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document
Prospective , randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy . PURPOSE We report a prospective , randomized comparison of transperitoneal laparoscopic adrenalectomy ( TLA ) vs retroperitoneal laparoscopic adrenalectomy ( RLA ) for adrenal lesions with long-term followup . MATERIALS AND METHODS Between December 1997 and November 1999 , 57 consecutive eligible patients with surgical adrenal disease were prospectively randomized to undergo TLA ( 25 ) or RLA ( 32 ) . Study exclusion criteria were patient age greater than 80 years , body mass index greater than 40 , bilateral adrenalectomy and significant prior abdominal surgery in the quadrant of interest . Mean followup was 5.96 years in the 2 groups . RESULTS The groups were matched in regard to patient age ( p = 0.84 ) , body mass index ( p = 0.43 ) , American Society of Anesthesiologists class ( p = 0.81 ) and laterality ( p = 0.12 ) . Median adrenal mass size was 2.7 cm ( range 1 to 9 ) in the TLA group and 2.6 cm ( range 0.5 to 6 ) in the RLA group ( p = 0.83 ) . TLA was comparable to RLA in terms of operative time ( 130 vs 126.5 minutes , p = 0.64 ) , estimated blood loss ( p = 0.92 ) , specimen weight ( p = 0.81 ) , analgesic requirements ( p = 0.25 ) , hospital stay ( p = 0.56 ) and the complication rate ( p = 0.58 ) . One case per group was electively converted to open surgery . Pathology data on the intact extracted specimens were similar between the groups . Averaged convalescence was 4.7 weeks in the TLA group and 2.3 weeks in the RLA group ( p = 0.02 ) . During a mean followup of 6 years 2 patients in the TLA group had a late complication ( port site hernia ) . Mortality occurred in 5 patients , including 1 with TLA and 4 with RLA , during the 6-year followup . CONCLUSIONS For most benign adrenal lesions requiring surgery laparoscopic adrenalectomy can be performed safely and effectively by the transperitoneal or the retroperitoneal approach .
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Intervention_Surgical
transperitoneal
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Intervention_Surgical
retroperitoneal laparoscopic adrenalectomy
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Intervention_Surgical
transperitoneal laparoscopic adrenalectomy ( TLA )
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Intervention_Surgical
retroperitoneal laparoscopic adrenalectomy ( RLA )
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Intervention_Surgical
TLA
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Intervention_Surgical
RLA
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Intervention_Surgical
laparoscopic adrenalectomy
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Outcome_Physical
adrenal mass size
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Outcome_Other
operative time
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Outcome_Physical
estimated blood loss
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Outcome_Physical
specimen weight
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Outcome_Pain
analgesic requirements
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Outcome_Other
hospital stay
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Outcome_Adverse-effects
complication rate
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Outcome_Other
convalescence
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Outcome_Adverse-effects
late complication ( port site hernia )
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Outcome_Mortality
Mortality
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Outcome_Other
safely
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Outcome_Other
effectively