Laparoscopic adrenalectomy: the new standard?

PRINCIPLES

Since 1994 we have been removing most non-malignant classified pathologies of the adrenal gland laparoscopically. Does this minimal invasive procedure involve advantages over the conventional approach?

METHODS

Retrospective analysis of 22 all-consecutive laparoscopic adrenalectomies in 21 patients (10 women, 11 men, age 26-70 years, mean 43 years, 11 right, 9 left, one bilateral in MEN IIa syndrome). These procedures were performed between 1994 and 2001 transperitoneally in the lateral decubitus position, recently by use of the Ultracision device and once with a handport. These results are compared with 20 consecutive open transperitoneal unilateral adrenalectomies with similar pathologies (13 women, 7 men, age 28-77 years, median 51.5 years, 8 right, 12 left) carried out between 1988 and 1993.

RESULTS

The mean operating times were 150 and 115 minutes with the laparoscopic and the open procedure respectively (p <0.011). On the other hand, mean hospital stay (6 versus 15 days, p <0.00001), intraoperative blood loss (200 versus 300 ml, p <0.04) and postoperative need for analgesics were significantly shorter or lower. Two out of the first five laparoscopic operations had to be converted into open adrenalectomy due to intraabdominal adhesions and a diaphragmatic injury with pneumothorax. In both groups three complications occurred (14% and 15%).

CONCLUSION

Laparoscopic adrenalectomy is a safe, effective and useful procedure involving a shorter hospital stay, lower intraoperative blood loss and a lower postoperative analgesics requirement compared with the open approach. The laparoscopic approach is the procedure of choice for all benign adrenal pathologies.