title: Impact of posterior retroperitoneoscopic adrenalectomy in a tertiary care center: a paradigm shift.
abstract: BACKGROUND
  Posterior retroperitoneoscopic adrenalectomy has substituted its anterior laparoscopic counterpart as the treatment of choice in the management of adrenal tumors at the authors' institution. The authors present their comparative results between these operative techniques, demonstrating the reasons for this change.
  
  
  METHODS
  From May 2008 to September 2010, 30 patients underwent posterior retroperitoneoscopic adrenalectomy. Operative time, complications, hospital stay, postoperative pain, and cost were compared with those of 30 selected laparoscopic control subjects treated from 2005 to 2010. Statistical analysis was based on Chi-square, the Mann-Whitney U test, the independent-samples t-test, and the Wilcoxon matched pairs test, as appropriate.
  
  
  RESULTS
  The median tumor size was 3.8 cm (range, 1.5-8.0 cm) in the retroperitoneoscopic group and 4.9 cm (range, 2.4-8.0 cm) in the laparoscopic group. The median operative time was similar between the two groups (90.0 min; range, 60-165 min vs. 77.5 min; range, 55-120 min; P = 0.138). It was, however, significantly reduced after the 20th case (97.5 min; range, 80-165 min vs. 70 min; range, 60-110 min; P < 0.001) in the retroperitoneoscopic group. The median visual analog pain scores were significantly lower in the retroperitoneoscopic group on both the first and the third postoperative days, respectively (1; range, 0-1 vs. 4; range, 3-6; P < 0.001 and 0; range, 0-1 vs. 3; range, 2-6; P < 0.001). The median postoperative hospital stay also was shorter in the retroperitoneoscopic group (2 days; range, 2-3 days vs. 4 days; range, 3-6 days; P < 0.001). The cost of the posterior approach was significantly less than that of the laparoscopic technique (P < 0.001).
  
  
  CONCLUSIONS
  Posterior retroperitoneoscopic adrenalectomy compared with laparoscopic adrenalectomy was safe, fast, and vastly superior in terms of postoperative pain and hospital stay in this series. Because of the ability to reproduce such excellent operative results, the impressive patient recovery, and the significantly reduced operative cost, the authors suggest that the retroperitoneoscopic approach should become the method of choice in minimally invasive adrenal surgery.
authors.affiliation: Department of Surgery, Hygeia' Hospital, 4 Erythrou Stavrou Street and Kifissias Avenue, Marousi, 15123 Athens, Greece. kirian@ontelecoms.gr
authors.forename: Andreas
authors.initials: A
authors.lastname: Kiriakopoulos
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Economopoulos
authors.forename: Efthimios
authors.initials: E
authors.lastname: Poulios
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Linos
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis; D056888:Patient Positioning; D055815:Young Adult