Comparison of three techniques for adrenalectomy

Background Conventional open adrenal surgery requires relatively large incisions and is associated with postoperative wound pain, intercostal neuralgia and pulmonary complications. Introduction of laparoscopic techniques has enabled development of minimally invasive adrenalectomy. Methods A case-control study of nine open, nine transperitoneal laparoscopic and 12 retroperitoneal endoscopic adrenalectomies was done in patients who were matched for Quetelet index, adrenal disorder and size of adrenal lesion; all tumours were less than 6 cm in diameter. Results Conversion to open adrenalectomy was necessary in two patients having transperitoneal laparoscopic adrenalectomy and in one having retroperitoneal endoscopic adrenalectomy. Operative time was longest in transperitoneal laparoscopic adrenalectomy (P=0.004 and P=0.005 versus open and retroperitoneal endoscopic adrenalectomy respectively). Blood loss was least in retroperitoneal endoscopic adrenalectomy (P=0.01 versus both other groups). End-tidal carbon dioxide increase was greater in transperitoneal laparoscopic and retroperitoneal endoscopic than in open adrenalectomy (P=0.014 and P=0.01 respectively). After retroperitoneal endoscopic adrenalectomy, use of analgesia was least (P=0.0003 versus other groups). Postoperative hospital stay was shortest after retroperitoneal endoscopic adrenalectomy (P=0.024 and P=0.027 versus open and transperitoneal laparoscopic procedures respectively). Conclusion Retroperitoneal endoscopic adrenalectomy was optimal in patients with small adrenal tumours.