Laparoscopic adrenalectomy: 12-year experience in a single institution
Igor Hartmann, Vladimir Student, Zdenek Frysak, Oldrich Smakal & Michal Grepl
Introduction: Laproscopic adrenalectomy (LA) was first described in the literature in 1992 and has become the preferred method for the removal of functioning and non-functioning tumours. More than 75% of Las are performed for endocrine causes of hypertension such as Conns or Cushings syndrome and pheochromocytoma. The majority of centers (80%) perform laparoscopic transabdominal adrenalectomy. The first LA in our institution was performed in 1998 and the procedure is routinely done from 2000.
Methods: We have retrospectively evaluated the records of patients who underwent the laparoscopic adrenalectomy between 1998 and 2010 in our institution.
Results: LA was performed in 171 cases in above mentioned period for functional or non-functional adrenal mass. Every patient underwent endocrinologic and radiographic evaluation, from 2007 adrenal venous sampling in functional tumours. As contraindication we considered carcinoma suspicion and tumours larger than 12 cm. The transperitoneal approach with 4 or 5 trocars was used in all of the cases. The average size of the specimen was 4.5 cm (1.512 cm). The partial adrenalectomy was performed in seven cases for adenoma of solitary gland or bilateral aldosterone producing adenoma. The average operating time was 62 min (38200 min.). In 15 cases there was a blood loss more than 100 ml (100600 ml). We have experienced three serious signallingsh complications pancreas lesion in two cases and lesion of the colon in one case. We had to convert to open surgery in six cases. We did not experience severe postoperative complications.
Conclusions: The laparoscopic adrenalectomy is a safe procedure with low occurrence of complications. LA is ideal for all benign tumours <12 cm. The transperitoneal approach offers large operative field with good orientation.