title: Minimally invasive approach for adrenal lesions: Systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications.
abstract: In the last decades, minimally invasive transperitoneal laparoscopic adrenalectomy has become the standard of care for surgical resection of the adrenal gland tumors. Recently, however, adrenalectomy by a mininvasive retroperitoneal approach has reached increasingly popularity as alternative technique. Short hospitalization, lower postoperative pain and decrease of complications and a better cosmetic resolution are the main advantages of these innovative techniques. In order to determine the better surgical management of adrenal neoplasms, the Authors analyzed and compared the feasibility and the postoperative complications of minimally invasive adrenalectomy approaches. A systematic research of the English literature, including major meta-analysis articles, clinical randomized trials, retrospective studies and systematic reviews was performed, comparing laparoscopic transperitoneal adrenalectomy versus retroperitoneoscopic adrenalectomy. Many studies support that posterior retroperitoneal adrenalectomy is superior or at least comparable to laparoscopic transperitoneal adrenalectomy in operation time, pain score, blood loss, hospitalization, complications rates and return to normal activity. However, laparoscopic transperitoneal adrenalectomy is up to now a safe and standardized procedure with a shorter learning curve and a similar low morbidity rate, even for tumors larger than 6 cm. Nevertheless, further studies are needed to objectively evaluate these techniques, excluding selection bias and bias related to differences in surgeons' experiences with this approaches.
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: giovanni.conzo@unina2.it.
authors.forename: G
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: ernestart@msn.com.
authors.forename: E
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: claudiog86@hotmail.it.
authors.forename: C
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: daniela.esposito82@yahoo.it.
authors.forename: D
authors.initials: D
authors.lastname: Esposito
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: valerio.sciascia@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Sciascia
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: claudio.mauriello@live.it.
authors.forename: C
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: annamed82@virgilio.it.
authors.forename: A
authors.initials: A
authors.lastname: Nunziata
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: giusicil@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Siciliano
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: graziellaizzo@live.it.
authors.forename: G
authors.initials: G
authors.lastname: Izzo
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: fabiocavallo@iol.it.
authors.forename: F
authors.initials: F
authors.lastname: Cavallo
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: guglielmo.thomas@mail.com.
authors.forename: G
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Advanced Biomedical Sciences Department, AOU "Federico II", Naples, Italy. Electronic address: mario.musella@unina.it.
authors.forename: M
authors.initials: M
authors.lastname: Musella
authors.affiliation: Unit of General and Oncologic Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine and Surgery Second University of Naples, Italy. Electronic address: luigi.santini@unina2.it.
authors.forename: L
authors.initials: L
authors.lastname: Santini
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D012187:Retroperitoneal Space; D012307:Risk Factors
keywords: Adrenal gland; Adrenal tumor; Laparoscopic transperitoneal adrenalectomy; Posterior retroperitoneal adrenalectomy