Posterior Retroperitoneoscopic Adrenalectomy:a Report Of31Cases And Related Contrast Study

Objective:To report31cases who underwent posterior retroperitoneoscopicadrenalectomy(PRA). Compare these cases with lateral retroperito-neoscopic adrenalectomy(LRA) and transperitoneal laparoscopicadrenalectomy(TLA). Provide reference for the clinical usage of PRA.Methods:From Aug.2013to Feb.2015,31patients with adrenal tumorsunderwent PRA in our urinary center. There were18men and19women, and their age ranged from24to70years old, the averageage was46.2years. All these patients were diagnosed of adrenaltumors by high resolution CT.17cases of tumor position were on theleft side and14cases of tumor position were on the right side. Therewere21cases of primary hyperaldosteronism,4cases of pheochro-mocytoma and6case of nonfunctioning adenoma. The diameter oftumor ranged from10to60mm, the average diameter was30mm.One patient had a renal cyst on the opposite side of adrenal tumor. We compared PRA with LRA and TLA in the following aspects:patients’ age, size of adrenal tumor, operative time, blood loss,catheter indwelling time, drainage tube indwelling time, postoperativehospital stay, and hospitalization expense.Results:The procedures were performed successfully in all these31patients. The mean operative time was70.1min (range from38to138). There was little blood loss that couldn’t be counted exactly. Themean catheter indwelling time was1.8days(range from1to5). Themean drainage tube indwelling time was2.0days(range from1to5).Because of the blood loss was extremely little,2patients didn’tindwell drainage tube. The mean postoperative hospital stay was3.7days(range from2to6). The mean hospitalization expense was21068.63yuan(range from14789to31992). No perioperativecomplications occurred. The pathological diagnosis were similar tothe preoperative diagnosis:21cases of adrenocortical adenoma,4cases of pheochromocytoma and6case of nonfunctioning adenoma.Compared with LRA and TLA, the patients’ age had no differenceamong these3groups. The size of adrenal tumor in the PRA groupwere larger than that in the LRA group, smaller than that in the TLAgroup. The operative time were similar in the PRA group and TLA group, longer than that in LRA group. The blood loss in the PRAgroup and LRA group were little, but in the TLA group there was muchmore blood loss. In the aspects of catheter indwelling time, drainagetube indwelling time, postoperative hospital stay, and hospitalizationexpense, PRA and LRA were similar, less than TLA.Conclusion:PRA has significant advantages in handling large adrenal tumor,especially adrenal tumor after IVC, and performing bilateraladrenalectomy at the same time. Compared with traditionallaparoscopic adrenalectomy, PRA is a safe, feasible, minimallyinvasive, and economical procedure. It provides a new alternativemethod for laparoscopic adre-nalectomy．...