Predictive Factors for Operative Time and Blood Loss in Retroperitoneal Laparoscopic Adrenalectomy: A Single‐Center Experience

OBJECTIVES: Operative time and intraoperative blood loss in retroperitoneal laparoscopic adrenalectomy have decreased over time. This study aimed to identify predictive factors associated with operative time and blood loss and to clarify factors underlying improvements in operative outcomes, with particular focus on sealing device use. METHODS: We retrospectively reviewed 597 patients who underwent retroperitoneal laparoscopic adrenalectomy for adrenal tumors at a single institution between December 1993 and October 2021. Patients treated after the introduction of robotic-assisted adrenalectomy were excluded. Predictors of prolonged operative time and increased intraoperative blood loss were evaluated using univariate and multivariate logistic regression analyses. To reduce potential confounding related to baseline differences in tumor characteristics and preoperative diagnoses, propensity score matching was performed between patients treated with and without sealing devices. RESULTS: Both operative time and intraoperative blood loss decreased over time, with more pronounced improvements in recent periods. Multivariate analysis identified right-sided tumors, higher body mass index, and the absence of sealing device use as independent predictors of prolonged operative time. Increased blood loss was independently associated with male sex, higher body mass index, and the absence of sealing device use. In propensity score-matched analyses, operative time and blood loss remained significantly lower in patients treated with sealing devices than in those without sealing devices. CONCLUSIONS: The appropriate use of sealing devices was independently associated with shorter operative time and reduced intraoperative blood loss in retroperitoneal laparoscopic adrenalectomy, suggesting a contribution to improved operative efficiency and surgical safety within the limited retroperitoneal working space.