ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2004) 7 P93

A new operation for adrenal pathology: laparoscopically-assisted mini-adrenalectomy

AT Abdel-Rahamn1, CA Laban1, GM Besser2, JP Monson2, AB Grossman2, MO Savage3, PJ Jenkins2, WM Drake2, SL Chew2, M Ashby4 & R Carpenter1

1Breast and Endocrine Surgery,Bart's and The London, Queen Mary School of Medicine and Dentistry, London,UK; 2Endocrinology Department, Bart's and The London, Queen Mary School of Medicine and Dentistry, London,UK; 3Paediatric Endocrinology, Bart's and The London, Queen Mary School of Medicine and Dentistry, London, UK; 4Department of Anaesthetics, Bart's and the London, Queen Mary School of Medicine and Dentistry, London, UK.

Background: Standard trans-peritoneal adrenalectomy has disadvantages, which are minimised by a less invasive procedure, but laparoscopic adrenalectomy is time consuming and unsuitable for large or malignant tumours.

Aims: To evaluate our experience of all laparoscopically assisted mini-adrenalectomy using a subcostal incision 10 cm or less, since July 1999.

Methods: Data were collected on wound size, operative time, blood loss (fall of postoperative haemoglobin g/dl), time to resume full diet, intra and post-operative complications, post-operative hospital stay, post-operative intravenous analgesia infusion requirement, tumour size and histo-pathological diagnosis.

Results: 44 underwent mini-adrenalectomy (additionally there were 37 standard open adrenalectomies during this time). There were 11 bilateral operations, 9 for Cushing's disease and 2 children had congenital hyperplasia. Median age was 48.7 years (range 11-77) with a female: male ratio of 36: 8. Median tumour size was 4.5 cm (range 0.5-12); median wound size 7 cm (range 4.5-10); median operative time was 120 minutes (range 65-220). There was no correlation between operative time and wound size. Median post-operative fall in haemoglobin was 1.4 g/dl (range 0-2.6); median postoperative intravenous analgesia was 2 days, median time to resume a fluid diet was one day and 3 days for solids. Post-operative hospital stay was a median of 4 days (range 3-7). There were 2 major complications; an IVC tear and splenic trauma. There was no mortality and to date no recurrence of disease. Histo-pathological diagnosis revealed that 22 (40 %) showed hyperplasia, 18 (32.7 %) pheochromocytoma, 12 (21.8 %) adenoma, 2 (3.6 %) carcinoma and one adrenal cyst (1.9 %).

Conclusion: We have established a trans-peritoneal laparoscopically assisted minimally invasive technique for adrenalectomy, with comparable outcomes to the Laparoscopic approach but with a shorter operating time. This technique is safe, extends the range of minimally invasive adrenalectomy and lends itself in particular to bilateral surgery.

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