Vol 70, No 5 (2019)
Original paper
Published online: 2019-06-10

open access

Page views 1499
Article views/downloads 1275
Get Citation

Connect on Social Media

Connect on Social Media

The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

Tomasz Kozłowski1, Alicja Rydzewska-Rosolowska2, Janusz Myśliwiec3, Barbara Choromańska1, Piotr Wojskowicz1, Jacek Dadan1, Marta Łukaszewicz-Zając4, Barbara Mroczko4, Piotr Myśliwiec1
Pubmed: 31274187
Endokrynol Pol 2019;70(5):409-416.


Introduction: Laparoscopic adrenalectomy is the gold standard management of benign adrenal masses and isolated metastases to adrenal glands. Two techniques of endoscopic adrenalectomy: lateral transperitoneal approach (LTA) and posterior retroperitoneal approach (PRA) seem to be equally safe and effective. Recent studies suggest advantages of PRA over LTA in terms of lower intensity of postoperative pain, shorter hospital stay, faster recovery, and lower early morbidity. However, PRA involves high insufflation pressure of CO2 within a limited retroperitoneal space. The aim of our study was to prospectively assess the effect of LTA versus PRA laparoscopic adrenalectomies on renal function.

Material and methods: We randomly assigned patients referred for unilateral adrenalectomy to either LTA (n = 33) or PRA (n = 44). The inclusion criteria were: hormonal activity and/or tumour diameter > 4 cm and/or suspicion of metastasis to adrenal gland. The exclusion criteria comprised: tumours > 8 cm, results of imaging studies suggesting primary invasive malignancy, and refusal to undergo randomisation. The patients were prospectively followed for a minimum of six months. Serum creatinine, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively and at postoperative days: 1, 7, and 30.

Results: We found increased concentrations of urinary NGAL at day 1 following laparoscopic adrenalectomy using PRA, as compared to LTA. Patients undergoing right-sided PRA had increased creatinine concentrations, as compared to left-sided PRA. Patients with aldosterone-producing adenoma had decreased preoperative eGFR as compared to subjects with non-functioning incidentaloma. NGAL increased significantly in this group postoperatively. All the disturbances normalised within one month postoperatively.

Conclusions: Renal function impairment after PRA may result from compression of inferior vena cava by high retroperitoneal pressure during right-sided adrenalectomy. Despite the transient character of the observed abnormalities, we suggest that patients with high risk of acute kidney injury may benefit from an alternative technique of adrenalectomy using LTA.

Article available in PDF format

View PDF Download PDF file


  1. Mansmann G, Lau J, Balk E, et al. The clinically inapparent adrenal mass: update in diagnosis and management. Endocr Rev. 2004; 25(2): 309–340.
  2. Szeliga J, Sondka Z, Jackowski M, et al. NOD2/CARD15 polymorphism in patients with rectal cancer. Med Sci Monit. 2008; 14(9): CR480–CR484.
  3. Kuklinski A, Kamocki Z, Koda M, et al. IGF-IR in patients with advanced colorectal cancer in correlation with certain clinico-morphological factors: Initial report. Oncol Lett. 2011; 2(6): 1155–1159.
  4. Swiglo BA, Murad MH, Schünemann HJ, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab. 2008; 93(3): 666–673.
  5. Myśliwiec J, Zukowski L, Grodzka A, et al. Problems in diagnostics of primary aldosteronism - analysis of the own data. Endokrynol Pol. 2010; 61(1): 2–5.
  6. Myśliwiec J, Siewko K, Zukowski L, et al. Pheochromocytoma — analysis of 15 consecutive cases from one centre. Endokrynol Pol. 2013; 64(3): 192–196.
  7. Myśliwiec J, Rudy A, Siewko K, et al. [Diagnostic difficulties in adrenal incidentaloma — analysis of 125 cases]. Endokrynol Pol. 2007; 58(5): 417–421.
  8. Szeliga J, Jackowski M. Minimally invasive procedures in severe acute pancreatitis treatment - assessment of benefits and possibilities of use. Wideochir Inne Tech Maloinwazyjne. 2014; 9(2): 170–178.
  9. Piątkowski J, Jackowski M, Szeliga J. Laparoscopic surgery of esophageal hiatus hernia - single center experience. Wideochir Inne Tech Maloinwazyjne. 2014; 9(1): 13–17.
  10. Tiberio GAM, Baiocchi GL, Arru L, et al. Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma. Surg Endosc. 2008; 22(6): 1435–1439.
  11. Lee CR, Walz MK, Park S, et al. A comparative study of the transperitoneal and posterior retroperitoneal approaches for laparoscopic adrenalectomy for adrenal tumors. Ann Surg Oncol. 2012; 19(8): 2629–2634.
  12. Nigri G, Rosman AS, Petrucciani N, et al. Meta-analysis of trials comparing laparoscopic transperitoneal and retroperitoneal adrenalectomy. Surgery. 2013; 153(1): 111–119.
  13. Barczyński M, Konturek A, Nowak W. Randomized clinical trial of posterior retroperitoneoscopic adrenalectomy versus lateral transperitoneal laparoscopic adrenalectomy with a 5-year follow-up. Ann Surg. 2014; 260(5): 740–7; discussion 747.
  14. Myśliwiec P, Marek-Safiejko M, Lukaszewicz J, et al. Videoscopic adrenalectomy — when does retroperitoneal seem better? Wideochir Inne Tech Maloinwazyjne. 2014; 9(2): 226–233.
  15. Marek-Safiejko M, Safiejko K, Łukaszewicz J, et al. A Comparison of Two Approaches to Laparoscopic Adrenalectomy: Lateral Transperitoneal Versus Posterior Retroperitoneal Approach. Adv Clin Exp Med. 2016; 25(5): 829–835.
  16. Yoshioka M, Nakajima Y, Miyamoto T, et al. Age-Dependent Progression of Renal Dysfunction After Adrenalectomy for Aldosterone-Producing Adenomas in Japan. J Endocr Soc. 2019; 3(3): 577–589.
  17. Onohara T, Takagi T, Yoshida K, et al. Assessment of postoperative renal function after adrenalectomy in patients with primary aldosteronism. Int J Urol. 2019; 26(2): 229–233.
  18. Utsumi T, Kamiya N, Kaga M, et al. Development of novel nomograms to predict renal functional outcomes after laparoscopic adrenalectomy in patients with primary aldosteronism. World J Urol. 2017; 35(10): 1577–1583.
  19. Major P, Matłok M, Pędziwiatr M, et al. Do we really need routine drainage after laparoscopic adrenalectomy and splenectomy? Wideochir Inne Tech Maloinwazyjne. 2012; 7(1): 33–39.
  20. Abella V, Scotece M, Conde J, et al. The potential of lipocalin-2/NGAL as biomarker for inflammatory and metabolic diseases. Biomarkers. 2015; 20(8): 565–571.
  21. Liebetrau C, Gaede L, Doerr O, et al. Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of contrast-induced nephropathy after percutaneous coronary intervention. Scand J Clin Lab Invest. 2014; 74(2): 81–88.
  22. Chapter 1: Definition and classification of CKD. Kidney Int Suppl. 2013; 3(1): 19–62.
  23. Natkaniec M, Pędziwiatr M, Wierdak M, et al. Laparoscopic adrenalectomy for pheochromocytoma is more difficult compared to other adrenal tumors. Wideochir Inne Tech Maloinwazyjne. 2015; 10(3): 466–471.
  24. Pędziwiatr M, Wierdak M, Ostachowski M, et al. Single center outcomes of laparoscopic transperitoneal lateral adrenalectomy — Lessons learned after 500 cases: A retrospective cohort study. Int J Surg. 2015; 20: 88–94.
  25. Çelik T, Altekin E, İşgüder R, et al. Evaluation of neutrophil gelatinase-associated lipocalin in pediatric patients with acute rotavirus gastroenteritis and dehydration. Ital J Pediatr. 2013; 39: 52.
  26. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem. 1992; 38(10): 1933–1953.
  27. Watanabe S, Okura T, Kurata M, et al. Valsartan reduces serum cystatin C and the renal vascular resistance in patients with essential hypertension. Clin Exp Hypertens. 2006; 28(5): 451–461.
  28. Salgado JV, Souza FL, Salgado BJ. How to understand the association between cystatin C levels and cardiovascular disease: Imbalance, counterbalance, or consequence? J Cardiol. 2013; 62(6): 331–335.
  29. Kim IlY, Park IS, Kim MJ, et al. Change in kidney function after unilateral adrenalectomy in patients with primary aldosteronism: identification of risk factors for decreased kidney function. Int Urol Nephrol. 2018; 50(10): 1887–1895.
  30. Kaga M, Utsumi T, Tanaka T, et al. Risk of New-Onset Dyslipidemia After Laparoscopic Adrenalectomy in Patients with Primary Aldosteronism. World J Surg. 2015; 39(12): 2935–2940.
  31. Choromańska B, Myśliwiec P, Dadan J, et al. The clinical significance of fatty acid binding proteins. Postępy Hig Med Dośw. 2011; 65: 759–763.
  32. Choromańska B, Myśliwiec P, Razak Hady H, et al. Metabolic Syndrome is Associated with Ceramide Accumulation in Visceral Adipose Tissue of Women with Morbid Obesity. Obesity (Silver Spring). 2019; 27(3): 444–453.
  33. Myśliwiec H, Baran A, Harasim-Symbor E, et al. Increase in circulating sphingosine-1-phosphate and decrease in ceramide levels in psoriatic patients. Arch Dermatol Res. 2017; 309(2): 79–86.
  34. Choromańska K, Choromańska B, Dąbrowska E, et al. Saliva of obese patients — is it different? Postepy Hig Med Dosw (Online). 2015; 69: 1190–1195.
  35. Donderski R, Stróżecki P, Sulikowska B, et al. Aldosterone antagonist therapy and its relationship with inflammation, fibrosis, thrombosis, mineral-bone disorder and cardiovascular complications in peritoneal dialysis (PD) patients. Int Urol Nephrol. 2017; 49(10): 1867–1873.
  36. Willenberg HS, Ansurudeen I, Schebesta K, et al. The endothelium secretes interleukin-6 (IL-6) and induces IL-6 and aldosterone generation by adrenocortical cells. Exp Clin Endocrinol Diabetes. 2008; 116(Suppl 1): S70–S74.
  37. Mysliwiec J, Zbucki R, Winnicka MM, et al. A crucial role of interleukin-6 in the pathogenesis of thyrotoxicosis-related disturbances of bone turnover in mice. Horm Metab Res. 2007; 39(12): 884–888.