title: Improving Minimally Invasive Adrenalectomy: Selection of Optimal Approach and Comparison of Outcomes.
abstract: BACKGROUND
  Minimally invasive adrenalectomy is commonly performed by either a transperitoneal laparoscopic (TLA) or posterior retroperitoneoscopic (PRA) approach. Our group described the technique for robot-assisted PRA (RAPRA) in 2010. Few studies are available that directly compare outcomes between the available operative approaches. We reviewed our results for minimally invasive adrenalectomy using the three different approaches over a 10-year period.
  
  
  METHODS
  Between January 2005 and April 2015, 160 minimally invasive adrenalectomies were performed. Clinicopathologic data were prospectively collected and retrospectively analyzed. The primary endpoints evaluated were operative time, blood loss, length of stay (LOS), and morbidity.
  
  
  RESULTS
  The study included 67 TLA, 76 PRA, and 17 RAPRA procedures. Tumor size for PRA/RAPRA was smaller than for patients undergoing TLA (2.38 vs 3.6 cm, p ≤ 0.0001). Procedure time was shorter for PRA versus TLA (133.3 vs 152.8 min, p = 0.0381), as was LOS (1.85 vs 2.82 days, p = 0.0145). Procedure time was longer in RAPRA versus TLA/PRA (177 vs 153/133 min, p = 0.008), but LOS was significantly decreased (1.53 vs 2.82/1.85 days, p = 0.004).
  
  
  CONCLUSIONS
  Minimally invasive adrenalectomy is associated with expected excellent outcomes regardless of approach. In our series, the posterior approach is associated with decreased operative time and LOS. Robotic technology provides potential advantages for the surgeon at the expense of more complex setup requirements and costs. Further study is required to demonstrate clear benefit of one surgical approach. Utilization of the entire spectrum of available operative techniques can allow for selection of the optimal approach based on individual patient factors.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Baylor Scott & White Health, MS-01-730C, 2401 S. 31st Street, Temple, TX, 76508, USA. terry.lairmore@bswhealth.org.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Lairmore
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Baylor Scott & White Health, MS-01-730C, 2401 S. 31st Street, Temple, TX, 76508, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Folek
authors.affiliation: Department of Surgery, Baylor Scott & White Hillcrest, 100 Hillcrest Medical Blvd, Waco, TX, 76712, USA.
authors.forename: Cara M
authors.initials: CM
authors.lastname: Govednik
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Baylor Scott & White Health, MS-01-730C, 2401 S. 31st Street, Temple, TX, 76508, USA.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Snyder
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D055815:Young Adult