title: Management of adrenal incidentaloma by laparoscopic transperitoneal anterior and submesocolic approach.
abstract: OBJECTIVE
  Laparoscopic adrenalectomy (LA) is becoming the main approach for incidentally discovered adrenal masses (adrenal incidentaloma (AI)). The aim of this study was to evaluate the results of LA with a transperitoneal anterior approach for right adrenal lesions and either a transperitoneal anterior or transperitoneal anterior submesocolic approach for the left-sided lesions.
  
  
  METHODS
  The study is a retrospective analysis of prospectively collected data. From January 1994 to December 2012, 393 patients underwent LA, 117 of these for an AI. Sixty-seven (57.26 %) and 50 (42.73 %) patients underwent right and left adrenalectomy, respectively. The transperitoneal anterior approach was used in all 67 patients with right lesions (57.26 %) (group A) and in 13 patients with left-sided lesions (11.11 %) (group B). The transperitoneal anterior submesocolic approach was used in the remaining 37 left-sided lesions (31.62 %) (group C).
  
  
  RESULTS
  Mean operative time in groups A, B, and C was 104.6 min (range 35-255), 148.9 min (range 80-210), and 82.7 min (range 45-230), respectively. One right and one left anterior LA (1.7 %) were converted to open surgery. There were one major and one minor complications (1.7 %). The mean lesion size was 4.73 cm (range 1-10 cm). Mean hospital stay was 3.6 days.
  
  
  CONCLUSIONS
  With adequate experience, LA with a transperitoneal anterior approach for AI is a safe and effective procedure. Early control of the adrenal vein with minimal gland manipulation and limited surgical dissection are its major advantages. In case of left LA, the submesocolic approach reduces the operative time significantly.
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Paganini
authors.affiliation: Department of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121, Ancona, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Guerrieri
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00186, Rome, Italy. andrea.balla@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Balla
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Quaresima
authors.affiliation: Department of Experimental Medicine, Sapienza University, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Isidori
authors.affiliation: Department of Radiological Oncological and Pathological Sciences, Sapienza University, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Iafrate
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambrosio
authors.affiliation: Department of General Surgery, Università Politecnica delle Marche, Piazza Roma 22, 60121, Ancona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lezoche
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00186, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lezoche
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D055815:Young Adult
keywords: Adrenal incidentaloma; Adrenal tumors; Laparoscopic adrenalectomy; Submesocolic approach; Transperitoneal anterior approach