Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial

Tomasz Kozłowski; Barbara Choromanska; Piotr Wojskowicz; Kamil Astapczyk; Jerzy Łukaszewicz; Dominika Rutkowski; Jacek Dadan; Alicja Rydzewska-Rosołowska; Piotr Myśliwiec

doi:10.5114/wiitm.2019.84694

eISSN: 2299-0054
ISSN: 1895-4588

Videosurgery and Other Miniinvasive Techniques

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2/2019
vol. 14

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abstract:

Original paper

Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial

Tomasz Kozłowski

,

Barbara Choromanska

,

Piotr Wojskowicz

,

Kamil Astapczyk

,

Jerzy Łukaszewicz

,

Dominika Rutkowski

,

Jacek Dadan

,

Alicja Rydzewska-Rosołowska

,

Piotr Myśliwiec

Videosurgery Miniinv 2019; 14 (2): 160–169

DOI: https://doi.org/10.5114/wiitm.2019.84694

Online publish date: 2019/05/05

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AMA

Kozłowski T, Choromanska B, Wojskowicz P, et al. Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial. Videosurgery and Other Miniinvasive Techniques. 2019:160-169. doi:10.5114/wiitm.2019.84694.

APA

Kozłowski, T., Choromanska, B., Wojskowicz, P., Astapczyk, K., Łukaszewicz, J.,  & Rutkowski, D. et al. (2019). Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial. Videosurgery and Other Miniinvasive Techniques, 160-169. https://doi.org/10.5114/wiitm.2019.84694

Chicago

Kozłowski, Tomasz, Barbara Choromanska, Piotr Wojskowicz, Kamil Astapczyk, Jerzy Łukaszewicz, Dominika Rutkowski,  and Jacek Dadan et al. 2019. "Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial". Videosurgery and Other Miniinvasive Techniques: 160-169. doi:10.5114/wiitm.2019.84694.

Harvard

Kozłowski, T., Choromanska, B., Wojskowicz, P., Astapczyk, K., Łukaszewicz, J., Rutkowski, D., Dadan, J., Rydzewska-Rosołowska, A.,  and Myśliwiec, P. (2019). Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial. Videosurgery and Other Miniinvasive Techniques, pp.160-169. https://doi.org/10.5114/wiitm.2019.84694

MLA

Kozłowski, Tomasz et al. "Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial." Videosurgery and Other Miniinvasive Techniques, 2019, pp. 160-169. doi:10.5114/wiitm.2019.84694.

Vancouver

Kozłowski T, Choromanska B, Wojskowicz P, Astapczyk K, Łukaszewicz J, Rutkowski D et al. Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial. Videosurgery and Other Miniinvasive Techniques. 2019:160-169. doi:10.5114/wiitm.2019.84694.

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Introduction
Laparoscopic adrenalectomy has become the gold standard of surgical treatment for benign adrenal masses. Two alternative surgical approaches are currently advocated: the lateral transperitoneal approach (LTA) and the posterior retroperitoneal approach (PRA). Several randomized trials have compared LTA to PRA, but most of them included small numbers of patients or had stringent inclusion criteria.

Aim
To compare clinical results of LTA and PRA endoscopic adrenalectomies for tumors < 8 cm with wide inclusion criteria.

Material and methods
We randomized 77 patients to either LTA (n = 33) or PRA (n = 44). The groups were comparable in terms of age, gender proportions, body mass index, tumor size, clinical and pathological diagnosis. We analyzed duration of surgery, intraoperative blood loss, postoperative pain, length of hospital stay and postoperative morbidity.

Results
The follow-up concerned 98.8% of patients and was on average 28 (8–47) months long. There were no conversions. We identified significantly lower intensity of pain assessed 24 h after surgery in the PRA group (3.4 ±1), as compared to LTA (4.2 ±1), with lower prevalence of shoulder pain (2.3% vs. 30.3%, respectively). Postoperative hospital stay was shorter in the PRA (1.14 ±0.4) than in the LTA (1.36 ±0.5) group. Perioperative morbidity concerned 4 patients in each group with pain requiring oral analgesia > 7 days.

Conclusions
To our knowledge this is the largest prospective randomized study comparing LTA to PRA. We demonstrated safety, efficacy and very low morbidity of both techniques. The PRA proved superior to LTA in terms of lower intensity of postoperative pain and shorter hospital stay.

keywords:

Laparoscopic adrenalectomy: lateral transperitoneal versus posterior retroperitoneal approach – prospective randomized trial

Tomasz Kozłowski , Barbara Choromanska , Piotr Wojskowicz , Kamil Astapczyk , Jerzy Łukaszewicz , Dominika Rutkowski , Jacek Dadan , Alicja Rydzewska-Rosołowska , Piotr Myśliwiec

laparoscopic adrenalectomy, retroperitoneal approach, randomized control study, pain, length of hospital stay, safety

Tomasz Kozłowski

,

Barbara Choromanska

,

Piotr Wojskowicz

,

Kamil Astapczyk

,

Jerzy Łukaszewicz

,

Dominika Rutkowski

,

Jacek Dadan

,

Alicja Rydzewska-Rosołowska

,

Piotr Myśliwiec