[Morbidity of unilateral and bilateral laparoscopic adrenalectomy according to the indication. Report of a series of 100 consecutive cases]

Abstract

Introduction: Laparoscopic adrenalectomy is the reference technique for the treatment of adrenal tumours. This retrospective study reports the experience of 100 consecutive laparoscopic adrenalectomies, in order to assess its indications, the incision, the morbidity and to determine the limitations of this procedure.

Material and methods: Between April 1994 and June 2004, 100 laparoscopic adrenalectomies were performed in 92 patients via a transperitoneal (n = 93) or retroperitoneal (n = 7) approach, with 84 unilateral and 8 bilateral adrenalectomies. The mean age was 52 years. The operative and postoperative characteristics and the functional results were evaluated.

Results: The mean operating time was 112 min [70-175] via the retroperitoneal approach, 101 min [40-215] via the transperitoneal approach, and 135 min [120-270] for bilateral adrenalectomies. The mean tumour diameter was 44 mm [10-120 mm]. The mean blood loss was 215 ml [0-1210 ml]. Ten patients were transfused. The mean hospital stay was 3 days. Histology revealed 25 Conn adenomas, 20 cortisol-secreting adenomas and Cushing syndrome, 22 phaeochromocytomas, 20 metastases, 2 adrenal cortical adenomas, and 11 incidentalomas. Conversion to "open" surgery were necessary for technical difficulties in 6% of cases. There were 7 minor postoperative complications (7%) and 4 late complications (4%) (deep vein thrombosis, effusion, 2 local recurrences). Four patients in the group with secondary adrenal tumours were alive without recurrence 18, 20, 44 and 48 months after adrenalectomy. Antihypertensive treatment was stopped in 16 of the 25 patients operated for Conn adenoma. The mean follow-up was 31 months [5-98 months].

Conclusion: This technique has a low morbidity, requires minimal postoperative analgesia and a short hospitalisation. The retroperitoneal or transperitoneal approach must be chosen as a function of the patient's history and the surgeon's habits. Tumours larger than 8 cm can be resected, but with a higher morbidity. Laparoscopic adrenalectomy for malignant tumours is associated with higher morbidity.