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Vol. 99. Issue 4.
Pages 289-295 (April 2021)
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Vol. 99. Issue 4.
Pages 289-295 (April 2021)
Original article
Posterior Retroperitoneoscopic Adrenalectomy: Recommendations to Implement This Approach
Suprarrenalectomía retroperitoneoscópica por vía posterior. Recomendaciones para la implementación de esta técnica
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Georgina Ferret Granés, Clara Gené Skrabec
Corresponding author
clgenesk@gmail.com

Corresponding author.
, Jordi Tarascó Palomares, Ana Torres Marí, Albert Caballero Boza, Pau Moreno Santabárbara
Servicio de Cirugía General y del Aparato Digestivo, Hospital Germans Trias i Pujol, Badalona, Spain
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Tables (2)
Table 1. Pathology Characteristics of the Lesions.
Table 2. Results According to Surgical Time Being Longer or Shorter Than the Median (80min); Data Expressed as Absolute Values, Percentage (in Parentheses) and Median [in Brackets].
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Abstract
Introduction

The posterior retroperitoneoscopic approach (PRA) is seldom used in our country to perform adrenalectomies, although it offers possible advantages over laparoscopic anterior or lateral access, according to some authors. The aim of this study was to identify those features that determine the most suitable cases to start the implementation of this technique.

Methods

A prospective observational study was performed with a 50-patient cohort. All the cases were operated using the PRA. Sex, age, body mass index (BMI), operative time, left or right side, size and anatomopathological characteristics of the lesion, conversion rates, complications and hospital stay were analyzed.

Results

25 (50%) women and 25 (50%) men underwent surgery, with a median operative time of 80min (45–180). A significantly shorter operative time (P=.002) was observed in women and in adenomas (P=.002). However, no correlation was observed between surgical time and BMI, lesion side or lesion size. There were no conversions. The complication rate was 14%, and most of the complications were grade I on Clavien–Dindo's scale. Median hospital stay was two days.

Conclusions

Retroperitoneoscopic adrenalectomy by posterior approach is a safe and reproducible procedure, with very good outcomes. The most suitable cases to implement this technique would be female patients with adrenal adenomas.

Keywords:
Adrenalectomy
Retroperitoneal
Posterior approach
Laparoscopy
Retroperitoneoscopy
Resumen
Introducción

El abordaje retroperitoneoscópico posterior es una técnica poco extendida en España para la suprarrenalectomía a pesar de que, según algunos autores, ofrece ventajas respecto al acceso laparoscópico anterior o lateral. El objetivo del estudio fue identificar aquellas características que permitieran seleccionar los casos más favorables para iniciarse en esta técnica.

Métodos

Estudio observacional de una cohorte de 50 pacientes intervenidos mediante suprarrenalectomía retroperitoneoscópica posterior (SRP) en un único centro. Se evaluó: sexo, edad e índice de masa corporal (IMC), tiempo operatorio, lateralidad, tamaño y características anatomopatológicas de las lesiones, tasa de conversión, complicaciones y estancia hospitalaria.

Resultados

Se intervinieron 25 (50%) mujeres y 25 (50%) hombres con un tiempo operatorio mediano de 80 minutos (45-180). Se observó un tiempo operatorio significativamente menor en mujeres (p=0,002) y en adenomas (p=0,002). En cambio, no se observó correlación entre el tiempo quirúrgico e IMC, lateralidad o tamaño de la lesión. No hubo ningún caso de conversión. Las complicaciones fueron del 14% y la mayoría fueron leves, según la Escala de Clavien Dindo (i). La estancia hospitalaria mediana fue de dos días.

Conclusiones

La suprarrenalectomía retroperitoneoscópica por vía posterior es una técnica segura, reproducible y con muy buenos resultados. Los casos más favorables para iniciar la implantación de este abordaje son mujeres con adenomas suprarrenales.

Palabras clave:
Suprarrenalectomía
Retroperitoneal
Abordaje posterior
Laparoscopia
Retroperitoneoscopia

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