Expanding the indications for laparoscopic retroperitoneal adrenalectomy: Experience with 81 resections

Irene Epelboym, Christopher S. Digesu, Michael G. Johnston, John A. Chabot, William B. Inabnet, John D. Allendorf, James A. Lee

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background Laparoscopic retroperitoneal (RP) adrenalectomy has gained popularity as the preferred approach over transabdominal (TA) method; however, surgeons have been reluctant to offer this operation to obese patients because of the concerns over inadequate working space and overall perceived higher rate of complications. The aim of the present study was to evaluate the feasibility and safety of RP adrenalectomy compared with TA adrenalectomy, specifically in morbidly obese patients. Methods All laparoscopic adrenalectomies performed at our institution between 2004 and 2012 were reviewed retrospectively. Presenting features, operative characteristics, and postoperative outcomes were evaluated. Complications were graded using Clavien system. Continuous variables were compared using Student t-test. Categorical variables were compared using χ2-test. Prediction models were constructed using linear or logistic regression as appropriate. Results Eighty-one RP and 130 TA procedures were performed, 26 (12.3%) and 60 (28.4%), respectively in obese patients (BMI > 30). Among the obese patients, operative time and estimated blood loss were less for RP (90 versus 130 min; P < 0.001 and 0 versus 50 mL; P < 0.001). Differences in the length of stay, overall mortality, incidence and severity of postoperative complications, and rates of readmission were not statistically significant between RP and TA procedures for all comers and in the obese patients. Controlling the operative characteristics and patient-specific factors, neither operative approach nor obesity was found to independently predict the postoperative complications. Conclusions Laparoscopic RP adrenalectomy is a safe and feasible technique for obese patients. In the obese patients and for all comers, it offers shorter operative time, decreased estimated blood loss, with comparable length of stay and morbidity and mortality rates. We therefore recommend that this technique should be considered for patients undergoing adrenal resection.

Original languageEnglish
Pages (from-to)496-501
Number of pages6
JournalJournal of Surgical Research
Volume187
Issue number2
DOIs
StatePublished - Apr 2014

Keywords

  • Endocrine
  • Laparoscopic adrenalectomy
  • Obesity
  • Retroperitoneal adrenalectomy

ASJC Scopus subject areas

  • Surgery

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