Comparative Study On Retroperitoneal Laparoscopic Adrenalectomy And Open Adrenalectomy With Adrenal Tumors

Objective:The extensive application of B-mode ultrasound. computerized tomography (CT), and magnetic resonance imaging (MRI) has led to an increasing rate of detection of adrenal tumors. Laparoscopic adrenalectomy has become the gold standard for treatment of most adrenal tumors. There are many laparoscopic surgical procedure, urologists incline the lateral retroperitoneal approach. With simple and direct approach, it is easy to expose the adrenal and less likely to damage abdominal organs. Along with the laparoscopic technology development, more familiar to anatomy and skilled in the operate technique, retroperitoneal laparoscopic adrenalectomy take its advantages and expand surgical indications for adrenal tumors. It is the most common surgical procedure, the article compares and evaluates the clinical effects between retroperitoneal laparoscopic adrenalectomy and open adrenalectomy for the treatment of adrenal tumors.Methods:The clinical data of 503 cases from March,2002 to March, 2010 were analyzed retrospectively, All of 503,265 patients, average 2.6±1.5cm in tumors diameter(range:0.9-5.5cm), underwent retroperitoneal laparoscopic adrenalectomy and 238 open adrenalectomy, with average 3.5±1.8cm in tumors diameter(range:1.5-5.9cm).The therapeutic effects of the two groups were compared. The differences in age, tumor size, and average operating time, the bleeding volume during operation, use of analgesic, the time to oral intake, hospitalization stay after operation and the complication rates were analyzed. Result:Retroperitoneal laparoscopic adrenalectomy for 265 cases,249 cases were successful,238 cases underwent open adrenalectomy. No statistically significant difference was found in average operating time between the two groups. The intra-operative bleeding loss (79.5±30.6ml), the mean time to oral intake (1.4±0.6d), use of analgesic (1.5±0.9times), duration of post-operative hospital stay (6.7±3.4d) and incidence of complications were significantly superior to those (163.4±43.7ml), (3.0±1.6d), (3.9±3.2times), (9.7±2.1d) with the other group (P<0.05) Retroperitoneal laparoscopic adrenalectomy had lower rate of complications than open adrenalectomy,including incisional hernia, wound infection and injury of pleura.409 cases were followed an average of 29 months (3 to 60 months), there were partial or complete disappearance of symptoms, without evidence of recurrence.Conclusion:Adrenal tumors can be completed safely and effectively through retroperitoneal laparoscopic procedure. Retroperitoneal laparo-scopic adrenalectomy had lower rate of complications than open adrenalectomy, including incisional hernia, wound infection and injury of pleura. Because of its less traumatic, quicker recovery, retroperitoneal laparoscopic surgery should be performed as the choice for benign adrenal tumors.Along with the rapid development of laparoscopic techniques and instruments, urological physicians familiar to anatomy and skilled in the operate technique, it leads to significantly reduce complications after retroperitoneal laparoscopic adrenalectomy, surgical indications has expanded gradually. Retroperitoneal laparoscopic adrenalectomy becomes standard for treatment of adrenal tumors.