title: Videoscopic adrenalectomy - when does retroperitoneal seem better?
abstract: BACKGROUND
  Videoscopic adrenalectomy is the gold standard for the surgical treatment of benign adrenal tumours. The two most common approaches are the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA). So far it has not been established which is the preferable one. The choice depends primarily on the surgeon's preference and contraindications for a particular approach in individual cases.
  
  
  OBJECTIVE
  To compare the two most common approaches for videoscopic adrenalectomy, LTA and PRA, based on a literature review and our own experience.
  
  
  METHODS
  We reviewed the literature (PubMed and Cochrane 1990 - current) and analysed retrospectively our own patients who underwent videoscopic adrenalectomy between 2009 and 2013. The analysis covered patient features, tumour characteristics, reasons for qualification for each approach, operative time and postoperative complications.
  
  
  RESULTS
  Out of 71 videoscopic adrenalectomies, 50 were performed using PRA and 21 using LTA. Patients in the PRA group on average were older, but had smaller tumours. There was no significant difference in perioperative morbidity between PRA and LTA. Mean blood loss and total operative time were smaller/shorter for the PRA group in comparison to the LTA group. Time to first oral intake and the average postoperative hospital stay were shorter for PRA than LTA.
  
  
  CONCLUSIONS
  Videoscopic adrenalectomy is a safe and efficient technique performed using both LTA and PRA approaches. The choice of technique should be guided, most of all, by surgeon experience, patient characteristics, tumour size and location. Our preferable approach is PRA, especially for small (< 6 cm) benign tumours. We find LTA advantageous for tumours of larger size, with suspected malignant character (either primary or secondary), in ectopic position, as well as in patients lacking an ipsilateral kidney or when a simultaneous abdominal operation is planned.
authors.affiliation: 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Myśliwiec
authors.affiliation: Department of Oncological and General Urology, Bialystok Sniadecki Memorial Provincial Hospital, Bialystok, Poland.
authors.forename: Magda
authors.initials: M
authors.lastname: Marek-Safiejko
authors.affiliation: 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Lukaszewicz
authors.affiliation: 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Safiejko
authors.affiliation: Department of Oncological and General Urology, Bialystok Sniadecki Memorial Provincial Hospital, Bialystok, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Kozlowski
authors.affiliation: 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Wojskowicz
authors.affiliation: 1 Department of General and Endocrinological Surgery, Medical University of Bialystok, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Dadan
keywords: adrenal tumours; laparoscopic surgery; retroperitoneal; videoscopic adrenalectomy
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