Laparoscopic adrenalectomy - ten-year experience

Abstract

Objectives: The objective of the study is to summarize the authors' 10-year experience with laparoscopic adrenalectomy and to analyze the intra- and postoperative complications of the procedure.

Material and methods: The records of 80 patients who had undergone laparoscopic adrenalectomy from January 2002 to January 2012 were reviewed retrospectively. There were 51 female and 29 male patients. The average age was 52. In 33 cases the right adrenal gland was affected, in 47 it was the left adrenal gland. Nineteen operations were performed with the retroperitoneal approach, in 61 a transperitoneal access was used. The average size of the tumor was 5 cm. The diagnosis was based on ultrasonography (USG) and computed tomography (CT). The biochemical tests were performed in all cases to assess hormonal activity of the tumor. Pheochromocytoma was diagnosed in 16 cases, Cushing syndrome in 3 cases, and Conn syndrome in 4 cases. All other tumors were hormonally inactive. Six patients were operated on because of adrenal metastases - from renal carcinoma in five cases and from lung carcinoma in one case.

Results: There were three open conversions. The mean operative time was 158 minutes. The mean hospital stay was 5.5 days Blood transfusion was necessary in three patients. Postoperative complications were observed in 11 patients (13.7%).

Conclusions: Laparoscopic adrenalectomy is a safe and effective procedure and should be considered the first - line treatment of benign adrenal masses. Our experience indicates that patients with adrenal metastases are suitable candidates for laparoscopic adrenalectomy, providing a skilled laparoscopic surgeon is involved in operation.

Keywords: adrenalectomy; laparoscopy.

Fig. 1

Trocar placement for transperitoneal laparoscopic adrenalectomy: A – right side, B – left side.

Fig. 2

Trocar placement for left retroperitneal adrenalectomy.