Comparison of two single-layer approaches in retroperitoneal laparoscopic adrenalectomy

doi:10.3877/cma.j.issn.1674-3253.2026.01.011

Abstract

Abstract:

Objective

To compare the application of two single-layer approaches in retroperitoneal laparoscopic adrenalectomy for adrenal tumors.

Methods

The data of patients with retroperitoneal laparoscopic adrenalectomy procedures performed in our hospital from June 2016 to June 2023 were retrospectively analyzed. Patients were divided into two groups based on the surgical procedure. Group A, which underwent complete resection of the adrenal gland; group B, which underwent partial resection with preservation of the adrenal gland. The patients were further classified into two subgroups based on the surgical approach: approach one, which involved the renal surface layer, and approach two, which was between the perirenal fat and the anterior layer of the renal fascia. Among them, group A had 64 cases in approach one and 56 cases in approach two. Group B had 47 cases in approach one and 42 cases in approach two. A comparison was made between the two groups regarding gender, age, BMI, tumor diameter, surgical time, hospital stay, intraoperative blood loss, time to first flatus (indicating postoperative gastrointestinal recovery), drainage volume, time to removal of drainage tube, and surgical complications.

Results

All operations were successful. In group A, there were no statistically significant differences between approach one and approach two in gender, age, BMI, tumor diameter, length of hospital stay, intraoperative blood loss, time to drainage tube removal, incidence of complications (P>0.05). However, there were statistically significant differences in terms of surgical time, time to postoperative gastrointestinal recovery, drainage volume (P<0.05). In group B, there were no statistically significant differences in gender, age, BMI, tumor diameter, length of hospital stay, postoperative gastrointestinal function recovery time, postoperative drainage volume, incidence of complications between the two approaches (P>0.05); however, there were statistically significant differences in terms of surgical time and intraoperative blood loss between the two approaches (P<0.05).

Conclusion

In retroperitoneal laparoscopic adrenalectomy for complete resection of the adrenal gland, the approach one can reduce surgical time, time to postoperative gastrointestinal recovery, and drainage volume. In retroperitoneal laparoscopic adrenalectomy with partial resection and preservation of the adrenal gland, the approach two can reduce surgical time and blood loss.

Key words: Adrenal tumor, Adrenalectomy, Laparoscopy, Surgical approach

Yiyang Tian, Han Li, Xiefen Hu, Xianhui Hu, xin Qin, Lihai Jiang, Zhiyuan Xie, Daichun Li, Yong Yin. Comparison of two single-layer approaches in retroperitoneal laparoscopic adrenalectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2026, 20(01): 77-83.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2026.01.011

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2026/V20/I01/77

Figures/Tables 4

References 21

[1]	梁朝朝, 邰胜. 肾上腺肿瘤微创手术治疗方法的选择[J]. 临床泌尿外科杂志, 2018, 33(10): 765-768. DOI: 10.13201/j.issn.1001-1420.2018.10.001.
[2]	马中立, 贾占奎, 顾朝辉, 等. 后腹腔镜单层面肾上腺切除术临床价值研究(附298例报告)[J]. 临床泌尿外科杂志, 2016, 31(3): 253-255. DOI: 10.13201/j.issn.1001-1420.2016.03.016.
[3]	马亚南, 王志新, 丁友鹏, 等. 后腹腔镜单层面肾上腺肿瘤切除术的临床研究(附53例报告)[J]. 微创泌尿外科杂志, 2018, 7(5): 294-296. DOI: 10.19558/j.cnki.10-1020/r.2018.05.002.
[4]	Bowlin PR, Farhat WA. Laparoscopic nephrectomy and partial nephrectomy: intraperitoneal, retroperitoneal, single site[J]. Urol Clin North Am, 2015, 42(1): 31-42. DOI: 10.1016/j.ucl.2014.09.012.
[5]	张旭. 解剖性后腹腔镜肾上腺切除术的手术方法和技巧[J]. 临床泌尿外科杂志, 2007, 22(8): 561-564. DOI: 10.3969/j.issn.1001-1420.2007.08.001.
[6]	田义阳, 李涵, 秦鑫, 等. 单孔和标准通道后腹腔镜在肾上腺肿瘤手术中的对照研究[J]. 临床泌尿外科杂志, 2023, 38(11): 822-826, 834. DOI: 10.13201/j.issn.1001-1420.2023.11.004.
[7]	丁映辉, 黄珍林, 顾朝辉, 等. 单层面与传统三层面分离法后腹腔镜肾上腺切除手术比较[J]. 中华实验外科杂志, 2015, 32(11): 2866-2868. DOI: 10.3760/cma.j.issn.1001-9030.2015.11.076.
[8]	马涛, 杨文增, 索勇, 等. 经肾表层面后腹腔镜肾上腺解剖性切除的应用体会(附光盘)[J]. 现代泌尿外科杂志, 2020, 25(2): 101-104. DOI: 10.3969/j.issn.1009-8291.2020.02.003.
[9]	Janetschek G, Finkenstedt G, Gasser R, et al. Laparoscopic surgery for pheochromocytoma: adrenalectomy, partial resection, excision of paragangliomas[J]. J Urol, 1998, 160(2): 330-334. DOI: 10.1016/s0022-5347(01)62886-6.
[10]	Indupur RR, Nerli RB, Reddy MN, et al. Laparoscopic adrenalectomy for large pheochromocytoma[J]. BJU Int, 2007, 100(5): 1126-1129. DOI: 10.1111/j.1464-410X.2007.07179.x.
[11]	Rossitti HM, Söderkvist P, Gimm O. Extent of surgery for phaeochromocytomas in the genomic era[J]. Br J Surg, 2018, 105(2): e84-e98. DOI: 10.1002/bjs.10744.
[12]	Meyer LS, Wang X, Sušnik E, et al. Immunohistopathology and steroid profiles associated with biochemical outcomes after adrenalectomy for unilateral primary aldosteronism[J]. Hypertension, 2018, 72(3): 650-657. DOI: 10.1161/HYPERTENSIONAHA.118.11465.
[13]	Weisbrod AB, Webb RC, Mathur A, et al. Adrenal histologic findings show no difference in clinical presentation and outcome in primary hyperaldosteronism[J]. Ann Surg Oncol, 2013, 20(3): 753-758. DOI: 10.1245/s10434-012-2670-2.
[14]	罗光恒, 刘刚. 肾上腺部分切除术与肾上腺全切术治疗原发性醛固酮增多症的争议与决策[J]. 中华医学杂志, 2021, 101(34): 2662-2666. DOI: 10.3760/cma.j.cn112137-20210506-01061.
[15]	Fu B, Zhang X, Wang GX, et al. Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma[J]. J Urol, 2011, 185(5): 1578-1582. DOI: 10.1016/j.juro.2010.12.051.
[16]	Chen SF, Chueh SC, Wang SM, et al. Clinical outcomes in patients undergoing laparoscopic adrenalectomy for unilateral aldosterone producing adenoma: partial versus total adrenalectomy[J]. J Endourol, 2014, 28(9): 1103-1106. DOI: 10.1089/end.2014.0102.
[17]	Nieman LK, Biller BMK, Findling JW, et al. Treatment of Cushing's syndrome: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2015, 100(8): 2807-2831. DOI: 10.1210/jc.2015-1818.
[18]	Walz MK, Peitgen K, Diesing D, et al. Partial versus total adrenalectomy by the posterior retroperitoneoscopic approach: early and long-term results of 325 consecutive procedures in primary adrenal neoplasias[J]. World J Surg, 2004, 28(12): 1323-1329. DOI: 10.1007/s00268-004-7667-y.
[19]	罗光恒, 刘刚. 肾上腺部分切除术与肾上腺全切术治疗原发性醛固酮增多症的争议与决策[J]. 中华医学杂志, 2021, 101(34): 2662-2666. DOI: 10.3760/cma.j.cn112137-20210506-01061.
[20]	李艳丽, 李迎晔, 林英立. 后腹腔镜单层面右肾上腺嗜铬细胞瘤切除术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(6): 656. DOI: 10.3877/cma.j.issn.1674-3253.2024.06.023.
[21]	郑建波，汤凯，路盛行，等. 后腹腔镜下左侧单层面肾上腺切除术的临床研究(附13例报告)[J/OL]. 泌尿外科杂志(电子版), 2018, 10(4): 32-34. DOI: 10.3969/j.issn.1674-7410.2018.04.010.

组别	例数	性别		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
入路一组	64	35	29	40.80±8.90	25.14±2.16	2.88±0.45	37.69±6.27	5.30±1.00	47.50±4.10	15.28±1.50	138.73±6.56
入路二组	56	26	30	42.41±8.40	25.41±2.74	2.80±0.47	42.75±6.03	5.34±0.90	46.79±3.87	17.75±1.39	167.59±7.82
统计值		χ² =0.815		t=1.015	t=0.603	t=0.952	t=4.490	t=0.229	t=0.971	t=9.311	t=21.982
P值		0.367		0.312	0.548	0.343	<0.001	0.819	0.333	<0.001	<0.001
组别	拔除引流管时间[d，(±s)]	并发症（例）				肿瘤类型（例）
组别	拔除引流管时间[d，(±s)]	血管损伤	腹膜损伤	术后肾上腺皮质功能减退	术后切口感染	嗜铬细胞瘤	醛固酮瘤	无功能肿瘤	库欣综合征
入路一组	2.22±0.48	1	0	2	2	11	31	18	4
入路二组	2.34±0.54	1	4	2	1	9	25	16	6
统计值	t=1.289	χ² =1.296				χ² =0.831
P值	0.200	0.255				0.842

组别	例数	性别		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
入路一组	64	35	29	40.80±8.90	25.14±2.16	2.88±0.45	37.69±6.27	5.30±1.00	47.50±4.10	15.28±1.50	138.73±6.56
入路二组	56	26	30	42.41±8.40	25.41±2.74	2.80±0.47	42.75±6.03	5.34±0.90	46.79±3.87	17.75±1.39	167.59±7.82
统计值		χ² =0.815		t=1.015	t=0.603	t=0.952	t=4.490	t=0.229	t=0.971	t=9.311	t=21.982
P值		0.367		0.312	0.548	0.343	<0.001	0.819	0.333	<0.001	<0.001
组别	拔除引流管时间[d，(±s)]	并发症（例）				肿瘤类型（例）
组别	拔除引流管时间[d，(±s)]	血管损伤	腹膜损伤	术后肾上腺皮质功能减退	术后切口感染	嗜铬细胞瘤	醛固酮瘤	无功能肿瘤	库欣综合征
入路一组	2.22±0.48	1	0	2	2	11	31	18	4
入路二组	2.34±0.54	1	4	2	1	9	25	16	6
统计值	t=1.289	χ² =1.296				χ² =0.831
P值	0.200	0.255				0.842

组别	例数	性别		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
入路一组	47	26	21	43.36±3.60	25.79±2.19	2.99±0.52	32.47±2.72	5.28±1.01	52.02±5.67	15.09±1.33	95.36±4.55
入路二组	42	20	22	45.76±9.57	25.60±2.99	2.81±0.53	26.07±1.61	5.36±0.90	47.40±3.54	15.33±0.92	95.31±5.82
统计值		χ² =0.527		t=1.598	t=0.344	t=1.616	t=13.303	t=0.393	t=4.546	t=0.979	t=0.045
P值		0.468		0.114	0.731	0.110	<0.001	0.696	<0.001	0.331	0.964
组别	拔除引流管时间[d，(±s)]	并发症（例）				肿瘤类型（例）
组别	拔除引流管时间[d，(±s)]	血管损伤	腹膜损伤	术后肾上腺皮质功能减退	术后切口感染	嗜铬细胞瘤	醛固酮瘤	无功能肿瘤	库欣综合征
入路一组	2.21±0.50	0	0	0	1	4	14	26	3
入路二组	2.24±0.53	0	2	0	1	3	15	22	2
统计值	t=0.275	χ² =0.394				χ² =0.432
P值	0.784	0.530				0.933

组别	例数	性别		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	肿瘤直径[cm，(±s)]	手术时间[min，(±s)]	住院时间[d，(±s)]	估计出血量[mL，(±s)]	首次排气时间[h，(±s)]	术后引流量[mL，(±s)]
入路一组	47	26	21	43.36±3.60	25.79±2.19	2.99±0.52	32.47±2.72	5.28±1.01	52.02±5.67	15.09±1.33	95.36±4.55
入路二组	42	20	22	45.76±9.57	25.60±2.99	2.81±0.53	26.07±1.61	5.36±0.90	47.40±3.54	15.33±0.92	95.31±5.82
统计值		χ² =0.527		t=1.598	t=0.344	t=1.616	t=13.303	t=0.393	t=4.546	t=0.979	t=0.045
P值		0.468		0.114	0.731	0.110	<0.001	0.696	<0.001	0.331	0.964
组别	拔除引流管时间[d，(±s)]	并发症（例）				肿瘤类型（例）
组别	拔除引流管时间[d，(±s)]	血管损伤	腹膜损伤	术后肾上腺皮质功能减退	术后切口感染	嗜铬细胞瘤	醛固酮瘤	无功能肿瘤	库欣综合征
入路一组	2.21±0.50	0	0	0	1	4	14	26	3
入路二组	2.24±0.53	0	2	0	1	3	15	22	2
统计值	t=0.275	χ² =0.394				χ² =0.432
P值	0.784	0.530				0.933

Please choose a citation manager

Content to export