Has experience changed the scenario in laparoscopic adrenalectomy?

Abstract

Background: Laparoscopic adrenalectomy (LA) is a relatively uncommon operation performed by surgeons with a specific interest in endocrine surgery as well as advanced laparoscopic surgery. LA is technically difficult and it is recommended to tackle small glands first till adequate experience is reached [1]. A minimum of 30 cases are required to master the technique [2]. The present study reviews data of 60 laparoscopic adrenalectomies comparing the later results with the first 30 cases.

Material and methods: Starting 2001, patients diagnosed to have adrenal disorders were subjected to laparoscopic approach in a graded manner. A database was maintained with respect to age, sex, duration of symptoms, co-morbid conditions, diagnosis, size of tumor, weight of tumor, blood loss, duration of surgery, conversion to open, in-hospital stay, referral pattern, morbidity (both early and late) and mortality. The database was divided into two groups. First 30 patients constituted Group A, Group B constituted the next 30 adrenalectomies and deviation in the two was noted. Statistical analysis was performed to determine the importance of deviation of factors.

Results: Sixty adrenalectomies were performed in 49 patients (11 being bilateral) between February 2001 and July 2008. Age group varied from 12-54 years with mean of 30.73 years, Twenty four were males. Thirty-one right and 29 left LA were performed. The comparison of factors in relation to the two groups (Group A and B respectively) revealed an increase in number of adrenalectomies performed (0.4 v/s 0.76) in relation to timeline, increased incidence of pheochromocytoma (6 v/s 18) and incidentalomas (zero v/s 8), larger tumor size (4.17 cm v/s 6.6 cm), comparable blood loss (72 cc v/s 98.3 cc) and duration of surgery (122 min v/s 112 min), increased conversion to open surgery (1 v/s 6) leading to increased in-hospital stay (2.8 days v/s 3.37 days) but a comparable morbidity (2 v/s 1) and no mortality.

Conclusion: Though technically difficult, with increasing experience and focused approach, laparoscopic skills in adrenalectomy improves. The spectrum of indications broadens, thus making laparoscopic interventions for vascular and large adrenal glands safe and patient friendly.

Keywords: Laparoscopic adrenalectomy; Large adrenal tumours; Pheochromocytoma.