Analysis Of Factors Associated With Surgery Difficulty Of Retroperitoneal Laparoscopic Adrenalectomy

Objective:Retroperitoneal laparoscopic adrenalectomy is the standard treatment for adrenal benign tumors.Our study is to explore the risk factors affecting the difficulty of retroperitoneal laparoscopic adrenalectomy.Methods:In this study,clinical data of patients diagnosed with adrenal tumors and undergoing retroperitoneal laparoscopic adrenalectomy(N=127)in the Department of Urology,Zhujiang Hospital of Southern Medical University from February 2020 to July 2022 were retrospectively analyzed.Patients were continuously enrolled.Medical records were collected including age,sex,Body Mass Index(BMI),tumor laterality,tumor size and Mayo Adhesive Probability(MAP)score,whether the tumor was adjacent to crucial blood vessels,the position of tumor on the upper pole of the kidney(whether it was in the same level as the kidney),operation time and intraoperative blood loss.The difficulty of the surgery was measured by the operation time and the intraoperative blood loss.In this study,Kendalls tau-b correlation analysis was used to analyze the correlation between factors.Besides,univariate and multivariate Logistic regression and as linear regression models were also used to analyze the correlation between factors and operation time or intraoperative blood loss,respectively.Results:A total of 127 patients were included in the study,including 68 males(53.5%)and 59 females(46.5%),tumors on left side 71 cases(55.9%)and right side 56 cases(44.1%),BMI>23.9 kg/m287 cases(68.5%)and BMI ≤23.9 kg/m240 cases(31.5%),86 cases(67.7%)with tumors adjacent to peripheral crucial vessels and 41 cases(32.3%)with tumors not adjacent to crucial vessels,106 cases(83.5%)with tumors not on the same level as the kidney and on the contrary,21 cases(16.5%)with tumors on the level as the kidney.The median tumor size was 1.7(P25,P75=1.1,2.5)cm.The median operative time was 100(P25,P75=84,125)minutes,and the median intraoperative blood loss was 50(P25,P75=30,100)ml.As for MAP score,41 cases(32.3%)scored 0,and 50 cases(39.4%)scored 1,accounting for more than half(71.7%).Correlation analysis results showed that operation time was positively correlated with MAP score,tumor adjacent to crucial blood vessels and intraoperative blood loss,with correlation coefficients of 0.137,0.187,and 0.185.respectively.Intraoperative blood loss was also positively correlated with tumor side and tumor size,with correlation coefficients of 0.176 and 0.171,respectively.Multivariate Logistic regression results showed that age,tumor adjacent to crucial blood vessels and MAP score were significantly correlated with operation time,and the OR value were 0.955(95%CI:0.920,0.990),3.420(95%CI:1.289,9.069)and 3.390(95%CI:1.234,9.316).Tumor side was positively correlated with intraoperative blood loss,OR value was 1.715(95%CI:1.160,2.535),P<0.05.Multiple linear regression results showed that tumor size and MAP score were positively correlated with operation time,and the coefficients were 7.391(95%CI:2.694,12.087)and 5.571(95%CI:0.306,10.837).The tumor size was also positively correlated with intraoperative blood loss,and the coefficient was 9.895(95%CI:0.112,19.679),P<0.05.Conclusions:Increased MAP score,increased tumor size and tumor adjacent to crucial blood vessels were risk factors of increased operation time.Increased tumor size and tumor adjacent to crucial blood vessels were risk factors of increased intraoperative blood loss.Therefore,the study suggests that we can evaluate the difficulty of operation by MAP score,tumor size and whether the tumor is adjacent to crucial blood vessels from medical radiography of patients such as CT or MRI before we start the retroperitoneal laparoscopic adrenalectomy.