The preferred approach in adrenal surgery is currently minimally invasive, with low morbidity and complication rates in specialized centers. However, access today varies, being feasible either through transperitoneal (TPA) or retroperitoneal endoscopic (RPA) approaches. The aim of our study is to assess the implementation of the RPA approach compared to TPA over the last 5 years in a specialized center.

All patients undergoing minimally invasive adrenalectomy (RPA vs TPA) from 2018 to 2023 were included. Demographic variables, those related to diagnosis and surgical intervention, and immediate postoperative outcomes were analyzed.

83 patients were included, of which 26 cases (32%) were operated using the RPA approach and 57 (69%) through TPA. Demographic characteristics and diagnosis in both groups are comparable, except that patients undergoing RPA were older (61.8±12 vs. 55.7±12 years, p= 0.04). The size of the adrenal gland was also similar when comparing RPA vs TPA (44,2±22,2 vs. 41,4±24,2 mm, p=0.63). There were no differences in surgical time, intraoperative or postoperative complications in both groups, all being minimal in both cases. The mean hospital stay was significantly shorter in the RPA-operated group (1.9±1.2 vs. 2.6±1.1 days, p= 0.01).

Minimally invasive adrenalectomy via RPA shows a profile of indications and safety comparable to the TPA approach and appears to decrease the average hospital stay, probably due to better pain control and quicker recovery of intestinal transit. It represents an alternative to consider in specialized centers and can facilitate surgical intervention in certain patients.