Lateral transperitoneal laparoscopic adrenalectomy |
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Authors: | Steven J Shichman C D Anthony Herndon R Ernest Sosa Giles F Whalen Dougald C MacGillivray Carl D Malchoff E Darracott Vaughan |
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Institution: | (1) Connecticut Surgical Group, P.C., Division of Urology, 85 Seymour Street, Suite 416, Hartford, CT 06106, USA, US;(2) Department of Surgery, University of Connecticut, Farmington, Connecticut, USA, US;(3) Department of Urology, Cornell University Medical Center, New York, USA, US |
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Abstract: | 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. |
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