title: A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors.
abstract: BACKGROUND
  Laparoscopic adrenalectomy is considered the gold standard for the surgical treatment of small adrenal tumors. However, several approach routes, such as the transperitoneal (TP), lateral retroperitoneal, and the posterior retroperitoneal (PR) approaches are being used based on surgeon's preference. The PR approach has several benefits compared with the others. Recently, the authors used the PR approach to treat several adrenal tumors and here describe the methods used in detail and the preliminary results obtained.
  
  
  METHODS
  From January 2009 to July 2010, 58 patients underwent adrenalectomy. Open adrenalectomy and robotic adrenalectomy were performed in 5 and 10 patients. Also, 43 patients underwent laparoscopic adrenalectomy, and the TP and PR approaches were used in 26 and 17 patients, respectively. Clinicopathologic data and surgical outcomes were evaluated and compared retrospectively.
  
  
  RESULTS
  There were no significant differences between the TP and PR groups in terms of age, sex, BMI, lesion side, volume of blood loss, or tumor size (3.86 ± 3.83 in TP approach, 2.64 ± 1.61 in PR approach). Mean operative time and average oral intake time using the PR approach were shorter than for the TP approach. Less analgesia use was required in patients who underwent PR approach.
  
  
  CONCLUSIONS
  This study shows that posterior retroperitoneoscopic adrenalectomy is a safe procedure and the operative time is comparable to transperitoneoscopic adrenalectomy. The use of the PR approach for small adrenal tumor can provide very favorable surgical outcomes compared with the TP approach.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Cho Rok
authors.initials: CR
authors.lastname: Lee
authors.forename: Martin K
authors.initials: MK
authors.lastname: Walz
authors.forename: Seulkee
authors.initials: S
authors.lastname: Park
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Park
authors.forename: Jun Soo
authors.initials: JS
authors.lastname: Jeong
authors.forename: So Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kang
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Jeong
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
authors.forename: Cheong Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies