Endoscopic retroperitoneal adrenalectomy: lessons learned from 111 consecutive cases

Abstract

Objective: To evaluate the effectiveness of endoscopic retroperitoneal adrenalectomy (ERA).

Summary background data: Minimally invasive adrenalectomy has become the procedure of choice for benign adrenal pathology. Although the adrenal glands are located in the retroperitoneum, most surgeons prefer the transperitoneal laparoscopic approach to adrenal tumors.

Methods: Clinical characteristics and outcomes of 111 ERAs from January 1994 to December 1999 were evaluated.

Results: Ninety-five patients underwent 111 ERAs (79 unilateral, 16 bilateral). Indications were Cushing syndrome (n = 22), Cushing disease (n = 8), ectopic adrenocorticotropic hormone syndrome (n = 6), Conn's adenoma (n = 25), pheochromocytoma (n = 19), incidentaloma (n = 11), and other (n = 4). Tumor size varied from 0.1 to 8 cm. Median age was 50 years. Unilateral ERA required 114 minutes, with median blood loss of 65 mL. Bilateral ERA lasted 214 minutes, with median blood loss of 121 mL. The conversion rate to open surgery was 4.5%. The complication rate was 11%. Median postoperative hospital stay was 2 days for unilateral ERA and 5 days for bilateral ERA. The death rate was 0.9%. At a median follow-up of 14 months, the recurrence rate of disease was 0.9%.

Conclusion: For benign adrenal tumors less than 6 cm, ERA is recommended.

Figure 1. Retroperitoneal endoscopic right adrenalectomy in the lateral decubitus position.

Figure 2. Number of open, transperitoneal laparoscopic, and retroperitoneal endoscopic adrenalectomies, 1994–1999.