title: Laparoscopic anterior versus endoscopic posterior approach for adrenalectomy: a shift to a new golden standard?
abstract: OBJECTIVE
  There has been an increased utilization of the posterior retroperitoneal approach (PRA) for adrenalectomy alongside the "classic" laparoscopic transabdominal technique (LTA). The aim of this study was to compare both procedures based on outcome variables at various ranges of tumor size.
  
  
  METHODS
  A retrospective analysis was performed on 204 laparoscopic transabdominal (UMC Groningen) and 57 retroperitoneal (UMC Utrecht) adrenalectomies between 1998 and 2013. We applied a univariate and multivariate regression analysis. Mann-Whitney and chi-squared tests were used to compare outcome variables between both approaches.
  
  
  RESULTS
  Both mean operation time and median blood loss were significantly lower in the PRA group with 102.1 (SD 33.5) vs. 173.3 (SD 59.1) minutes (p < 0.001) and 0 (0-200) vs. 50 (0-1000) milliliters (p < 0.001), respectively. The shorter operation time in PRA was independent of tumor size. Complication rates were higher in the LTA (19.1%) compared to PRA (8.8%). There was no significant difference in recovery time between both approaches.
  
  
  CONCLUSIONS
  Application of the PRA decreases operation time, blood loss, and complication rates compared to LTA. This might encourage institutions that use the LTA to start using PRA in patients with adrenal tumors, independent of tumor size.
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
authors.forename: O M
authors.initials: OM
authors.lastname: Vrielink
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
authors.forename: K P
authors.initials: KP
authors.lastname: Wevers
authors.affiliation: Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Kist
authors.affiliation: Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: I H M
authors.initials: IHM
authors.lastname: Borel Rinkes
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
authors.forename: P H J
authors.initials: PHJ
authors.lastname: Hemmer
authors.affiliation: Department of Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: M R
authors.initials: MR
authors.lastname: Vriens
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Department of Surgical Oncology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands. s.kruijff@umcg.nl.
authors.forename: S
authors.initials: S
authors.lastname: Kruijff
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Adrenalectomy; Approach; Laparoscopy; Retroperitoneal; Transabdominal