Trans- and retroperitoneal endoscopic adrenalectomy: experience in 26 consecutive adrenalectomies

OBJECTIVE: To assess our current concept and results of transperitoneal laparoscopic adrenalectomy (TPLA) and retroperitoneal endoscopic adrenalectomy (ERA) for a variety of benign disorders of the adrenal glands. BACKGROUND DATA: According to the literature, minimal invasive adrenalectomy has shown to be a safe and effective surgical alternative to open adrenalectomy. Both, transperitoneal and retroperitoneal endoscopic minimal invasive access are currently used for surgical removal of benign adrenal tumors. There is still some debate about the indications and the access used for a minimal invasive approach. PATIENTS AND METHODS: Treatment and clinical outcome of all patients who underwent either transperitoneal laparoscopic or endoscopic retroperitoneal adrenalectomies for benign diseases from February 1997 to August 2002 were analyzed retrospectively. RESULTS: Twenty-six minimal invasive adrenalectomies were performed in 23 patients with a mean age of 57 years. Whereas 11 patients underwent unilateral right- sided ERA, unilateral TPLA was performed in 9 patients on the left side. Three patients had bilateral TPLA. The mean operating time for unilateral ERA and TPLA was 114 and 79 min, respectively. Bilateral TPLA was prolonged to 223 min operating time. There were only two minor postoperative complications. The mean hospital stay for unilateral TPLA, ERA and bilateral TPLA was 4.7, 5 and 6 days, respectively. There was no mortality. CONCLUSION: Both, ERA and TPLA are safe and clinically effective treatment modalities for benign disorders of the adrenal glands. We currently favor a transperitoneal laparoscopic approach for bilateral and left-sided adrenal tumors, whereas right-sided tumors <8 cm are removed by a retroperitoneal approach. Large right-sided tumors >8 cm are better removed by transperitoneal access.     

Applicability and outcome of laparoscopic adrenalectomy

Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy, although careful selection of patients accounts for the favourable clinical outcome observed. Laparoscopic adrenalectomy was adopted as the procedure of choice for patients requiring adrenalectomy in our institution in 1995. From 1995 to 2001, 82 consecutive patients underwent adrenalectomies for various adrenal pathologies. The laparoscopic approach was used for 60 of these patients, whose selection was based on the preoperative size and/or benign nature of the adrenal lesion. The procedures were successfully performed in 57 patients (54 unilateral, 3 bilateral), while three (5%) patients required conversion to open surgery. There was no hospital mortality and complications occurred in two (3%) patients. The median hospital stay was 3 days (range, 2-8 days) and analgesic requirement was minimal. Laparoscopic adrenalectomy can be done for all patients with small and benign adrenal pathologies, and has become the gold standard for patients undergoing adrenalectomies. When successfully performed, the laparoscopic approach offers the advantages of a minimally invasive procedure with improved patient comfort and faster postoperative recovery.     

Laparoscopic adrenalectomy

BACKGROUND: Laparoscopic adrenalectomy is a good option for removal of the adrenal gland that is becoming preferred over the conventional open technique. METHODS: We reviewed the initial 30 laparoscopic adrenalectomies (in 27 patients) that were performed at our institution from 1995 to 1998. We used the lateral decubitus transperitoneal approach in 26 cases and the retroperitoneal approach in only one case. The indications for adrenalectomy were Conn's adenoma in eight patients, pheochromocytoma in six, Cushing's syndrome in five, nonfunctional adenomas in seven, and metastasis in one case. RESULTS: Only two patients (7%) were converted to laparotomy. Operating time ranged from 75 to 240 min. Average adrenal gland size was 6.1 cm (range, 4-9 cm). There was no mortality, and morbidity occurred in only two patients (8%)-one case of self-limited gastrointestinal bleeding and one case of hypercapnia and subcutaneous emphysema (in the only patient operated by the retroperitonal approach). Mean hospital stay was 3 days (range, 1-6). CONCLUSIONS: Laparoscopic adrenalectomy is a safe and useful procedure for nearly all adrenal pathologies. Lateral decubitus transperitoneal approach is the procedure of choice in most cases.     

Laparoscopic adrenalectomy by the anterior transperitoneal approach

BACKGROUND: The feasibility, safety, and results of 108 laparoscopic anterior transperitoneal adrenalectomies (six bilateral) were evaluated in a series of 105 patients. Three patients with a preoperative diagnosis of primary adrenal carcinoma were excluded from the study. METHODS: A total of 102 patients were included in the study based on exhaustive endocrinological and imaging assessment. Twenty-nine patients with nonsecreting adenoma, 34 with aldosterone-producing adenoma, 27 with cortisol-producing adenoma (five bilateral), 13 with pheochromocytoma (one bilateral), two with androgen-secreting adenoma, and three with metastases were considered eligible for adrenalectomy. Lesion size ranged from 3.5 to 12 cm. Concurrent surgical procedures were performed in 10 patients (9.8%). RESULTS: One (0.9%) intraoperative complication, a colon tear in a bilateral adrenalectomy, required conversion. There were two (1.9%) postoperative complications: one patient with thrombocytopenia developed hemoperitoneum and required a second laparoscopic procedure, and an intraabdominal abscess was treated medically. Mean postoperative hospital stay was 2.5 days (range, 1-7 days). Postoperative mortality was 0.9%; the patient with the colon tear died of sepsis 60 days after the operation. At a mean follow-up of 30 months (range, 1-62), normalization or improvement in hormone levels was observed in all patients with secreting adenomas, and significant improvement or cure was achieved in all patients with hypertension. CONCLUSION: Patients with secreting and nonsecreting adrenal lesions can be treated safety and effectively by laparoscopy with the anterior transperitoneal approach.     

Lateral transperitoneal laparoscopic adrenalectomy

Several laparoscopic approaches to the adrenal gland have been described. The lateral transperitoneal approach has several distinct advantages when contrasted with other techniques for laparoscopic adrenalectomy (LA). We present our technique and results obtained in 50 consecutive transperitoneal LAs. We review 50 consecutive laparoscopic adrenalectomies (28 female, 19 male) performed from 1993 to 1998. S.J. Shichman or R.E. Sosa was either the primary surgeon or the first assistant for all cases. The lateral transperitoneal approach described below was used in all cases. Indications for adrenalectomy included Cushing's syndrome (13), aldosteronoma (15), pheochromocytoma (7), nonfunctioning adenoma (11), hyperplasia (2), and 1 case each of Carney's syndrome and metastasis to the adrenal gland. We performed 5 bilateral, 22 left, and 18 right laparoscopic adrenalectomies. The average time needed for bilateral adrenalectomy was 503 min (range 298–690 min); for left adrenalectomy, 227 min (range 121–337 min); and for right LA, 210 min (range 135–355 min). We demonstrated a yearly trend in lower operative times. The largest adrenal gland removed measured 13.8 × 6.7 × 3.5 cm. Intraoperative blood loss was low. Only one patient received a blood transfusion. Conversion to open adrenalectomy was not required. Postoperative analgesic requirements were low. The average length of stay was 3.8 days for bilateral LA and 3 days for unilateral LA. Complications occurred in 5 patients (2 wound infections, 2 hematomas, and 1 pleural effusion). There was no mortality. Lateral transperitoneal adrenalectomy is a safe and efficient technique for the removal of functional and nonfunctional adrenal masses. This technique is associated with low morbidity, a minimal postoperative analgesic requirement, and a short hospital stay and, in our opinion, is more versatile than the retroperitoneal approach.     

Laparoscopic adrenalectomy. A new standard of care.

OBJECTIVE: The authors review their experience with laparoscopic adrenalectomy in patients with benign adrenal neoplasms. Efficacy, safety, and cost effectiveness of the procedure are examined. BACKGROUND: Laparoscopic adrenalectomy is replacing open adrenalectomy in some medical centers as the standard surgical approach for uncomplicated tumors. However, laparoscopic adrenalectomy often is considered more difficult and more expensive than traditional "open" surgery. METHODS: Perioperative and postoperative records as well as hospital charges from the first 19 patients undergoing laparoscopic unilateral adrenalectomies at the authors' medical institutions were examined and compared with 19 patients who underwent open unilateral adrenalectomies. RESULTS: None of the 19 patients undergoing unilateral laparoscopic adrenalectomy required conversion to open adrenalectomy. Mean operative times as well as total hospital charges were similar in those patients undergoing either laparoscopic or open adrenalectomy. However, the morbidity and postoperative length of hospital stay were significantly less in those patients undergoing laparoscopic adrenalectomy. CONCLUSIONS: Laparoscopic adrenalectomy can be performed safety and with the benefits associated with minimally invasive surgery. In addition, the procedure is cost effective. These factors suggest that laparoscopic adrenalectomy should be the preferential surgical technique for benign adrenal disease.     

Comparison of open posterior versus transperitoneal laparoscopic adrenalectomy.

BACKGROUND: This study reviewed the results of initial experiences of open posterior adrenalectomy and transperitoneal laparoscopic adrenalectomy in 46 patients. METHODS: Twenty-three adrenalectomies were performed using the open posterior approach. Detailed records of the patients' operative and postoperative progress were compared with those of the first 36 laparoscopic adrenalectomies undertaken for a similar range of conditions. RESULTS: Conversion to laparotomy was necessary in one of 23 open posterior adrenalectomies and five of 36 laparoscopic adrenalectomies. The mean operating time for laparoscopic unilateral adrenalectomy was nearly double that for open surgery (158 versus 85 min). Postoperative complications occurred more frequently in the open adrenalectomy series (12 of 23 versus two of 36) but one late unexplained death followed bilateral laparoscopic adrenalectomy. A mean reduction in hospital stay of 5 days was recorded after laparoscopic adrenalectomy (range 2-5 days for laparoscopic versus 6-11 days for open operation). CONCLUSION: Transperitoneal laparoscopic adrenalectomy was attended by a lower morbidity rate than open adrenalectomy and patients were discharged from hospital more quickly.     

Laparoscopic adrenalectomy — a review of initial 24 consecutive patients

Aim

To analyze patient demographics, pathology, surgical procedure and outcome in initial 24 consecutive patients who underwent laparoscopic adrenalectomy in our department.

Methods

Twenty four patients underwent laparoscopic adrenalectomy between September 2000 and August 2005. There were 12 males and 12 females with a mean age of 44.6 years (range 25–68 years). The indications for adrenalectomy were pheochromocytoma (13 patients), Cushing’s syndrome (5 patients), myelolipoma (2 patients), adrenal cyst (2 patients), aldosteronoma (1 patient) and adrenal incidentaloma (1 patient). Nineteen of our patients with functioning adrenal tumours were prepared preoperatively for periods ranging up to 2 weeks by the endocrinologist. All laparoscopic adrenalectomies were performed via lateral transperitoneal approach using standard four-port technique. Patients with pheochromocytoma and Cushing’s syndrome were monitored in the surgical intensive care unit during immediate postoperative period. The clinical and intraoperative characteristics, complications and outcomes of all patients were analyzed.

Results

The mean operative time for laparoscopic adrenalectomy was 136 minutes. Intraoperative hypertension occurred in 8 patients. Intraoperative hypotension occurred in 2 patients. One patient required conversion due to dense adhesions and hemorrhage. Postoperative complications were seen in six patients — immediate postoperative hypotension (2 patients), features of steroid withdrawal (2 patients) and postoperative pyrexia (2 patients). Five patients with pheochromocytoma required antihypertensive drugs in the postoperative period. There was no mortality in our series.

Conclusions

Laparoscopic adrenalectomy is a safe operation that incorporates all the benefits of minimal access surgery and is associated with a satisfactory postoperative outcome. A careful preoperative preparation in functioning adrenal tumours aids in the faster recovery of these patients.     

Anterior,lateral, and posterior retroperitoneal approaches in endoscopic adrenalectomy

BACKGROUND: Three approaches are currently used for endoscopic adrenalectomy-the lateral (transperitoneal), the posterior (retroperitoneal), and the anterior (transperitoneal). Both the lateral and posterior approaches are performed with the patient placed in the flank decubitus position; in the anterior approach the patient is supine. This study was designed to compare these three types of access in a relatively large series of patients undergoing adrenalectomy at three different institutions. METHODS: Laparoscopic adrenalectomy was performed in 216 patients with a variety of adrenal disorders, including 66 patients with Conn's syndrome, 55 with incidentaloma, 58 with Cushing's syndrome, 33 with pheochromocytoma, two with virilizing adrenogenital syndrome, and two with other lesions. Seventy-two adrenalectomies were performed using the lateral access, 67 via the posterior approach, and 77 via the transperitoneal anterior approach. There were 111 right and 105 left lesions. RESULTS: One patient in the lateral access group and three patients in the posterior group required conversion to open surgery. No conversions were needed in the anterior group. The learning curve was statistically significant only in the anterior access group. In both of the transperitoneal approaches (lateral and anterior), a statistically significant correlation was found between the operative time and the patient's body mass index (BMI). The postoperative hospital stay and time needed to return to normal activities were similar for the three groups. One patient who underwent retroperitoneal adrenalectomy for Cushing' disease died in the postoperative period of Candida sepsis and peritonitis. CONCLUSIONS: The anterior access route requires that the surgeon be skilled in advanced laparoscopic surgery. Both of the transperitoneal approaches (anterior and lateral) are suitable to remove larger adrenal masses. The posterior access may represent a better option in obese patients or in cases with small lesions.     

Clinical evaluation of our first 50 laparoscopic adrenalectomies

We performed 50 laparoscopic adrenalectomies during the period from 1998 through 2003. We report our experience and the outcomes of this procedure, which has become a standard surgery for adrenal tumors. In most cases, the transperitoneal approach was used. In 48 cases, laparoscopic adrenalectomy was performed successfully. However, in two cases, the operation was converted to an open procedure because of bleeding. As our experience with laparoscopic adrenalectomy increased, operation time decreased. Laparoscopic adrenalectomy should be used more widely in the future.     

Laparoscopic adrenalectomy: the New York-Presbyterian Hospital experience

BACKGROUND AND PURPOSE: Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland. The advantages of the laparoscopic approach include shorter length of stay (LOS), a decrease in postoperative pain, faster return to preoperative activity level, improved cosmesis, and reduced complications. We report our experience with laparoscopic adrenalectomy via a lateral transperitoneal approach. PATIENTS AND METHODS: Between September 1993 and April 2001, we performed 100 lateral transperitoneal adrenalectomies in 91 patients. In 82 cases, the adrenalectomy was unilateral and in the other 9, it was bilateral. A total of 59 left-sided lesions and 41 right-sided lesions were removed. The indications for surgery were Cushing's syndrome (24), aldosteronoma (34), pheochromocytoma (17), nonfunctioning adenoma (13), Carney's syndrome (1), and a metastasis from colon cancer (1) RESULTS: The overall success rate was 98%. Complications occurred in the two patients who required open conversion. In addition, three patients suffered pneumothoraces because of direct iatrogenic injury to the diaphragm during laparoscopic dissection. One additional patient suffered a splenic laceration. Operative time, blood loss, and intraoperative complications were similar in the laparoscopic and open surgery control group (N = 32). CONCLUSIONS: Laparoscopic adrenalectomy is technically feasible and reproducible. The lateral transperitoneal technique offers distinct advantages to the laparoscopist, including better visibility of familiar anatomic landmarks, easy access to other organ systems, the use of gravity to retract the spleen and liver, and a wide exposure, which allows removal of large adrenal lesions.     

Laparoscopic adrenal-sparing surgery for primary hyperaldosteronism due to aldosterone-producing adenoma

Background: Laparoscopic adrenalectomy has been shown to be safe and effective in the treatment of patients with primary hyperaldosteronism due to aldosterone-producing adenoma. Most laparoscopic adrenalectomies for aldosterone-producing adenomas involve total removal of the adrenal gland, and there have been few reports of laparoscopic adrenal-sparing surgery or partial adrenalectomies. Methods: A prospective review is performed on eight patients with primary hyperaldosteronism due to aldosterone-producing adenoma who underwent laparoscopic transperitoneal adrenal-sparing surgery in our institution over a 2-year period. Results: There were 1 male and 7 females with a mean age of 43.1 years. The mean diameter of the adenoma was 2 cm; there were six right-sided lesions and two left-sided lesions. The adenoma was located in the anterior margin of the adrenal gland in seven cases and was removed by laparoscopic enucleation. One patient had a partial adrenalectomy using the vascular stapler for an adenoma that was located posteriorly in the adrenal gland. Hemostasis was excellent in all cases. All patients were able to tolerate liquid orally on the day of operation and were on diet on the second postoperative day. Postoperative analgesic requirement was minimal. The mean hospital stay was 3.8 days. At a mean follow-up of 25 months, seven patients were cured of their hypertension and one patient had her antihypertensive medications significantly reduced. Conclusion: Laparoscopic transperitoneal adrenal-sparing surgery is safe and effective in the treatment of patients with primary hyperaldosteronism due to aldosterone-producing adenoma.     

Sub-mesocolic access in laparoscopic left adrenalectomy

Background This article reports an alternative laparoscopic access to left adrenal gland.Methods From January 1994 to August 2004, 209 laparoscopic adrenalectomies were performed in our Department. Indications were Conn adenoma (55 cases), incidentaloma (64), Cushing adenoma (45), pheochromocytoma (32), adreno-genital syndrome (two), mielolipoma (two), and metastatic mass(nine). Of 209, in 12 cases the left adrenalectomy was performed through a submesocolic access (seven pheochromocytoma, two incidentaloma, two Cushing adenoma, one Conn adenoma,). The identification and closure of the adrenal vein with minimal gland manipulation resulted the main benefit of this approach. Moreover, the adrenalectomy was performed with minimal anatomical dissection.Results No mortality or major complications occurred. During the operation, the blood pressure and cardiac rhythm were significantly more stable, in the group of patients who underwent a left adrenalectomy by the submesocolic approach compared to the anterior or flank lateral transperitoneal group.Conclusions Left adrenal lesions, as selected cases of pheochromocytoma, can be safely treated by laparoscopic submesocolic access.     

Laparoscopic transperitoneal adrenalectomy using the LigaSure vessel sealing system

BACKGROUND: Laparoscopic adrenalectomy is being performed with increasing frequency in the surgical treatment of adrenal tumors. Among laparoscopic approaches to the adrenal glands, the transperitoneal access is preferred. Along with advances in technology, different energy systems have been utilized. Laparoscopic adrenalectomy has become easier with the use of the LigaSure vessel sealing system (Valleylab, Boulder, Colorado). MATERIALS AND METHODS: Between January 2002 and August 2004, 23 laparoscopic transperitoneal adrenalectomies were performed in 22 patients using the LigaSure vessel sealing system: 16 of the patients were female, 6 were male and the mean age was 44 years (range, 17-70 years). Indications for surgery were non-functioning adenoma (n = 10), pheochromocytoma (n = 4), Cushing's syndrome (n = 5), Conn's syndrome (n = 2), and lymphoma (n = 1). The mean diameter of lesions was 4 cm (range, 1-7 cm). The distribution was 12 left, 9 right, and 1 bilateral adrenalectomies. RESULTS: The mean operative time for unilateral adrenalectomies was 57 minutes (range, 30-75 minutes). The operative time for the patient with Cushing's disease in whom a bilateral adrenalectomy was performed was 180 minutes. All operations were completed laparoscopically. A nonsteroidal anti-inflammatory drug (Lornoxicam) was sufficient for postoperative analgesia. Oral feeding was started 6 hours postoperatively. When used, drains were removed on postoperative day 1. The mean postoperative hospital stay was 1.5 days (range, 1-3 days). Wound infections developed in two patients with Cushing's syndrome. There was no mortality. Histopathologic examination of specimens revealed a cortex adenoma in 16 cases (10 of which was nonfunctional), a pheochromocytoma in 4 cases, a bilateral cortical hyperplasia in 1 case, and a lymphoma in 1 case. CONCLUSION: Laparoscopic adrenalectomy is an established method in the treatment of adrenal masses. Laparoscopic adrenalectomy as well as other laparoscopic procedures has become easier with the introduction of new energy systems.Vascular control and dissection of the gland by Liga- Sure is feasible. It makes the procedure easier and eventually shortens the operation time.     

Laparoscopic resection of large adrenal tumors

Background The maximum size of adrenal tumors that should be removed with a laparoscopic approach is controversial. It has been suggested that laparoscopic adrenalectomy is appropriate only for adrenal tumors <6 cm in size. We report our experience with laparoscopic adrenalectomy in patients with adrenal tumors of ≥6 cm compared with patients with smaller tumors. Methods We retrospectively reviewed a consecutive series of patients who had a laparoscopic adrenalectomy. Patients were considered candidates for laparoscopic adrenalectomy if their computed tomography (CT) scan showed a well-encapsulated tumor confined to the adrenal gland. Results Sixty laparoscopic adrenalectomies were performed in 53 patients. Twelve of the adrenalectomies (20%) were for tumors that were ≥6 cm (median, 8 cm; range, 6 to 12 cm). There have been no local or regional recurrences but one patient with adrenocortical carcinoma developed pulmonary metastases. When the 12 patients with large tumors were compared with the 36 patients with tumors <6 cm, the median operative time (190 vs. 180 minutes;P=.32), operative blood loss (100 vs. 50 mL;P=.53), and postoperative hospital stay (2 vs. 2 days;P=1.0) were similar. Conclusions The size of an adrenal tumor should not be the primary factor in determining whether a laparoscopic adrenalectomy should be performed. Large adrenal tumors that are confined to the adrenal gland on CT can be removed with a laparoscopic approach.     

Laparoscopic bilateral adrenalectomy for occult ectopic ACTH syndrome

INTRODUCTION: Ectopic adrenocorticotropic hormone (ACTH) production is responsible for approximately 15% of the cases of Cushing's syndrome. Bilateral adrenalectomy is the most effective treatment for ectopic ACTH syndrome due to occult or disseminated tumors, but the open approach carries substantial morbidity. In this paper, we review our experience with laparoscopic bilateral adrenalectomy for occult ectopic ACTH syndrome. MATERIALS AND METHODS: Adrenalectomies performed by the authors were identified and the outcomes of laparoscopic bilateral adrenalectomies for ectopic ACTH syndrome were examined. Bilateral adrenalectomies were performed sequentially in full lateral decubitus, with patient repositioning between the sides. RESULTS: From 2001 to 2006, the authors performed 16 adrenalectomies in 14 patients, with 11 performed laparoscopically. Two women with occult ectopic ACTH syndrome, refractory to medical management, underwent laparoscopic bilateral adrenalectomies. Operative times were 240 and 245 minutes, including repositioning. One patient underwent a simultaneous wedge liver biopsy for a right lobar lesion. There were no complications. Each patient resumed a regular diet on the first postoperative day. Inpatient hospital stays were 3 days each, mainly for steroid-replacement management. Final pathologic diagnoses were diffuse adrenocortical hyperplasia. Both patients noted a quick improvement in Cushing's syndrome symptoms and signs and were maintained on hydrocortisone and fludrocortisone replacement without incident for over 2 years. CONCLUSIONS: Laparoscopic bilateral adrenalectomy for ectopic ACTH syndrome refractory to medical management can be performed with low morbidity. Symptoms and signs of hypercortisolism rapidly improve postoperatively.     

Laparoscopic right and left adrenalectomies

Background: Laparoscopic approach for adrenalectomy was recently described and the operative technique is not yet well defined. Methods: Twenty-seven laparoscopic adrenalectomies were performed between 1992 and 1995. There were 18 women and nine men ranging in age from 31 to 70 years (mean, 50.8 years). The surgical procedure was a lateral decubitus transperitoneal flank approach in 26 patients, and a retroperitoneal approach in one. Twelve right and 15 left glands were removed. Adrenal diseases were primary aldosteronism in 20 patients, nonfunctional adenoma in four patients, Cushing adenoma in two, and an adrenal cyst in one. Median adrenal gland size was 2.0 cm (range 0.5–8 cm). Results: Five patients were converted to laparotomy (18%)—for dissection problems in four and for an unrecognized gland in one. The median anesthesia time was 200 min and the median surgical time was 140 min. Operative morbidity was one adrenal vein injury sectioned close to the vena cava. The hemorrhage was controlled by laparoscopic suturing without conversion. This patient required a three-unit blood transfusion. No mortality occurred and postoperative morbidity was one minor chest infection. The median postoperative in-hospital stay was 4.6 days (range 2–8) for nonconverted patients. Conclusions: Laparoscopic adrenal gland removal is safe and offers fast recovery and short in-hospital stay. Laparoscopic adrenalectomy combines the advantages of both the conventional anterior and posterior approach.     

Safety of Laparoscopic Adrenalectomy in Patients with Large Pheochromocytomas: A Single Institution Review

Background Laparoscopic adrenalectomy is the procedure of choice for small adrenal tumors, but some concerns have been voiced when this approach is adopted for larger tumors and pheochromocytomas. The aim of this study was to examine the results of the laparoscopic resection of large pheochromocytomas. Methods A retrospective review of adrenalectomies performed for adrenal pheochromocytomas >6 cm in diameter. We compiled and analyzed the early operative complications, histologic findings, and cure rates with a minimum of 1 year of follow-up after surgery. Results From 1996 to 2005, a total of 445 laparoscopic adrenalectomies were performed in our institution using the anterolateral transperitoneal approach. From this series we identified 18 procedures for pheochromocytomas with an average diameter on imaging of 78.2 mm (range 60–130 mm). All patients were rendered safe with a standard departmental protocol involving calcium-channel blockade initiated at least 2 weeks prior to surgery. The average peak intraoperative blood pressure was 187 mmHg. Capsular disruption occurred in two cases. One patient required an intraoperative blood transfusion due to intraoperative blood loss. No immediate conversions to an open procedure were required, but one patient underwent a delayed laparotomy for hematoma formation. Histologically, four of the adrenal tumors displayed evidence of vascular invasion. Biochemical cure was achieved in all patients after a median follow-up of 58 months (16–122 months). Conclusions Laparoscopic adrenalectomy appears to be a safe and effective approach for large pheochromocytomas when no preoperative or intraoperative evidence of local invasion is present. Paper Presented at the ISW Congress.     

Laparoscopic adrenalectomy: Akita University experience

We performed 52 laparoscopic adrenalectomies between January 1997 and March 2003. In 51 patients, adrenal tumors were successfully removed laparoscopically. In one patient, the laparoscopic procedure was converted to open surgery because of insufflator's trouble and hemorrhage. Perioperative blood transfusion was required in two patients; one for intraoperative and another for postoperative bleeding. We compared laparoscopic adrenalectomy with conventional open surgery which had been performed in our clinic before the laparoscopic adrenalectomy era. The mean operative time of the laparoscopic adrenalectomy (187 +/- 59 min) was not significantly longer than that of the open surgery (193 +/- 49 min). The mean estimated blood loss of laparoscopic adrenalectomy (75 +/- 145 g) was significantly less than that of the open surgery (438 +/- 447 g). Time to oral intake and ambulation for laparoscopic adrenalectomy were significantly earlier than those of the open surgery. Operation time was significantly shortened as the experience of this surgery was accumulated. The results of our experience support the concept that laparoscopic adrenalectomy is safe and is a standard treatment for surgical treatment of adrenal tumors.     

Transperitoneal Laparoscopic Adrenalectomy in Children

Purpose:

The use of a minimally invasive approach for adrenalectomy is poorly defined in pediatric patients, although laparoscopic adrenalectomy is considered a standard procedure in adults. The aim of our study was to describe the safety and feasibility of minimally invasive adrenalectomy in children on the basis of surgical skills and results.

Materials and Methods:

This was a retrospective study of 4 pediatric laparoscopic adrenalectomies performed at our center between 2009 and 2012. All patients underwent transperitoneal lateral laparoscopic adrenalectomies (2 right and 2 left adrenalectomies).

Results:

Four laparoscopic adrenalectomies were performed. Indications for surgery were neuroblastoma in 2 patients, secernent adrenocortical tumor in 1 patient, and adrenocortical nodular hyperplasia in 1 patient. Patients had a mean age of 87 months (range, 17–156 months) at diagnosis, and the average lesion size was 3.23 cm (range, 0.7–6.4 cm). All laparoscopic adrenalectomies were successful, no conversions to open surgery were required, and no postoperative complications or deaths occurred. The average operating time was 105 minutes (range, 80–130 minutes), blood loss during surgery was minimal, and the mean postoperative hospital stay was 3.75 days (range, 3–5 days). None of the patients showed signs of recurring disease at 15-month follow-up.

Conclusions:

Laparoscopic adrenalectomy is a safe, feasible, and reproducible technique offering numerous advantages, including shortening of operating times and postoperative hospital stays, as well as reduction of blood loss and complications. It also provides good visibility and easy access to other organs.