Laparoscopic right adrenalectomy: Is it necessary to use liver retraction trocar?

Background and aims: We aimed to evaluate the surgical outcomes and complications in patients who underwent right laparoscopic adrenalectomy (RLA) with or without using a liver retractor trocar. Materials and Methods In this cohort study, all patients who were candidates for RLA were included. One surgeon did not use a liver retractor at all while it was used by the others. All the pre-operative, peri-operative and surgical complications including hospitalization, surgical duration, Hb drop and pack cell injection, conversion to open surgery, and ICU admission were compared between the two groups. Results A total of 228 patients were included in this study: 60 patients in the group without liver retraction and 168 patients in the group with liver retraction. There were no differences in pre-operative data including sex (p = 0.740), history of surgery (p = 0.618), age (0.682), BMI (0.864), risk of anesthesia (p = 0.418), and tumor size (p = 0.218) between two groups. There were also no significant differences in peri-operative data and surgical complications including pack cells injection (p = 0.882), re-hospitalization (0.682), conversion of procedure to open surgery (p = 0.990), ICU admission (p = 0.782), hemoglobin drop (p = 0.662), surgical duration (p = 0.188), hospitalization duration (p = 0.062) and pathology report (0.916) between the two groups Conclusion According to the results of this study, the use or non-use of liver retraction in laparoscopic right adrenalectomy by an expert surgeon has no significant impact on peri-operative and post-operative outcomes and surgical complications. We do not recommend the routine use of a liver retractor trocar for this surgery, but only when the surgeon feels the need for it intraoperatively, which is rare in experienced surgeons.