title: Expanding the indications for laparoscopic retroperitoneal adrenalectomy: experience with 81 resections.
abstract: BACKGROUND
  Laparoscopic retroperitoneal (RP) adrenalectomy has gained popularity as the preferred approach over transabdominal (TA) method; however, surgeons have been reluctant to offer this operation to obese patients because of the concerns over inadequate working space and overall perceived higher rate of complications. The aim of the present study was to evaluate the feasibility and safety of RP adrenalectomy compared with TA adrenalectomy, specifically in morbidly obese patients.
  
  
  METHODS
  All laparoscopic adrenalectomies performed at our institution between 2004 and 2012 were reviewed retrospectively. Presenting features, operative characteristics, and postoperative outcomes were evaluated. Complications were graded using Clavien system. Continuous variables were compared using Student t-test. Categorical variables were compared using χ(2)-test. Prediction models were constructed using linear or logistic regression as appropriate.
  
  
  RESULTS
  Eighty-one RP and 130 TA procedures were performed, 26 (12.3%) and 60 (28.4%), respectively in obese patients (BMI > 30). Among the obese patients, operative time and estimated blood loss were less for RP (90 versus 130 min; P < 0.001 and 0 versus 50 mL; P < 0.001). Differences in the length of stay, overall mortality, incidence and severity of postoperative complications, and rates of readmission were not statistically significant between RP and TA procedures for all comers and in the obese patients. Controlling the operative characteristics and patient-specific factors, neither operative approach nor obesity was found to independently predict the postoperative complications.
  
  
  CONCLUSIONS
  Laparoscopic RP adrenalectomy is a safe and feasible technique for obese patients. In the obese patients and for all comers, it offers shorter operative time, decreased estimated blood loss, with comparable length of stay and morbidity and mortality rates. We therefore recommend that this technique should be considered for patients undergoing adrenal resection.
authors: Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors: Irene
authors: I
authors: Epelboym
authors: Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors: Christopher S
authors: CS
authors: Digesu
authors: Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors: Michael G
authors: MG
authors: Johnston
authors: Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors: John A
authors: JA
authors: Chabot
authors: Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida, Mount Sinai Hospital, New York, NY.
authors: William B
authors: WB
authors: Inabnet
authors: Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
authors: John D
authors: JD
authors: Allendorf
authors: Division of Endocrine Surgery, Department of Surgery, Columbia University Medical Center, New York, New York. Electronic address: jal74@columbia.edu.
authors: James A
authors: JA
authors: Lee
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications* / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Endocrine; Laparoscopic adrenalectomy; Obesity; Retroperitoneal adrenalectomy