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A Contemporary Experience of Posterior Retroperitoneoscopic Adrenalectomy in the United States
Alexander Chiu, *Susana Vargas-Pinto, *Sara Abou-Azar, *Richard Maduka, *Jianling Man, *Nicholas Peters, Tobias Carling, Courtney Gibson
Yale School of Medicine, New Haven, CT

Objective: To provide a contemporary update on outcomes following Posterior Retroperitoneoscopic Adrenalectomy (PRA)
Design: Retrospective chart review
Setting: Academic tertiary care center
Patients: All patients undergoing PRA between 2013 and 2019
Main Outcome Measures: 30-day mortality, conversion to open or trans-abdominal approach, postoperative complication, and 30-day readmission.
Results: A total of 237 PRAs were performed between 2013 and 2019. The population was 54% female with an average age of 54.1 (SD 14.1) and BMI of 30.5 (SD 6.3). Most (60.8%) lesions were left-sided, compared with 37.6% on the right side; 1.7% were bilateral. The most common diagnosis was non-functioning adenoma (38.8%), followed by pheochromocytoma (21.1%) and aldosteronoma (16.0%). The average tumor size was 3.2 cm (SD 1.7) with a range from 0.5 to 9.4 cm. Overall, the complication rate was 6.8%. Five patients (2.1%) had significant complications requiring unplanned ICU care or intervention, including one mortality (0.4%). There were two conversions to open (0.8%). The most common complications included need for blood transfusion (2.1%), UTI (1.3%) and wound infection (0.4%). There were no incidences of pneumothorax.
The average operative length was 116.0 minutes (SD 48.8) and decreased from an average of 160.2 minutes to 110.1 minutes over the study period. The majority (57.8%) of patients were discharged on postoperative day one, and 93.3% were discharged by postoperative day three. The 30-day readmission rate was 2.1%.
Conclusions: This is the largest American series of PRA to date and demonstrates that PRA is an extremely safe approach, with a low complication rate and fast recovery time. These results demonstrate that PRA is as safe, if not safer, than a trans-abdominal approach.


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