Single-plane retroperitoneoscopic adrenalectomy: a new operative procedure for benign adrenal disease

RepoRtS | Single-plane retroperitoneoscopic adrenalectomy: a new operative procedure for benign adrenal disease Songchao Li 0 1 2 Jun Wang 0 1 2 Erwei Zhang 0 1 2 Wansheng Gao 2 JinjianYang 0 1 2 Zhankui Jia email: 0 1 2 0 Tumor Molecular Biology Key Laboratory of Zhengzhou, The First Affiliated Hospital of Zhengzhou University , Jianshe Road, Erqi District, Zhengzhou City, 450052, Henan Province , People's Republic of China 1 Urology Laboratory,The First Affiliated Hospital of Zhengzhou University, Urological Institute of Henan , Jianshe Road, Erqi District, Zhengzhou City, 450052, Henan Province , People's Republic of China 2 Department of Urology, The First Affiliated Hospital of Zhengzhou University , Jianshe Road, Erqi District, Zhengzhou City, 450052, Henan Province , People's Republic of China OPEN Published: xx xx xxxx To evaluate the therapeutic effect of single-plane retroperitoneoscopic adrenalectomy. From February 2014 to March 2017, 251 patients underwent single-plane retroperitoneoscopic adrenalectomy, and their operative outcomes were compared with those of 98 patients who underwent anatomical threeplane retroperitoneoscopic adrenalectomy. Among 35 patients with a body mass index (BMI) of ≥30 kg/ m2, their operative outcomes were compared between two operative procedures. The demographic data and perioperative outcomes of the patients were statistically analysed. The single-plane and three-plane groups were comparable in terms of estimated blood loss, time to oral intake, hospital stay, and incidence of complications among patients with similar baseline demographics. The singleplane group had a significantly shorter operation time (46.9 ± 5.8 vs 54.8 ± 7.0 mins, P < 0.0001) and lower analgesia requirement (56/251 vs 33/98, p = 0.03). For obese patients with a BMI of ≥30 kg/m2, single-plane adrenalectomy was also associated with a significantly shorter operation time(48.1 ± 6.2 vs 64.1 ± 5.1 mins, p < 0.0001). Single-plane retroperitoneoscopic adrenalectomy is feasible, safe, and effective in the treatment of adrenal masses <5 cm in size and provides a shorter operation time and better pain control than anatomical retroperitoneal adrenalectomy, especially in obese patients. - Minimally invasive adrenalectomy has been the gold standard treatment for benign adrenal tumours for the past two decades. Laparoscopic transperitoneal adrenalectomy is the most widely practiced technique because it offers a clear anatomical view and large working space. However, with improvements of laparoscopic instruments and surgical techniques, posterior retroperitoneal adrenalectomy is now regarded as a better approach for small benign adrenal tumours in terms of a shorter operative time, reduced blood loss, reduced length of hospital stay, less postoperative pain, and faster recovery1,2. In retroperitoneoscopic adrenalectomy, access to the adrenal gland routinely proceeds from initial dissection of the renal hilum and renal vein to resultant identification of the adrenal vein and then to the adrenal gland3. Another adrenalectomy technique involves initial dissection of the perinephric fat covering the kidney and adrenal gland from the surrounding muscles. The adrenal vein is finally reached, clipped, and divided4,5. Retroperitoneal adrenalectomy can be performed through a dorsal approach6. In these series, however, the mean operative time was 65 to 194 minutes and the complication rate was 3.2% to 11.0%3–6. Anatomic retroperitoneal adrenalectomy, which is characterised by “three bloodless planes” through a lateral retroperitoneal approach, has been proven safe, effective, and technically efficient for surgical treatment of adrenal disease. Its mean operative time in previous studies was 45.0 ± 19.1 mins, and its complication rate was 1.5%7,8. We performed three-plane anatomic retroperitoneal adrenalectomy in our institution before 2015. However, we found we can perform adrenalectomy by only dissecting the ventral side of the kidney, without dissection of the lateral side and upper pole. Single plane group Three planes group P We call this procedure single-plane adrenalectomy. The purpose of this study was to compare the perioperative outcomes of single-plane versus three-plane retroperitoneoscopic adrenalectomy. Results The baseline demographic data were broadly comparable between the two groups with respect to patient age, sex, BMI, tumour size, and tumour laterality (Table 1). Surgery was performed in all 251 patients undergoing single-plane retroperitoneoscopic adrenalectomy. Anatomical retroperitoneal adrenalectomy was successful in all 98 patients. Conversion to open surgery was not necessary in any case. One patient with an adrenal tumour adjacent to the renal hilum was converted to anatomical adrenalectomy. Table 2 summarises the intraoperative outcomes. Compared with the three-plane group, the single-plane group had a significantly shorter operation time (46.9 ± 5.8 vs. 54.8 ± 7.0 mins, respective (...truncated)