results of a prospective follow-up study.
abstract: BACKGROUND
  Endoscopic adrenalectomy is currently performed using either a retroperitoneal or transperitoneal approach. The aim of this study was to determine which of these is the optimal surgical technique in a prospectively designed analysis of a large series of patients operated on by a single team over a 10-year period.
  
  
  METHODS
  From February 1994 to March 2004, 267 endoscopic adrenalectomies (retroperitoneal in 132 patients and transperitoneal in 135 patients) were performed in 245 consecutive patients. There were 102 right lateral and 121 left lateral procedures (22 patients had a bilateral procedure). The most prevalent indication was incidentaloma (35.9%), followed by pheochromocytoma and Conn's adenoma.
  
  
  RESULTS
  The endoscopic procedure was performed in 238 of 245 patients (97.1%). The conversion rate was 1.5% for the transperitoneal approach and 3.8% for the retroperitoneal approach. No statistically significant influence was noted for the parameters of intraoperative blood loss, rate of postoperative complications, and duration of hospital stay with regard to the surgical technique. The operative time and the learning curve proved to be significantly longer for the retroperitoneal adrenalectomy. In addition, a variance analysis identified tumor size (>5 cm) as a significant factor influencing the operative time, whereas body mass index and localization (right/left lateral) did not prove significant.
  
  
  CONCLUSIONS
  Independent of the underlying pathology, endoscopic adrenalectomy using either the trans- or retroperitoneal approach can be performed in 96-98% of all patients. Differences between the two techniques in operative time and learning curves clearly favor the transperitoneal adrenalectomy.
authors.affiliation: Department of General and Abdominal Surgery, Johannes Gutenberg University, Langenbeckstrasse 1, 55101 Mainz, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Gockel
authors.forename: W
authors.initials: W
authors.lastname: Kneist
authors.forename: A
authors.initials: A
authors.lastname: Heintz
authors.forename: J
authors.initials: J
authors.lastname: Beyer
authors.forename: T
authors.initials: T
authors.lastname: Junginger
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000193:education / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000601:surgery; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003480:Cushing Syndrome / Q000601:surgery; D004724:Endoscopy / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000601:surgery; D010537:Peritoneum; D010673:Pheochromocytoma / Q000601:surgery; D011446:Prospective Studies; D012187:Retroperitoneal Space; D016896:Treatment Outcome