title: Comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy in a prospective randomized study.
abstract: OBJECTIVE
  This article reports a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) versus retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with medium-term follow-up.
  
  
  METHODS
  Between September 2008 and November 2011, 24 patients with surgical adrenal diseases were prospectively randomized to undergo TLA (Group 1, 11 patients) or RLA (Group 2, 13 patients). Study exclusion criteria were patients with a body mass index of >40 kg/m(2), significant prior abdominal surgery, and bilateral adrenalectomy. Mean follow-up was 9 months in both groups.
  
  
  RESULTS
  The groups were matched in regard to patients' age (P=.80), sex (P=.72), body mass index (P=.62), and laterality (P=.72). Median adrenal mass size was 2.92 cm (range, 2-5 cm) in the TLA group and 2.63 cm (range, 2-5 cm) in the RLA group (P=.55). TLA was comparable to RLA in terms of operative time (P=.22), estimated blood loss (P=.83), time to ambulation (P=.21), hospital stay (P=.25), analgesic requirement (P=.40), and postoperative pain (P=.40), whereas time to oral intake resumption (P=.001) and convalescence period (P=.002) were significantly shorter in the RLA group. One case from the RLA group was electively converted to open surgery. During a mean follow-up of 9 months, there were no late complications, and no deaths occurred in any group.
  
  
  CONCLUSIONS
  Laparoscopic adrenalectomy is a viable treatment option for removal of benign adrenal lesions that can be performed safely and effectively by either the transperitoneal or retroperitoneal approach. All operative parameters are similar in the two approaches, except that the convalescence period and time to oral intake resumptions that are significantly shorter with retroperitoneal surgery.
authors.affiliation: Urology, Nephrology, and Kidney Transplant Research Center, Department of Urology, Imam Medical Center, Urmia University of Medical Sciences, Urmia, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Mohammadi-Fallah
authors.forename: Alireza
authors.initials: A
authors.lastname: Mehdizadeh
authors.forename: Afshin
authors.initials: A
authors.lastname: Badalzadeh
authors.forename: Behzad
authors.initials: B
authors.lastname: Izadseresht
authors.forename: Niloofar
authors.initials: N
authors.lastname: Dadkhah
authors.forename: Azarakhsh
authors.initials: A
authors.lastname: Barbod
authors.forename: Mehdi
authors.initials: M
authors.lastname: Babaie
authors.forename: Sepehr
authors.initials: S
authors.lastname: Hamedanchi
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum; D011446:Prospective Studies; D012187:Retroperitoneal Space; D055815:Young Adult