Retroperitoneal laparoscopic adrenalectomy via the extra or intra perinephric fat approach：a comparative study

Abstract:

Objective To investigate the safety and efficacy of retroperitoneal laparoscopic adrenalectomy via the extra or intra perinephric fat approach，and to provide experience and a basis for retroperitoneal adrenalectomy.Methods Related clinical data were collected from 497 patients who underwent retroperitoneal laparoscopic adrenalectomy in The First Affiliated Hospital of Chongqing Medical University from December 2017 to March 2023，and a retrospective analysis was performed for their basic features and the changes in perioperative indicators.Results A total of 233 patients receiving the intra perinephric fat approach（IPFA） were included，among whom 224 underwent laparoscopic surgery and 9 underwent robotic surgery，and 264 patients receiving the extra perinephric fat approach（EPFA） were included，among whom 253 underwent laparoscopic surgery and 11 underwent robotic surgery. The two groups had comparable tumor size，estimated blood loss，and time of operation. The EPFA group had a tumor size of （30.47±15.83） mm，which was significantly larger than the tumor size in the IPFA group（P=0.000）. Compared with the EPFA group，the IPFA group had a significantly longer time of operation（P=0.000） and a significantly lower volume of estimated blood loss[（119.07±82.32） mL vs. （158.88±106.94） mL，P=0.000]. There were no significant differences between the two groups in blood transfusion rate and length of hospital stay.Conclusion Retroperitoneal laparoscopic adrenalectomy is a safe and effective procedure that can be performed via the extra and intra perinephric fat approaches. IPFA patients have lower estimated blood loss and postoperative blood transfusion rate than EPFA patients，while EPFA patients have a longer time of operation than IPFA patients. The selection of surgical approach mainly depends on the experience of the surgeon，the characteristics of adrenal tumor，and the nature of perirenal adipose tissue.