title: Retroperitoneoscopic adrenalectomy: comparison of retrograde and antegrade approach among a series of 279 cases.
abstract: OBJECTIVE
  To compare the results of retroperitoneal laparoscopic adrenalectomy using the antegrade and retrograde approach.
  
  
  METHODS
  We performed an analysis of a single-center series of 279 retroperitoneal laparoscopic adrenalectomies from 1996 to 2010. We compared 172 cases performed with an antegrade approach and 107 with a retrograde approach without dissection of the renal hilum and initial control of the adrenal vein in comparable populations.
  
  
  RESULTS
  The operative time was shorter in the group treated with the retrograde technique, 101±51 vs 140±40 minutes, respectively (Student's t test, P<.001). Blood loss was similar in both groups, 85±224 vs 80±126 mL, respectively (P=NS). Hemodynamic instability was defined as the maximal systolic blood pressure minus the minimal systolic blood pressure divided the maximal systolic blood pressure. It was lower in the group who underwent the retrograde technique (32.7 vs 37.6 mL; Student's t test, P=.005) with a lower perioperative consumption of ephedrine (2.2 vs 5.1 mg, P=.004) and atropine (0.09 vs 0.22 mg, P=.026). No difference was found between the 2 groups in the frequency of perioperative complications or postoperative mortality (1 death in each group of causes unrelated to the surgery).
  
  
  CONCLUSIONS
  Retroperitoneal laparoscopic adrenalectomy using a retrograde approach is a safe and reproducible technique. It makes it possible to perform adrenalectomy without dissection of the renal hilum, with a reduction in the operative time. The good hemodynamic stability observed with this technique makes it very attractive for the treatment of pheochromocytoma.
authors.affiliation: Department of Urology, Toulouse Rangueil University Hospital, Toulouse, France. huyghe.e@chu-toulouse.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Huyghe
authors.forename: Guillaume
authors.initials: G
authors.lastname: Crenn
authors.forename: Béatrice
authors.initials: B
authors.lastname: Duly-Bouhanick
authors.forename: Delphine
authors.initials: D
authors.lastname: Vezzosi
authors.forename: Antoine
authors.initials: A
authors.lastname: Bennet
authors.forename: Fouad
authors.initials: F
authors.lastname: Atallah
authors.forename: Michel
authors.initials: M
authors.lastname: Mazerolles
authors.forename: Ali
authors.initials: A
authors.lastname: Salloum
authors.forename: Matthieu
authors.initials: M
authors.lastname: Thoulouzan
authors.forename: Boris
authors.initials: B
authors.lastname: Delaunay
authors.forename: Solange
authors.initials: S
authors.lastname: Grunenwald
authors.forename: Jacques
authors.initials: J
authors.lastname: Amar
authors.forename: Pierre
authors.initials: P
authors.lastname: Plante
authors.forename: Bernard
authors.initials: B
authors.lastname: Chamontin
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
authors.forename: Michel
authors.initials: M
authors.lastname: Soulié
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D018663:Adrenergic Agents / Q000008:administration & dosage; D018246:Adrenocortical Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D016063:Blood Loss, Surgical; D001794:Blood Pressure; D003480:Cushing Syndrome / Q000601:surgery; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010673:Pheochromocytoma / Q000601:surgery*; D012187:Retroperitoneal Space
chemical_list: D018663:Adrenergic Agents; D000701:Analgesics, Opioid; D000889:Anti-Arrhythmia Agents; D009020:Morphine; D001285:Atropine; D004809:Ephedrine