Perioperative Outcomes of 3D Transperitoneal Laparoscopic Adrenalectomy Stratified by Tumor Size.

BACKGROUND: Laparoscopic adrenalectomy is the standard surgical approach for most adrenal tumors. Although three-dimensional (3D) transperitoneal laparoscopic adrenalectomy (TLA) is increasingly used, size-stratified perioperative outcomes remain incompletely characterized. We evaluated perioperative outcomes following 3D TLA by comparing patients with adrenal tumors <5 cm and ≥5 cm. METHODS: A retrospective cohort study was conducted on 57 consecutive patients who underwent 3D TLA at Hospital Episcopal San Lucas between 2018 and 2025. Patients were stratified into a small category (SC) (<5 cm) and a large category (LC) (≥5 cm). Primary outcomes included operative time, estimated blood loss (EBL), perioperative complications, conversion to open surgery, and length of hospital stay. RESULTS: Twenty-two patients had tumors <5 cm and 35 had tumors ≥5 cm. Median operative time was significantly longer in the large-tumor group (80 versus 60 minutes; P < .001). EBL was not significantly different between groups, and median hospital stay was 28.27 hours in the SC group and 29.46 hours in the LC group (P = .554). More than 90% of patients were discharged within 48 hours. No patients required blood transfusion or conversion to open surgery, and no intraoperative or postoperative complications were observed. CONCLUSIONS: In this single-center cohort, 3D TLA was feasible for both small and large adrenal tumors. Tumors ≥5 cm were associated with longer operative time but not with significantly greater EBL or longer hospitalization. More than 90% of patients were discharged within 48 hours, and no conversions, transfusions, or perioperative complications were observed. Because this study lacked a contemporaneous 2D comparator, no conclusions regarding the incremental benefit or superiority of 3D visualization can be drawn.