"Totally No Tube" laparoscopic technique in the management of adrenal diseases: a safe and efficient practice

Background Laparoscopic adrenal surgery has become a common procedure for some adrenal diseases. The necessity of surgical related tubes, such as abdominal drainage tubes, catheters and endotracheal tubes, are controversial. These materials may induce regional tissue inflammation and be accompanied with uncomfortable. In this study, we evaluated the safety and feasibility of “Totally No Tube (TNT)” transperitoneal laparoscopic technique in adrenal surgery. Methods From January 2021 to December 2023, a total of 67 patients who were underwent TNT laparoscopic adrenal surgery were reviewed, and 78 patients who were underwent conventional laparoscopic adrenal surgery were included as the control group. A retrospectively analysis was conducted on indicators such as the time of anesthesia and operation, intraoperative blood loss, postoperative hospital stay, postoperative visual analogue scale, Quality of Recovery-40 score, time to first ambulation after surgery, total hospitalization cost, and postoperative complications in both groups. Results All 145 patients underwent surgery without grade II-IV complications. The TNT group showed significantly shorter postoperative hospital stay, lower postoperative pain score, better QOR-40 score, earlier ambulation after surgery, lower total hospitalization cost, and fewer certain postoperative complications. There were no significant differences in anesthesia time, operation time, and intraoperative blood loss. Conclusion TNT transperitoneal laparoscopic adrenal surgery is safe and well tolerated when strict selection criteria are followed. It indicates a similar rate of postoperative complications compared to the common laparoscopic approaches. Concurrently, it offers advantages such as less postoperative discomfort, more satisfaction with recovery from surgery, and lower healthcare expenditure.