Evaluation of Outcomes between the Right and Left-Sided Transperitoneal Laparoscopic Adrenalectomy in a Tertiary Care Center: A Retrospective Study

Abstract

Introduction: Several studies have corroborated the feasibility and safety of laparoscopic transperitoneal adrenalectomy for the removal of adrenal tumours however, there is very limited clinical evidence comparing right and left transperitoneal laparoscopic adrenalectomies. This comparison enables surgeons in preoperative counseling of patients regarding postoperative outcomes. Aim: To evaluate the outcomes between the right and left-sided laparoscopic adrenalectomy in patients admitted to a tertiary care center. Materials and Methods: The present retrospective study considered data from patients, who underwent transperitoneal laparoscopic adrenalectomy between December 2013-December 2019 admitted to the Vydehi Institute of Medical Sciences and Research Centre. All the selected subjects with adrenal tumours were operated on by a single surgeon through a standardised transperitoneal laparoscopic approach for right and left-side adrenalectomies. The data collected were age, gender, symptoms, size of the tumour, duration of surgery, intraoperative blood loss, complications, duration of stay and histopathology of tumours. Both sides were compared for age, gender, size of tumour, operative time, blood loss, duration of hospital stay, histopathological diagnosis, benign and malignant lesions. The Student’s t-test was used for the evaluation of continuous data and the Chi-square test and Fisher’s-exact test for categorical variables. Results: The study considered the data of 42 patients. The corresponding number of subjects who had undergone right and left adrenalectomies for various adrenal pathologies were 18 (42.85%, 9 each of both genders) and 24 (17 males, 7 females). The mean age for right-sided adrenalectomy was 44.17 and the left-side was 46.83. The mean tumour size (in cm) was significantly larger in the right-side group as opposed to the left-side (7.97±2.7 vs. 5.62±2.37, p-value=0.0053). The duration of surgery (136.22±25.53 vs.112.92±27.21 min, p=0.0074) and average intraoperative blood loss were also more in the right-side group (431.67±259.73 vs 277.08±193.92 mL, p=0.02). There was no significant difference in the mean duration of hospital stay between the groups (3.94±1.06 vs. 3.67±1.13, p=0.4212). The most common tumour was adenoma in both groups. No major complications were noted in either group. Conclusion: Outcomes were comparable between right and left-side adrenalectomies. However, longer mean operative time and larger tumour size were noted for right-side laparoscopic adrenalectomy.

Keywords

• adenoma
• adrenal
• intraoperative blood loss
• laparoscopy