Retroperitoneal Laparoscopic Adrenalectomy For Adrenal Tumors With Open Surgery

Objective: The study aims to evaluate the feasibility of the retroperitoneoscopicapproach to adrenalectomy for various clinical adrenal tumors and to compare it with theopen retroperitoneal approach. and further discuss the security and feasibility ofretroperitoneal laparoscopic adrenalectomy for complicated adrenal tumors, such as largeadrenal tumors，pheochromocytoma, to summarize reasonable treatment of options ofvarious kinds of adrenal tumors and improve the security and operation skills ofretroperitoneal laparoscopic adrenalectomy.Methods: From June2008to December2013,90patients underwent retroperitoneallaparoscopic adrenalectomy. Open adrenalectomy were performed in102patients. Whoseoperation were performed by the skilled doctor. Clinic pathologic data and surgicaloutcomes were evaluated and compared retrospectively. Statistics the average operationtime, intraoperative blood loss, intraoperative rate of blood pressure and heart volatility,the average drainage time after operation, postoperative analgesic, complications, and theaverage length of hospital stay, postoperative symptom remission rate and other clinicaldata to comparative analysis;At the same time in the two groups of cases according to thepatient’s tumor diameter (>6cm) and postoperative pathological diagnosis is divided intolarger tumor group and pheochromocytoma group to statistics and comparative analysismajor clinical indicators. Results: In the retroperitoneal laparoscopic group, retroperitoneal laparoscopicadrenalectomy was successfully performed on90patients with5elective openconversions because of dense peritumor adhesions. Retroperitoneal laparoscopic group inaverage operation time, intraoperative blood loss, postoperative average fasting time,postoperative analgesic application number, the average hospitalization time and theincidence of complications were better than the open group, with statistical difference (p<0.05), but the two groups in symptom remission rate, improve rate of blood pressure andtumor recurrence rate has no significant statistical difference (p>0.05).in the large tumorgroup：retroperitoneal laparoscopic group in average operation time，average blood lossand postoperative the average hospitalization days is superior to open group，and havestatistical significance (p>0.05)；The intraoperative blood transfusion cases after operation,intraoperative rate of blood pressure and heart volatility and main complications in nosignificant statistical difference (p>0.05).In pheochromocytoma group: retroperitoneallaparoscopic group in average operation time, average blood loss, intraoperative andintraoperative rate of blood pressure and heart volatility are superior to open group withstatistical significance (p<.05), and postoperative blood transfusion cases，intraoperative，postoperative blood pressure improvement rate and into the ICU rate hasno significant statistical differences between the two groups (p>0.05).Conclusions: Retroperitoneoscopy is a safe and feasible option for adrenalectomyfor various clinical adrenal tumors. It requires shorter operative time, less postoperativeanalgesia, a shorter hospitalization, and blood loss is less. After mastering thelaparoscopic technology and sufficient preoperative assessment and preparation,retroperitoneal laparoscopic adrenalectomy for complicated adrenal tumors of largerdiameter of tumor and pheochromocytoma is safe and feasible.