Diagnosis and surgical treatment of adrenal tumors

Adrenal surgery is necessary for the management of functioning adrenal tumors, such as aldosterone-producing adenoma, cortisol-producing adenoma, and pheochromocytoma. The role of adrenal imaging in primary hyperaldosteronism is to separate the surgically resectable unilateral aldosteronoma from bilateral hyperplasia. Once the clinical diagnosis of primary hyperaldosteronism is confirmed, adrenal computed tomography (CT) with 3-mm sections should be the first imaging study. If the results of CT and NP-59 scintigraphy are equivocal, adrenal venous sampling is necessary. Cortisol-producing adrenocortical adenomas are seen as adrenal masses 2.5 cm or larger in diameter in CT scanning. When an adrenal mass measures more than 5 cm in diameter, a functioning adrenal carcinoma should be considered. Symptomatic pheochromocytomas are almost always 2 cm or larger. On MR scanning, pheochromocytomas are extremely bright on T2-weighted images. In patients with ectopic pheochromocytomas, 131I-MIBG scintigraphy should be mandatory. In the past decade, laparoscopic adrenalectomy has replaced open adrenalectomy as a standard operative procedure for benign adrenal tumors. Adrenal-sparing laparoscopic surgery has recently become a feasible option in patients with hereditary bilateral pheochromocytomas.     

腹腔镜切除5～10 cm肾上腺嗜铬细胞瘤的安全性分析

目的 探讨5～10 cm肾上腺嗜铬细胞瘤腹腔镜切除术的安全性. 方法 2001年1月至2007年6月在北京大学第一医院泌尿外科行肾上腺嗜铬细胞瘤切除的连续79例患者中肿瘤最大径5～10 cm者共41例,回顾分析其临床资料.腹腔镜组11例(其中2例中转开放,数据分析时排除在外),开放手术组30例.应用t检验、Mann-Whitney U检验对两组患者的临床资料及围手术期数据进行分析. 结果 两组患者年龄、肿瘤最大径、术前最高收缩压及舒张压、术前心率、血儿茶酚胺水平的差异均无统计学意义(P>0.05).腹腔镜组均经腹膜后途径.开放手术组经腹腔途径11例,经腹膜后途径19例.两组患者手术时间分别为(132±54)min和(178±64)min;术中出血量分别为100 ml(0～800 m1)和450 ml(0～9500 ml);术后住院时间分别为(7±2)d和(9±4)d,差异均有统计学意义(P<0.05).腹腔镜组术中均未输血,开放手术组术中输血量的中位值为225 ml(0～3800 ml).2组患者术中最高血压、最低血压、最快心率、最慢心率、收缩压增加基础血压30%的次数、收缩压≥200 mm Hg(1 mm Hg=0.133 kPa)次数、收缩压≤90 mm Hg次数、心率≥110次/min次数、心率≤50次/min次数的差异均无统计学意义(P>0.05).两组患者引流量、拔管时间、住ICU时间、术后开始进食时间、住院费用差异均无统计学意义(P>0.05). 结论 腹腔镜切除5～10 cm肾上腺嗜铬细胞瘤的手术时间、术中出血量、术中输血量、术后住院日较开放手术有优势,且术中血压、心率波动等指标不高于开放手术.因此,5～10 cm的肾上腺嗜铬细胞瘤不是腹腔镜的绝对禁忌,经验丰富的术者可以考虑开展腹腔镜手术切除较大肾上腺嗜铬细胞瘤.     

腹腔镜肾上腺巨大肿瘤切除术临床分析

目的:探讨腹腔镜肾上腺巨大肿瘤切除术的临床可行性及意义。方法:应用经腹腔途径为45例肾上腺肿瘤患者行腹腔镜肾上腺肿瘤切除术。术前均经B超、CT或MRI等相关影像学检查初步确诊。45例患者分为2组,32例肾上腺肿瘤直径5cm(A组),13例肿瘤直径5cm(B组)。观察2组患者手术时间、术中出血量、住院时间、中转开放率及围手术期并发症等情况。术后常规随访,定期行B超及胸片检查。结果:45例均顺利完成腹腔镜手术,平均手术时间(A组58.6min,B组86.7min)、术中平均出血(A组31.6ml,B组84.3ml)两组差异均有统计学意义(P0.01);中转开放手术A组3例(9%),B组1例(8%),两组差异无统计学意义(P0.05)。B组术中1例需输血;术后平均住院A组5.2d,B组5.7d,两组差异无统计学意义(P0.05)。术后患者均顺利康复。结论:与腹腔镜较小肾上腺肿瘤(5cm)切除术相比,腹腔镜巨大肾上腺肿瘤(5cm)切除术手术时间长,术中出血多,但住院时间及围手术期并发症无显著差异。只要术者具备娴熟的腹腔镜操作技巧及充分的临床经验,腹腔镜较大肾上腺肿瘤切除术切实可行。     

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 anterior adrenalectomy for the treatment of adrenal metastases

Aim of this study was to evaluate the results in 6 patients undergoing laparoscopic adrenalectomy for the treatment of solitary adrenal gland metastases. One hundred forty-five patients underwent laparoscopic adrenalectomy by transperitoneal anterior approach. In 6 patients the indication was the presence of a solitary adrenal gland metastasis. Primary tumors were the following: truncal melanoma, gastric cancer, renal cancer, lung cancer, and breast cancer. Mean age was 57 years (range 44-70 years). Three patients underwent right adrenalectomy and 3 patients a left adrenalectomy. No conversion to open surgery occurred. No mortality or intraoperative complications were observed. Mean operative time was 103 minutes (range 70-150) for right adrenalectomy and 170 minutes (range 90-280) for left adrenalectomy. No postoperative complications occurred. Mean diameter of the tumor was 3.5 cm (range 2-5 cm). Tumor free margins were obtained in every case. Mean hospital stay was 2 days (range 2-3 days). At follow-up, 2 patients have died of systemic dissemination of the disease, one 15 months and one 24 months after the operation. The remaining 4 patients are alive and disease free at a mean follow-up of 7 months (range 4-11 months). So far, no port site metastases or local recurrence have been observed. In our experience adrenal gland metastasis can be treated safely and effectively by the laparoscopic transperitoneal anterior approach.     

Laparoscopic adrenalectomy for pheochromocytoma

Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland for functional adrenal tumors including aldosteronoma, glucocorticoid, and androgen/estrogen-producing adenomas. Many laparoscopic surgeons also think that for small to moderately sized pheochromocytomas, the laparoscopic approach is as safe and effective as the open technique. Several physiologic considerations specific to pheochromocytoma must be addressed before and during surgery regardless of the operative approach. The advantages of laparoscopic adrenalectomy over open adrenalectomy remain the same for pheochromocytomas as for other pathologic conditions of the adrenal gland. These include a shorter length of stay, a decrease in postoperative pain, a shorter time to return to preoperative activity level, and improved cosmesis.     

Laparoscopic partial adrenalectomy

Background: Most laparoscopic adrenalectomies involve total removal of the whole adrenal gland, and reports of laparoscopic partial adrenalectomies have been very few. The criteria for performing a laparoscopic partial adrenalectomy have not been described. Methods: (a) Patients with functioning adrenal tumors smaller than 3 cm in diameter were selected. (b) The solitary adrenal tumors were evaluated by preoperative thin-slice computed tomography (CT) scan. (c) Solitary lesions were reconfirmed with intraoperative ultrasonography. (d) Partial adrenalectomy was performed with at least a 5-mm margin using a vascular stapler. Results: Laparoscopic partial adrenalectomy was performed in five patients using the vascular stapler. Hemostasis was perfect in all five patients. The tumor was located in the inferior part of the right adrenal gland in three cases and in the upper pole of the left adrenal gland in two cases. The postoperation pathologic diagnosis was adrenocortical adenoma in all five patients, and excessive hormonal levels or symptoms all disappeared. Conclusions: Laparoscopic partial adrenalectomy can be performed safely using a vascular stapler. Received: 26 May 1998/Accepted: 30 June 1998     

腹膜后腹腔镜治疗肾上腺疾病28例报告

目的:探讨腹膜后腹腔镜手术切除肾上腺病变的临床效果。方法:回顾分析我院为28例肾上腺病变患者行腹膜后腹腔镜肾上腺切除术的临床资料,其中皮质醇腺瘤4例,醛固酮腺瘤11例,嗜铬细胞瘤3例,无功能腺瘤8例,肾上腺囊肿2例。用观察镜扩张后腹腔,3个Trocar经腰部穿刺,超声刀切除肿瘤,用自制标本袋取出肿瘤。结果:28例手术均获成功,手术时间45~120min,平均70min。术中出血20~300ml,平均60ml,患者均未输血。切除肿瘤直径1~4.5cm,平均3.2cm。随访28例6~48个月,平均13个月,未见肿瘤复发和转移,肾上腺内分泌检查均恢复正常。结论:腹膜后腹腔镜肾上腺肿瘤切除术具有微创、患者出血少、康复快、并发症少等优点,可作为治疗肾上腺良性疾病的首选方法。     

肾上腺偶发瘤的外科治疗选择

目的 探讨肾上腺偶发瘤的手术指征.方法 总结147例肾上腺偶发瘤患者资料,分析偶发瘤的手术指征,比较腹腔镜和开放性手术的适应证.147例患者中,恶性肿瘤19例(12.9%),平均直径(8.5±3.9)cm,≤4 cm者4例(21.1%),其中肾上腺皮质癌15例、恶性嗜铬细胞瘤4例;良性功能性肿瘤29例(19.7%),平均直径(4.1±2.1)cm,其中≥3 cm者22例(75.9%);19例良性嗜铬细胞瘤中24 h尿香草扁桃酸升高2例,5例醛固酮瘤中血钾稍低2例,5例亚临床库欣综合征腺瘤患者血皮质醇升高,均无明显内分泌异常症状;良性无功能性肿瘤99例(67.3%),其中肾上腺皮质腺瘤61例(61.6%).结果 147例均行手术治疗.腹腔镜下手术组102例,开放性手术组45例,2组肿瘤直径分别为(3.4±1.8)cm和(6.7±1.5)cm(P＜0,0001);手术并发症发生率分别为5.9%(6/102)和15.6%(7/45)(P=0.1103).腹腔镜中转开放手术5例(4.9%),主要见于黏连严重的恶性肿瘤或肿瘤直径＞6 cm者.结论 肾上腺偶发瘤常见类型为无功能肾上腺腺瘤、嗜铬细胞瘤、肾上腺皮质癌.可疑恶性、有内分泌功能、直径≥3 cm的肾上腺偶发瘤应积极手术治疗.腹腔镜手术创伤小、恢复快,为手术首选;肿瘤直径＞6 cm、黏连严重、可疑恶性者应以开放性手术为主.     

腹腔镜手术切除巨大肾上腺肿瘤的临床探讨

目的：探讨腹腔镜手术切除巨大（直径≥8cm）肾上腺肿瘤的可行性。方法：采用经腹途径腹腔镜切除术治疗巨大肾上腺肿瘤患者6例,左侧4例,右侧2例,肿瘤最大径8．5～12cm。结果：6例腹腔镜手术均获得成功,无中转开放手术。手术时间平均120min（90～185min）,术中出血量平均150ml（50～400m1）。术后胃肠功能恢复时间1～2天,术后2～3天拔除引流管,术后住院6～lO天。随访4～24个月,未发现异常。病理检查报告肾上腺嗜铬细胞瘤2例,神经节细胞瘤1例,神经鞘瘤1例,髓性脂肪瘤2例。结论：肿瘤大小并不是选择腹腔镜手术的决定性因素。在技术娴熟的条件下,腹腔镜治疗巨大肾上腺肿瘤是安全、可行的。     

Current indications for laparoscopic adrenalectomy in the era of minimally invasive surgery

The aim of this study was to clarify the current indications for laparoscopic adrenalectomy, reviewing both our own experience and the literature data. Since January 2000, 22 patients have undergone adrenalectomy in our department: 17 (77.3%) with the laparoscopic approach and 5 (22.7%) with the traditional one. The indications for laparoscopy were: 6 Cushing's adenomas, 4 aldosterone-producing adenomas, 4 non-functional adenomas, 2 pituitary-dependent bilateral adrenocortical hyperplasias and 1 metachronous adrenal metastasis. The conversion rate to laparotomy was 11.7%. The indications for the open approach were: tumours greater than 7 cm and previous abdominal surgery. The mean size of laparoscopic specimens was smaller than those removed by the open procedure (3.9 cm versus 6.7 cm). The mean postoperative hospital stay in the laparoscopic group was 4.9 days as compared to 10.2 days in the open group. Morbidity was encountered in 2/17 laparoscopically treated patients (11.7%) and in 2/5 patients in the open group. In our early experience, laparoscopic adrenalectomy has been the procedure of choice for removing unilateral or bilateral tumours measuring less than 7 cm in diameter. Nevertheless, apart from diameter cut-off, on the basis of evidence from the literature, an invasive carcinoma is currently considered the only absolute contraindication to laparoscopy.     

Adrenal scintigraphy of well-differentiated (functioning) adrenocortical carcinomas: potential surgical pitfalls.

Adrenal scintigraphy with 131I-6 beta-iodomethylnorcholesterol (NP-59) has been widely used to evaluate adrenal cortical tumors during the past 20 years. Unilateral visualization on the side of an adrenal tumor has been considered diagnostic of a benign adrenocortical adenoma in the patient with Cushing's syndrome. Bilateral nonvisualization of the adrenal glands in the presence of Cushing's syndrome is considered diagnostic of adrenocortical carcinoma (ACC). ACCs characteristically are unable to incorporate enough NP-59 to be visualized on NP-59 adrenal scintigraphy. Two patients with well-differentiated cortisol-secreting ACCs, in which the primary tumor or subsequent metastases demonstrated intense uptake (visualization) on NP-59 scans are reported here. As a result of these findings on NP-59 adrenal scintigraphy, the lesions were initially misinterpreted to represent benign disease. In each patient the operative approach selected, based on the interpretation of the NP-59 scan, was inappropriate for the management of the respective adrenal neoplasm or its metastasis. A review of the literature reveals 16 other cases of either ACC or their metastases that were visualized with adrenal scintigraphy. Ninety percent of these cases were associated with adrenocortical hormone hypersecretion. It is concluded that in the presence of Cushing's syndrome or another adrenocortical hormone excess state, unilateral visualization of an adrenal tumor on NP-59 scintigraphy cannot be interpreted to represent uniformly benign disease.     

后腹腔镜巨大肾上腺肿瘤切除12例临床分析

目的：探讨后腹腔镜手术治疗巨大肾上腺肿瘤的体会.根据肿瘤大小、性质、血供情况、毗邻关系等,针对性制定个性化切除方案,确保手术安会、高效.方法：2002年3月～2010年2月.使用腹腔镜治疗10～19cm肾上腺肿瘤12例,男7例,女5例,左侧8例,右侧4例.年龄28～65岁,平均39岁.其中嗜铬细胞瘤2例,肾上腺皮质腺瘤4例,肾上腺髓样脂肪瘤5例,肾上腺转移性肿瘤1例.结果：本组12例,手术时间110～170min,平均130 min.术中出血60 ml～300 ml,平均（120±20）ml,4例输血300～800 ml.术后住院时间6～10天,无严重并发症发生.结论：后腹腔镜是治疗肾上腺肿瘤的金标准,巨大肾上腺肿瘤的切除难度较大.术前充分准备,制定个性化的围手术期治疗方案,把握操作技巧,缩短手术时间是确保手术顺利实施及患者安全的要素.     

Laparoscopic partial adrenalectomy for recurrent pheochromocytoma after open partial adrenalectomy in von Hippel-Lindau disease

BACKGROUND AND PURPOSE: Unilateral total adrenalectomy is the standard treatment for benign unilateral adrenal tumors. Partial adrenalectomy has to be considered for bilateral adrenal tumors. Recently, our group has reported the feasibility of unilateral and bilateral partial adrenalectomy by means of laparoscopy. Now, we present a case of recurrent pheochromocytoma after open bilateral adrenalectomy and demonstrate that laparoscopic cortex-sparing surgery is feasible for a recurrence after open surgery. Case Report: At the age of 10 years, a boy was found to have bilateral adrenal pheochromocytoma and was treated by open bilateral partial adrenalectomy. Eight years later, the patient presented with palpitation, sweating, and severe hypertension. Investigations biochemically and radiologically demonstrated functional recurrent pheochromocytoma in the left adrenal gland. Genetic studies confirmed mutation of the von Hippel-Lindau (VHL) gene. The patient was prepared for surgery preoperatively by phenoxybenzamine and metropolol. The surgery was performed as planned, and the normal adrenal tissue was spared. The patient had an uneventful postoperative course. His blood pressure was normal on the day of discharge. CONCLUSIONS: In a specialized center with experienced laparoscopic surgeons, laparoscopic partial adrenalectomy for recurrent pheochromocytoma is feasible even after previous open surgery on the ipsilateral adrenal gland. Adrenal-sparing surgery is indicated in hereditary syndromes such as VHL and MEN II to avoid the problems of life-long steroid replacement. Recurrences have to be expected, but further surgery may be less difficult by the previous laparoscopic approach.     

Laparoscopic posterior adrenalectomy: technical considerations

HYPOTHESIS: Although laparoscopic posterior adrenalectomy (LPA) offers a more direct access to the adrenal gland, it is not as popular as laparoscopic transabdominal adrenalectomy, and the worldwide experience has been limited. We hypothesized that LPA is a safe and efficacious procedure that could best serve certain patients with adrenal tumors. DESIGN: Case series of patients undergoing laparoscopic adrenalectomy in a single institution. SETTING: University teaching hospital. PATIENTS: Medical records of 31 patients with 33 tumors who underwent LPA were reviewed. Indications for operation included hormone secretion in 23 patients (74%), suspected or known malignant neoplasms in 7 patients (23%), and local symptoms in 1 patient (3%). INTERVENTION: The LPAs were performed with the patients in prone position. Preoperative ultrasonography localized the adrenal tumor and kidney to guide balloon trocar placement for the creation of a working retroperitoneal space. The LPAs were performed with three 10-mm trocars using laparoscopic ultrasound to localize the tumor and the harmonic scalpel to perform the dissection. MAIN OUTCOME MEASURES: Demographic data, type and size of tumor, operative time, blood loss, intraoperative and postoperative complications, and hospital stay were analyzed. RESULTS: All operations were successfully completed without conversion. Excluding the bilateral cases, the mean +/- SD operative time was 176 +/- 104 minutes. Estimated blood loss averaged 32 mL (range, 10-200 mL). There were no intraoperative complications. The mean +/- SD tumor size was 3.2 +/- 1.8 cm (range, 0.8-7.0 cm). Pathological evaluation revealed benign tumors in 25 patients (81%) and malignant tumors in 6 patients. The average hospital stay was 1.4 days (range, 1-3 days). There were no deaths. CONCLUSIONS: Although technically more demanding, LPA should be considered in patients with tumors less than 6 cm, bilateral tumors, or extensive previous abdominal surgery.     

后腹腔镜手术切除肾上腺肿瘤(附80例报告)

目的:探讨应用后腹腔镜术切除肾上腺肿瘤的疗效和安全性.方法:应用后腹腔镜手术切除肾上腺肿瘤80例:功能性肾上腺肿瘤56例,非功能性肾上腺肿瘤24例.用自制的气囊扩张后腹腔,腰部3个Trocar穿刺入路,超声刀将肿瘤切除,用自制的标本袋取出肿瘤.结果:80例中73例完全由腹腔镜手术完成,7例因术中粘连、出血等改开放手术.术中出血量10～500 ml,平均70 ml.患者均未输血.76例随访3～48个月,平均8个月,未见肿瘤复发和转移,血电解质、儿茶酚胺、醛固酮、皮质醇等肾上腺内分泌检查均恢复正常;但12例仍有高血压.结论:应用后腹腔镜术切除肾上腺肿瘤安全、创伤小、恢复快,对肾上腺恶性肿瘤主张行开放手术.     

基于肾上腺血管解剖的后腹腔镜肾上腺切除技术的改进及临床应用

目的:基于对肾上腺血管解剖的理解,探讨后腹腔镜肾上腺切除术的新技术。方法:2013年12月至2015年5月共收治179例肾上腺肿瘤患者,其中男92例,女87例;肿瘤位于右侧88例,左侧91例;患者12~79岁,平均(47.8±9.8)岁;肿瘤直径0.8~11.5 cm,平均(2.8±1.3)cm。根据患者病情完善术前准备后均由同一术者根据以下策略行后腹腔镜肾上腺切除术:(1)腹膜后空间建立后沿腰大肌表面游离并纵行打开肾筋膜直至膈肌脚,寻及膈下动脉并结扎切断肾上腺上动脉;(2)寻及肾动脉,紧贴肾动脉及肾上极内侧缘夹角向深面游离,结扎肾上腺中、下动脉;(3)通过肾动脉及肾脏内侧缘所形成的"中央静脉三角"寻找肾上腺中央静脉并离断;(4)在肾脏、肾上腺之间游离,到达肾前融合筋膜层面,将肾上腺与肾脏重叠部分分离;(5)离断肾上腺周围相连的结缔组织,完整切除肾上腺。结果:178例手术获得成功,1例中转开放手术;手术时间12~68 min,平均(30.2±10.3)min;出血量10~110 ml,平均(20.6±12.7)ml;术后住院1.5~3.9 d,平均(2.3±0.8)d;2例术中出现腹膜损伤,术后随访期间未见肿瘤复发及转移。结论:此操作方法更加直接的处理肾上腺血供,减少了出血的几率,游离面较少,根据肾上腺解剖关系不用刻意寻找肾上腺肿瘤,操作更加省时、简单。     

Efficacy and safety of laparoscopic surgery for pheochromocytoma

OBJECTIVE: Laparoscopic surgery for primary aldosteronoma and Cushing's syndrome is well established. We report on our experiences with laparoscopic adrenalectomy for pheochromocytoma, and assess the efficacy and safety of the laparoscopic approach. METHODS: Between April 1998 and April 2003, a total of 23 patients underwent laparoscopic adrenalectomy for pheochromocytoma at Chiba University Hospital and Yokohama Rosai Hospital, Japan. We compared the surgical outcomes of these patients with those of 106 patients with adrenal tumors due to other pathologies who underwent laparoscopic adrenalectomy during the same period. RESULTS: The mean tumor size of pheochromocytoma was 4.96 cm. Mean operative time was 192.7 min, and mean estimated blood loss was 130 mL. Neither mean operative time nor mean estimated blood loss was greater for patients with pheochromocytoma. Intraoperative hypertension (systolic blood pressure > 180 mmHg) occurred in 39.1% (9/23) of patients with pheochromocytoma. During the follow-up period, there were no mortalities or recurrences of endocrinopathy. CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytoma is a safe and minimally invasive procedure.     

Laparoscopic adrenalectomy

Advances in minimally invasive surgery have made it possible to remove solid organs such as the adrenal gland laparoscopically. Several studies have shown that when applied to appropriate operative candidates, laparoscopic adrenalectomy is a safe alternative to conventional open surgery with real advantages in terms of decreasing postoperative pain and length of hospital stay and allowing earlier return to normal activity. The indications for laparoscopic adrenalectomy are essentially the same as those described for open adrenalectomy. We do not recommend laparoscopic adrenalectomy for known primary or metastatic malignant tumors of the adrenal glands, because of the risk of tumor implantation that might compromise the patient's chance for cure, nor do we recommend it for lesions larger than 6 to 8 cm where the chance of malignancy is high. The preoperative preparation, laparoscopic instruments, operative techniques, and potential complications and their treatments are described in this review. Laparoscopic adrenalectomy is becoming the preferred method of surgically treating many adrenal problems. Although conventional surgical approaches will undoubtedly be required to treat certain adrenal lesions, surgeons with an interest in treating patients with adrenal disorders must become proficient in the technique of laparoscopic adrenalectomy. This will allow them to select the most appropriate operative approach for their patients' individual problems.     

Laparoscopic adrenalectomy for phaeochromocytoma: with caution

INTRODUCTION: Laparoscopic adrenalectomy is well described and many series include patients with phaeochromocytoma. Our aim was to establish whether laparoscopic adrenalectomy for phaeochromocytoma was a safe and feasible technique at our institution. METHODS: Patients requiring adrenalectomy were entered into a prospective database that included patient details, operative data, hormone excretion, tumour size, hospital stay and complications. All operations were performed under the supervision of a single surgeon. Analysis was performed for those patients with a diagnosis of phaeochromocytoma. RESULTS: Of 60 patients having laparoscopic adrenal surgery, 18 had phaeochromocytoma as the indication. Seventeen (89%) of 19 tumours in these 18 patients were successfully removed laparoscopically. Median operative time was 180 min (range 130-300 min) and this was significantly longer compared with other adrenal pathology. The median tumour size was 6 cm which was significantly larger than other adrenal tumours. Seven (38%) patients developed complications and median postoperative inpatient stay was 5 days (range 3-8 days). CONCLUSIONS: The postoperative stay was equivalent to other laparoscopic series and laparoscopic removal was successful in 89%. The laparoscopic approach to the adrenal gland in phaeochromocytoma is safe and effective treatment.