title: Retroperitoneoscopic or laparoscopic adrenalectomy? A single-centre UK experience.
abstract: BACKGROUND
  Laparoscopic adrenalectomy (LA) is the "gold standard" approach to benign adrenal tumours. Retroperitoneoscopic adrenalectomy (RA) is an increasingly popular alternative. The purpose of this study was to compare our preliminary experience with RA to the more established LA.
  
  
  METHODS
  Data on patients undergoing adrenalectomy over a 2-year period from 2010 were reviewed. Patients undergoing open adrenalectomy, bilateral adrenal surgery, or paraganglioma resection were excluded. The LA and RA patients were compared according to their operative time, time to first oral intake, complications, analgesic requirements, and length of hospital stay. Further analysis was performed on patients matched for all patient and disease-related criteria. Statistical analysis was performed using the χ (2) test and the Mann-Whitney U test as appropriate.
  
  
  RESULTS
  A total of 71 adrenalectomies that fit the inclusion criteria were performed during the period studied of which 36 patients underwent LA and 35 patients underwent RA. Mean tumour size differed between the two groups (2.83 cm in RA group vs. 4.1 cm in LA group; p = 0.033). Operative time, time to first oral intake, analgesic requirements, length of hospital stay, and postoperative complications were all significantly lower in the RA group. Analysis of matched patients showed a significant difference between RA and LA in analgesia requirements (5 vs. 8 paracetamol doses, p = 0.014; 2 vs. 10 tramadol doses, p = 0.042) as well as in the length of hospital stay (1.58 vs. 3.58 days, p = 0.038).
  
  
  CONCLUSIONS
  RA may be associated with reduced postoperative pain and length of hospital stay. It is a valuable alternative to LA in smaller tumours where it may prove to be superior.
authors.affiliation: Department of Thyroid and Endocrine Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 OHS, UK, vascons@doctors.org.uk.
authors.forename: Vasilis A
authors.initials: VA
authors.lastname: Constantinides
authors.forename: Ioannis
authors.initials: I
authors.lastname: Christakis
authors.forename: Philip
authors.initials: P
authors.lastname: Touska
authors.forename: Karim
authors.initials: K
authors.lastname: Meeran
authors.forename: Fausto
authors.initials: F
authors.lastname: Palazzo
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000601:surgery; D061646:Operative Time; D010235:Paraganglioma / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome