A Modified Technique For Retroperitoneal Laparoscopic Adrenalectomy Based On Adrenal Vascular Anatomy

Background:Adrenal gland is an important endocrine organ. A variety of diseases may develop in this gland.It is located on the top of renal. Adrenal tumors have many types,such as primary hyperaldosteronism、hypercortisolism、PHEO、PGL、ACC、 metastases and so on. Open adrenalectomy was the standard surgical procedure for adrenal tumors before 1990s. Since laparoscopic adrenalectomy was first described in 1992 by Gagner et.It has become the gold standard for the treatment of adrenal tumors instead of open adrenalectomy. At present, the most common surgical approaches include lateral transperitoneal, lateral retroperitoneal and posterior retroperitoneal. In foreign countries,lateral transperitoneal is the most popular surgical approache(70%),and the second is posterior retroperitoneal(20%),but in china,the most popular surgical approache is lateral retroperitoneal, and anatomical retroperitoneoscopic adrenalectomy which described by Zhang Xu is regarded as a typical model.Objective:To investigate a modified technique for retroperitoneal laparascopic adrenalectomy based on adrenal vascular anatomy.Methods:The clinical data of 179 cases (92 males and 87 females) of patients with adrenal lesions from December 2013 to May 2015 were analyzed retrospectively. Their average age was 48.6±16.3 years, ranging from 12 to 79. Ninty-one of the tumors was located in the left and eighty-eight in the right adrenal gland, the tumors averaged 2.8±1.9cm in diameter, ranging from 0.8 to 11.5 cm. All patients underwent adrenalectomy surgery according to this novel surgery. After the retroperitoneal working space created, Gerota’s fascia is dissected near the diaphragm to the iliac fossa, then exposed and coagulated the superior artery. To dissect the middle and inferior artery we mobile the dissect plane between the renal artery and the inner of upper kidney pole in order to divide the connective tissues that contain middle and inferior artery.We can easily find and ligate the central adrenal vein by triangle which consist renal artery, inner kidney and central adrenal vein. Finally, the tumor was extracted after the surround tissues were mobilized.Results:For each patient, surgery was successful without conversion to open surgery. The average operative time was 30.18 min, ranging from 12 to 60 min, and the mean blood loss was 20.61 ml, ranging from 10 to 110 ml. All patients were discharged from the hospital 1.5 to 3.9 days after surgery, the average post-operation hospital stay is 2.31 days. During surgery the peritoneum showed perforation in two cases. During the follow-up, there was no relapse or metastasis.Conclusions:This novel technique can reduce blood loss for direct dissection blood supply and simplify separation plane, this procedure is more simple and effective because there is no need to find especially during surgery based on adrenal gland vascular anatomy. This technique provide significant superiority for adrenal lesions, especially when the tumor< 1cm or> 6cm,also when patients with high BMI or vascular anatomy is complicated.