Laparoscopic and robot-assisted transperitoneal lateral adrenalectomy: a large clinical series from a single center

  • Antonello Niglio
  • Marica GrassoEmail author
  • Luciana Costigliola
  • Pasquale Zenone
  • Maurizio De Palma
Original Article
Part of the following topical collections:
  1. Endocrine surgery


Since Gagner performed the first laparoscopic adrenalectomy (LTLA) in 1992, laparoscopy has become the gold-standard procedure in the treatment of adrenal surgical diseases. Among all laparoscopic approaches, the transperitoneal lateral adrenalectomy (LTLA) is currently the most widespread procedure. The aim of this article is to analyze our experience in laparoscopy and robot-assisted laparoscopy for the management of surgical adrenal diseases and to value the safety and feasibility of those surgical approaches. From May 2011 until December 2018 were performed 112 adrenalectomies for adrenal tumors by the second division of General Surgery of tertiary care “A. Cardarelli” Hospital of Naples. Out of these, eight operations were carried out with an open surgery approach. Laparoscopic surgery was performed in 104 patients: 64 patients underwent to laparoscopic surgery (LTLA) and 40 patients were treated with a robot-assisted laparoscopy approach. Operative time, intraoperative blood loss, conversion rate, complications, and length of hospital stay were analyzed. Most patients were female and the mean age was 57.2 years in LTLA group, while in the r-LTLA group, the mean age was 55.7 years. Among the adrenal tumors, 55 were left-sided and 49 were right-sided. Median operative time was shorter in r-LTLA (102.2 ± 44.5 min) than in LTLA (128.5 ± 46.5 min). Conversion from LTLA to open surgery occurred in four cases. There were no statistical differences about tumor size and post-operative complications in the analyzed groups. A shorter hospitalization and intermediate care were recorded in the r-LTLA group. LTLA and r-LTLA are safe and effective approaches which ensure successful outcomes for the treatment of adrenal gland tumors.


Adrenalectomy Laparoscopic adrenalectomy Robot-assisted adrenalectomy Robotic surgery 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures, involving human participants, were in accordance with the ethical standards of the “A. Cardarelli” Hospital and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants involved in the study.


  1. 1.
    Zheng GY, Li HZ, Deng JH, Zhang XB, Wu XC (2018) Open adrenalectomy versus laparoscopic adrenalectomy for adrenocortical carcinoma: a retrospective comparative study on short-term oncologic prognosis. Onco Targets Ther 21(11):1625–1632CrossRefGoogle Scholar
  2. 2.
    Aggeli C, Nixon AM, Parianos C, Vletsis G, Papanastasiou L, Markou A, Kounadi T, Piaditis G, Zografos GN (2017) Surgery for pheochromocytoma: a 20-year experience of a single institution. Hormones 16(4):388–395PubMedGoogle Scholar
  3. 3.
    Hirano D, Hasegawa R, Igarashi T, Satoh K, Mochida J, Takahashi S, Yoshida T, Saitoh T, Kiyotaki S, Okada K (2015) Laparoscopic adrenalectomy for adrenal tumors: a 21-year single-institution experience. Asian J Surg 38(2):79–84CrossRefPubMedGoogle Scholar
  4. 4.
    Wu K, Liu Z, Liang J, Tang Y, Zou Z, Zhou C, Zhang F, Lu Y (2018) Laparoscopic versus open adrenalectomy for localized (stage 1/2) adrenocortical carcinoma: experience at a single, high-volumecenter. Surg 164(6):1325–1329CrossRefGoogle Scholar
  5. 5.
    Bulus H, Uslu HY, Karakoyun R, Koçak S (2013) Comparison of laparoscopic and open adrenalectomy. Acta Chir Belg 113(3):203–207CrossRefPubMedGoogle Scholar
  6. 6.
    Wang HS, Li CC, Chou YH, Wang CJ, Wu WJ, Huang CH (2009) Comparison of laparoscopic adrenalectomy with open surgery for adrenal tumors. Kaohsiung J Med Sci 25(8):438–444CrossRefPubMedGoogle Scholar
  7. 7.
    Gagner M, Lacroix A, Bolte E (1992) Laparoscopic adrenalectomy in Cushing’s syndrome and pheochromocytoma. N Engl J Med 327:1033CrossRefPubMedGoogle Scholar
  8. 8.
    Smith CD, Weber CJ, Amerson JR (1999) Laparoscopic adrenalectomy: new gold standard. World J Surg 23:389–396CrossRefPubMedGoogle Scholar
  9. 9.
    Toutounchi S, Pogorzelski R, Legocka ME, Krajewska E, Celejewski K, Ambroziak U, Gałązka Z (2018) Lateral laparoscopic adrenalectomy in patients with previous abdominal surgery—single-center experience. Wideochir Inne Tech Maloinwayjne 13(3):283–287Google Scholar
  10. 10.
    Natkaniec M, Pędziwiatr M, Wierdak M, Major P, Migaczewski M, Matłok M, Budzyński A, Rembiasz K (2016) Laparoscopic transperitoneal lateral adrenalectomy for large adrenal tumors. Urol Int 97(2):165–172CrossRefPubMedGoogle Scholar
  11. 11.
    Lezoche E, Guerrieri M, Feliciotti F et al (2002) Anterior, lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy. Surg Endosc 16:96–99CrossRefPubMedGoogle Scholar
  12. 12.
    Lezoche E, Guerrieri M, Crosta F et al (2008) Flank approach versus anterior sub-mesocolic access in left laparoscopic adrenalectomy: a prospective randomised study. Surg Endosc 22:2373–2378CrossRefPubMedGoogle Scholar
  13. 13.
    Lal G, Duh QY (2003) Laparoscopic adrenalectomy-indications and technique. Surg Oncol 12(2):105–123CrossRefPubMedGoogle Scholar
  14. 14.
    McKinlay R, Mastrangelo MJ Jr, Park AE (2003) Laparoscopic adrenalectomy: indications and technique. Curr Surg 60(2):145–149CrossRefPubMedGoogle Scholar
  15. 15.
    Bai S, Yao Z, Zhu X, Li Z, Jiang Y, Wang R, Wu B (2019) Comparison of transperitoneal laparoscopic versus open adrenalectomy for large pheochromocytoma: a retrospective propensity score-matched cohort study. Int J Surg 61:26–32CrossRefPubMedGoogle Scholar
  16. 16.
    Chung HS, Kim MS, Yu HS, Hwang EC, Kim SO, Oh KJ, Jung SI, Kang TW, Park K, Kwon DD (2018) Laparoscopic adrenalectomy using the lateral retroperitoneal approach: is it a safe and feasible treatment option for pheochromocytomas larger than 6 cm? Int J Urol 25(5):414–419CrossRefPubMedGoogle Scholar
  17. 17.
    Porpiglia F, Destefanis P, Fiori C et al (2002) Does adrenal size real affect safety and effectiveness of laparoscopic adrenalectomy? Urology 60(5):801–805CrossRefPubMedGoogle Scholar
  18. 18.
    Ramacciato G, Mercantini P, La Torre M, Di Benedetto F, Ercolani G, Ravaioli M, Piccoli M, Melotti G (2008) Is laparoscopic adrenalectomy safe and effective for adrenal masses larger than 7 cm? Surg Endosc 22:516–521CrossRefPubMedGoogle Scholar
  19. 19.
    Datta J, Roses RE (2016) Surgical Management of adrenocortical carcinoma: an evidence-based approach. Urg Oncol Clin N Am 25(1):153–170CrossRefGoogle Scholar
  20. 20.
    Stigliano A, Chiodini I, Giordano R, Faggiano A, Canu L, Della Casa S, Loli P, Luconi M, Mantero F, Terzolo M (2016) Management of adrenocortical carcinoma: a consensus statement of the Italian Society of Endocrinology(SIE). J Endocrinol Investig 39(1):103–121CrossRefGoogle Scholar
  21. 21.
    Suzuki K, Kageyama S, Hirano Y, Ushiyama T, Rajamahanty S, Fujita K (2001) Comparison of 3 surgical approaches to laparoscopic adrenalectomy: a nonrandomized, background matched analysis. J Urol 166(2):437–443CrossRefPubMedGoogle Scholar
  22. 22.
    Hanna GB, Cuschieri A (1999) Influence of the optical axis-to-target view angle on endoscopic task performance. Surg Endosc 13(4):371–375CrossRefPubMedGoogle Scholar
  23. 23.
    Pędziwiatr M, Wierdak M, Ostachowski M, Natkaniec M, Białas M, Hubalewska-Dydejczyk A, Matłok M, Major P, Budzyński P, Migaczewski M, Budzyński A (2015) Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy—lessons learned after 500 cases: a retrospective cohort study. Int J Surg 20:88–94CrossRefPubMedGoogle Scholar
  24. 24.
    You JY, Lee HY, Son GS, Lee JB, Bae JW, Kim HY (2013) Comparison of robotic adrenalectomy with traditional laparoscopic adrenalectomy with a lateral transperitoneal approach: a single-surgeon experience. Int J Med Robot 9(3):345–350CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.UOC Chirurgia Generale 2, AORN CardarelliNaplesItaly
  2. 2.Faculty of Medicine and SurgeryUniversity of SalernoBaronissiItaly

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