Accelerated Recovery Protocols Enhance Outcomes in Retroperitoneoscopic Surgery for PA

Overview

Implementation of an adrenal fast-track and enhanced recovery (AFTER) protocol in posterior retroperitoneoscopic adrenalectomy (PRA) for primary aldosteronism significantly reduced hospital stay and improved postoperative recovery metrics compared to standard care. The protocol emphasized preoperative education, standardized anesthesia, early mobilization, and home blood pressure monitoring, resulting in faster recovery and high patient satisfaction.

Background

Minimally invasive adrenalectomy is the preferred treatment for benign adrenal tumors under 7 cm, with two main approaches: transperitoneal laparoscopic adrenalectomy (TLA) and posterior retroperitoneoscopic adrenalectomy (PRA). PRA offers advantages such as shorter operating time, less blood loss, and faster recovery. Despite these benefits, perioperative care for PRA patients has traditionally mirrored that of TLA. Fast-track surgery protocols, focusing on multimodal strategies to accelerate recovery, have demonstrated improved outcomes in various surgical fields but have not been widely applied to PRA. This study evaluates the impact of a tailored fast-track protocol on recovery after PRA in patients with primary aldosteronism.

Data Highlights

Key Findings

• The AFTER protocol reduced hospital length of stay by enabling admission on the day of surgery and early discharge.
• Standardized multimodal anesthesia and avoidance of urinary catheters post-surgery decreased postoperative pain and improved comfort.
• Early postoperative mobilization and enteral feeding were facilitated by dedicated nursing support, accelerating recovery.
• Preoperative patient education via a tailored video improved patient preparedness and satisfaction.
• Home blood pressure monitoring with electronic transmission allowed safe early discharge and timely postoperative management.
• Patients in the AFTER group reported faster physical recovery and resumed normal activities sooner than those receiving standard care.

Clinical Implications

Adopting a fast-track perioperative protocol tailored for PRA can enhance patient recovery, reduce hospital resource utilization, and improve patient satisfaction. Key elements include preoperative education, standardized anesthesia, minimal use of invasive devices, early mobilization, and remote monitoring of vital parameters. These strategies support safe early discharge and may optimize outcomes in minimally invasive adrenal surgery.

Conclusion

The implementation of an accelerated recovery protocol in retroperitoneoscopic adrenalectomy for primary aldosteronism improves postoperative recovery, reduces hospital stay, and enhances patient satisfaction. This approach represents a valuable advancement in perioperative care for minimally invasive adrenal surgery.

References

1. Barczynski et al. 2014 -- Advantages of PRA over TLA in adrenalectomy
2. Previous study by authors 2019 -- PRA learning curve and outcomes
3. Fast-track surgery literature 2010-2020 -- Enhanced recovery benefits