Abstract

Background

Different techniques for laparoscopic adrenalectomy have been proposed with the lateral transperitoneal approach and posterior retroperitoneal approach being the two more frequently minimally invasive surgeries in most of the clinics. There are no sufficient studies in which the results of lateral transperitoneal and posterior retroperitoneal approaches in synchronous bilateral laparoscopic adrenalectomy have been compared. In the current study, we aimed to report our multicenter results of the lateral transperitoneal and posterior retroperitoneal synchronous bilateral laparoscopic adrenalectomy experience in patients who had different bilateral adrenal pathologies and to compare the outcomes of these two different operative procedures.

Methods

Between 2012 and 2018, a total of 52 patients with a mean age of 43.5 years underwent simultaneous bilateral laparoscopic adrenalectomy at 6 different centers. Twenty-seven and 25 patients underwent bilateral lateral transperitoneal and posterior retroperitoneal laparoscopic adrenalectomy, respectively. Patients' age, gender, body max index, operative indications, mass size, operation time, blood loss, length of hospitalization, intraoperative and postoperative complications and pathology reports were analyzed.

Results

Synchronous bilateral transperitoneal group was younger than synchronous posterior retroperitoneal group (37 years vs. 50.4 years.) (p: 0.001). Posterior retroperitoneal group had significantly decreased operating time and less blood loss than transperitoneal group. No significant difference was found with regard to postoperative hospital stay, perioperative and postoperative complications between two groups. Majority of the histopathological results were adrenal hyperplasia associated with Cushing’s disease (61.5%). Less frequent pathological results were adrenal adenoma and pheochromocytoma (15.4% and 13.5%, respectively). During the follow-up period, no recurrence or disease-related mortality was observed in the patients.

Conclusion

Our results shows that shorter operative time and less bleeding can be achieved with posterior retroperitoneal approach in synchronous bilateral laparoscopic adrenalectomy. In our series, intraoperative and postoperative complication rates were similar between both surgical approaches.

中文翻译：

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同步双侧经腹膜和后腹膜后腹腔镜肾上腺切除术的比较：多中心研究的结果

摘要

背景

已经提出了不同的腹腔镜肾上腺切除术技术，其中横向经腹膜入路和后腹膜后入路是大多数诊所中两种更常见的微创手术。没有足够的研究比较横向经腹膜和后腹膜后入路在同步双侧腹腔镜肾上腺切除术中的结果。在目前的研究中，我们旨在报告我们的多中心结果，即我们在具有不同双侧肾上腺病变的患者中进行横向经腹膜和后腹膜后同步双侧腹腔镜肾上腺切除术的经验，并比较这两种不同手术程序的结果。

方法

2012 年至 2018 年间，共有 52 名平均年龄为 43.5 岁的患者在 6 个不同的中心同时接受了双侧腹腔镜肾上腺切除术。27 例和 25 例患者分别接受了双侧侧腹膜和后腹膜后腹腔镜肾上腺切除术。对患者的年龄、性别、体最大指数、手术指征、肿块大小、手术时间、失血量、住院时间、术中及术后并发症及病理报告进行分析。

结果

同步双侧经腹膜组比同步后腹膜后组年轻（37 岁 vs. 50.4 岁）（p：0.001）。与经腹膜组相比，后腹膜组手术时间明显缩短，失血量更少。两组术后住院时间、围手术期及术后并发症无显着差异。大多数组织病理学结果是与库欣病相关的肾上腺增生（61.5%）。较少见的病理结果是肾上腺腺瘤和嗜铬细胞瘤（分别为 15.4% 和 13.5%）。随访期间，未观察到患者复发或疾病相关死亡率。

结论

我们的研究结果表明，在同步双侧腹腔镜肾上腺切除术中，后腹膜后入路可以实现更短的手术时间和更少的出血。在我们的系列中，两种手术方法的术中和术后并发症发生率相似。