# Optimizing Laparoscopic Adrenal Surgery: A Retrospective Study of 83 Patients at a Tertiary Cancer Center

## TL;DR

This study compares laparoscopic and open adrenal surgery outcomes, finding laparoscopic surgery feasible for small benign adrenal tumors with some technical adjustments.

## Contribution

The study introduces technical modifications like modified port positioning and gauze retractors to improve laparoscopic adrenal surgery.

## Key findings

- Laparoscopic adrenalectomy was feasible for lesions up to 6 cm with technical modifications.
- There was a significant difference in lesion size between open and laparoscopic approaches.
- One postoperative death occurred in the laparoscopic group, while no mortality was recorded in the open group.

## Abstract

Aim of the study

This study aims to report our institutional outcomes of laparoscopic adrenalectomy, to compare these with a cohort of patients undergoing open adrenalectomy, and to describe the feasibility and utility of technical modifications, including modified port positioning and the use of intra-abdominal gauze retractors.

Patients and methods

This retrospective cohort study included 83 patients with radiologically benign-appearing adrenal tumors who underwent adrenalectomy at the National Cancer Institute (NCI), Cairo University, Cairo, Egypt, between January 2014 and January 2020. Patient data were extracted from medical records and included demographics (age and gender), lesion characteristics (size, laterality, and functional status), surgical approach (laparoscopic or open), and results of endocrine investigations (serum metanephrines, urinary vanillylmandelic acid (VMA), aldosterone, cortisol, sodium, and potassium).

Results

Of the 83 patients, 57 (68.7%) underwent right adrenalectomy, and 26 (31.3%) had left adrenalectomy. Functioning adrenal lesions were identified in 32 patients (38.6%), including 31 pheochromocytomas and one cortisol-secreting tumor; the remaining 51 patients (61.4%) had non-functioning lesions. There was a statistically significant difference in pathological lesion size between patients undergoing open versus laparoscopic adrenalectomy (p = 0.014). No mortality was recorded in the open group; however, one postoperative death occurred in the laparoscopic cohort.

Conclusion

Laparoscopic adrenalectomy appears to be a feasible technique in selected patients with benign-appearing adrenal lesions, particularly for lesions up to 6 cm. Technical modifications, including modified port positioning and the use of gauze retractors, were subjectively found to facilitate operative exposure. However, due to the study’s retrospective design and limited sample size, no definitive conclusions can be drawn regarding comparative safety or effectiveness. Further prospective studies are needed to validate these findings.