Posterior retroperitoneoscopic adrenalectomy: outcomes and lessons learned from initial 50 cases.
BACKGROUND
Posterior retroperitoneoscopic adrenalectomy (PRA) is an alternative approach to minimally invasive adrenalectomy, potentially offering less pain and faster recovery compared with laparoscopic transperitoneal adrenalectomy (LA). The authors have recently changed from LA to PRA in suitable patients and audited their first 50 cases.


METHODS
Data were prospectively collected for 50 consecutive PRAs performed by the same surgeon. Patient demographics, tumour characteristics, analgesia use, operative and preparation time, length of stay, and complications were recorded.


RESULTS
Fifty adrenalectomies were performed in 49 patients. The median (range) age was 58.5 years (30-83) and the majority of patients were female (n = 33, 66.0%). The median (interquartile range (IQR)) preparation time was 35.5 (28.5-50.0) and median operation time was 70.5 (54-85) min, which decreased during the study period. After a learning curve of 15 cases, median operative time reached 61 min. PRA patients required minimal post-operative analgesia, with a median (IQR) of 0 (0-5) mg of intravenous morphine equivalent used. The median (IQR) length of stay was 1 (1-1) day, with 8 (16.0%) same-day discharges. There were four complications: one blood pressure lability from a phaeochromocytoma, one reintubation, one self-limited bleed and one temporary subcostal neuropraxia. There were no conversions to open surgery or deaths.


CONCLUSIONS
Our results support previously published findings that PRA is a safe procedure, with a relatively short learning curve, resulting in minimal post-operative analgesia use and short length of hospital stay.
Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.|Epworth Freemasons Hospital, Victoria, Australia.
Miguel S
MS
Cabalag
Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.|Department of Surgery, University of Melbourne, Victoria, Australia.
G Bruce
GB
Mann
Melbourne Epi Centre, Royal Melbourne Hospital, Victoria, Australia.
Alexandra
A
Gorelik
Endocrine Surgery Unit, Royal Melbourne Hospital, Victoria, Australia.|Epworth Freemasons Hospital, Victoria, Australia.|Department of Surgery, University of Melbourne, Victoria, Australia.
Julie A
JA
Miller
D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012187:Retroperitoneal Space
adrenalectomy; analgesia; minimally invasive; outcomes; posterior retroperitoneoscopic