[Minimally invasive adrenalectomy: transperitoneal vs. retroperitoneal approach].
Laparoscopic adrenalectomy is now regarded as the procedure of choice for most adrenal glands presenting surgical pathology. The primary adrenal-specific contraindication to laparoscopic adrenalectomy today is the presence of a large adrenal mass with evidence of local infiltration or venous invasion. We used our multicentre experience to compare the transperitoneal (TLA) and retroperitoneal (RLA) minimally invasive approaches. In our study we found statistically significant differences between RLA and TLA in terms of duration of surgery (148 minuti vs. 112; p < 0.005), intra-operative blood loss (439 cc vs 333 p < 0.005; p < 0.005) and time of first oral intake (1.2 +/- 0.5 days vs 1.8 +/- 1.08 days; p < 0.005). The RLA approach is preferable in cases of previous abdominal surgery, but its learning curve is extremely steep. TLA access needs a less demanding learning curve and tends to be faster than RLA, where the working area is penalised by limited manoeuvring space. There is no clear preference between TLA and RLA in the literature. However, the experience of the surgeon still remains the most important variable when choosing between the two approaches.
Ramacciato
Giovanni
G
Chirurgia Generale D, Azienda Ospedaliera Sant'Andrea, II Facoltà di Medicina e Chirurgia, Università degli Studi La Sapienza, Roma.
Nigri
Giuseppe
G
Di Santo
Vincenzo
V
Piccoli
Michaela
M
Pansadoro
Vito
V
Buniva
Paolo
P
Bellagamba
Riccardo
R
Cescon
Matteo
M
Ercolani
Giorgio
G
Cucchetti
Alessandro
A
Lauro
Augusto
A
Del Gaudio
Massimo
M
Ravaioli
Matteo
M
Valabrega
Stefano
S
D'Angelo
Francesco
F
Aurello
Paolo
P
Stigliano
Antonio
A
Toscano
Vincenzo
V
Melotti
Gianluigi
G
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003560:Cysts / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D012189:Retrospective Studies