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Objective <p>This study aimed to systematically evaluate the operative and perioperative outcomes of transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA) for the treatment of adrenal tumors, aiming to clearly identify the advantages and disadvantages of each surgical approach.</p> Methods <p>Databases, including PubMed, the Cochrane Library, Embase, Web of Science, and Scopus, were searched from their establishment to June 2025 for randomized controlled trials (RCTs) comparing the operative and perioperative outcomes of TLA and RLA. Meta-analysis was performed according to the PRISMA guidelines. Data on operative time, intraoperative blood loss, time to postoperative oral intake, time to postoperative ambulation, postoperative hospital stay, complication rate, conversion to open surgery rate, and postoperative pain score were extracted. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias. Meta-analysis was performed using RevMan&#xa0;5.4 (The Nordic Cochrane Centre, Copenhagen, Denmark) and Stata&#xa0;18 (StataCorp LP, College Station, TX, USA).</p> Results <p>Five studies were included, involving a&#xa0;total of 306 patients (143 in the TLA group and 163 in the RLA group). The results showed that compared with RLA, TLA had a&#xa0;longer time to postoperative oral intake (MD = 9.60, 95% CI [2.88, 16.31]; <i>P</i> = 0.005), a&#xa0;longer time to postoperative ambulation (MD = 0.23, 95% CI [0.17, 0.29]; <i>P</i> &lt; 0.001), greater intraoperative blood loss (MD = 14.29, 95% CI [2.33, 26.24]; <i>P</i> = 0.02), and greater postoperative pain (MD = 0.56, 95% CI [0.07, 1.05]; <i>P</i> = 0.03). There were no statistically significant differences in operative time, postoperative hospital stay, complication rate, and the conversion to open surgery rate between the two approaches.</p> Conclusion <p>Retroperitoneal laparoscopic adrenalectomy is superior to TLA in terms of intraoperative blood loss, time to postoperative oral intake, time to postoperative ambulation, and postoperative pain. However, no significant differences were found between the two approaches regarding operative time, postoperative hospital stay, complication rate, and the conversion to open surgery rate.</p>

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Transabdominal vs. retroperitoneal laparoscopic adrenalectomy: an updated systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Xiaoshan Li,
  • Xiumei Li,
  • Yongjuan Zhang,
  • Xiao Lu,
  • Yijia Ma,
  • Baizi Wu,
  • Yi Guo,
  • Shuang Bai,
  • Rui Sun,
  • Yuyang Zhang,
  • Lili Wang,
  • Xinyu Liu,
  • Panfeng Shang

摘要

Objective

This study aimed to systematically evaluate the operative and perioperative outcomes of transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA) for the treatment of adrenal tumors, aiming to clearly identify the advantages and disadvantages of each surgical approach.

Methods

Databases, including PubMed, the Cochrane Library, Embase, Web of Science, and Scopus, were searched from their establishment to June 2025 for randomized controlled trials (RCTs) comparing the operative and perioperative outcomes of TLA and RLA. Meta-analysis was performed according to the PRISMA guidelines. Data on operative time, intraoperative blood loss, time to postoperative oral intake, time to postoperative ambulation, postoperative hospital stay, complication rate, conversion to open surgery rate, and postoperative pain score were extracted. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias. Meta-analysis was performed using RevMan 5.4 (The Nordic Cochrane Centre, Copenhagen, Denmark) and Stata 18 (StataCorp LP, College Station, TX, USA).

Results

Five studies were included, involving a total of 306 patients (143 in the TLA group and 163 in the RLA group). The results showed that compared with RLA, TLA had a longer time to postoperative oral intake (MD = 9.60, 95% CI [2.88, 16.31]; P = 0.005), a longer time to postoperative ambulation (MD = 0.23, 95% CI [0.17, 0.29]; P < 0.001), greater intraoperative blood loss (MD = 14.29, 95% CI [2.33, 26.24]; P = 0.02), and greater postoperative pain (MD = 0.56, 95% CI [0.07, 1.05]; P = 0.03). There were no statistically significant differences in operative time, postoperative hospital stay, complication rate, and the conversion to open surgery rate between the two approaches.

Conclusion

Retroperitoneal laparoscopic adrenalectomy is superior to TLA in terms of intraoperative blood loss, time to postoperative oral intake, time to postoperative ambulation, and postoperative pain. However, no significant differences were found between the two approaches regarding operative time, postoperative hospital stay, complication rate, and the conversion to open surgery rate.