Laparoscopic adrenalectomy: history, indications, and current techniques for a minimally invasive approach to adrenal pathology.

Refinements in the field of laparoscopic general surgery have not only made the performance of laparoscopic adrenalectomy technically feasible, but have even made it the preferred method of treatment for benign adrenal pathology. The advantage of the laparoscopic approach lies in the fact that it allows precise, hemostatic dissection of the gland in a minimally invasive fashion. We present here the results of published reports of laparoscopic adrenalectomy as well as our own experience, and compare these data with reports from open procedures. The indications for the surgical removal of the adrenal gland have not changed, and include: endocrine active tumors, suspected malignancies, adrenal masses larger than 6 cm, and masses that have been followed and observed to be growing. Laparoscopic adrenalectomy can be accomplished with one of three approaches: anterior, lateral and posterior. Each approach has advantages and limitations, and our preferences are discussed. The general techniques are briefly described. The findings from many studies show that the blood loss, operative complications, hospital stay and recovery period are significantly reduced with the laparoscopic approach. Based on our experience with 19 laparoscopic adrenalectomies and a review of the current literature, laparoscopic adrenalectomy can be fairly described as the current "gold standard" treatment for benign adrenal disease. Patients benefit from short hospital stays, lower morbidity, and a more rapid recovery. The only question that remains is the appropriateness of laparoscopic adrenalectomy in the treatment of adrenal malignancy, and the answer to this will depend on the results of long-term outcome studies.