To investigate the indications, feasibility and surgical significance between different surgical approaches for laparoscopic adrenal-sparing surgery for adrenal tumors.

The patients with adrenal diseases in the Second Affiliated Hospital of Anhui Medical University were selected from January 2015 to August 2017. Fifty-four cases with benign adrenal tumor were treated with laparoscopic adrenal-sparing surgery (27 patients were treated by transperitoneal approach and 27 patients retroperitoneal approach). The indexes of perioperative period, the effect of operation, and the difference between two approaches were observed and compared.

Fifty-four casesunderwent laparoscopic with adrenal-sparing surgery. The mean operative time was (52.4 ±11.4) min and the mean intraoperative bleeding was (32.8±7.7) ml in transperitoneal group. The mean operative time was (68.4±12.6) min and the average intraoperative bleeding was (41.3±8.1) ml in retroperitoneal group. Fifty-nine tumors were resected in 54 cases. Pathology showed adenoma in 34 patients (including 16 cases of aldosteronoma, 7 cases of cortisol adenoma and 11 cases of nonfunctional adenoma), pheochromocytoma in 8 patients, myelolipoma in 5 patients, adrenocortical nodular hyperplasia in3 patients, medullary hyperplasia in 1 patient, angiolymphoma in 1 patient, neurofibroma in 1 patient, schwannoglioma in 1 patient. All patients were followed up for an average of 13 months (from 3 to24 months) without tumor recurrence. The blood pressure of 26 patients with hypertension returned to be normal, and the remaining 5 cases needed to take small doses of antihypertensive drugs. Four cases of hypercortisolism had stopped hormone supplement and 2 cases still needed a small dose of glucocorticoid.

Laparoscopic adrenal-sparing surgery is a safe and appropriate option for the treatment of benign adrenal tumors. The transperitoneal approach has some advantages over retroperitoneal approach in shortening the operative time and reducing the amount of intraoperative bleeding.