Laparoscopic adrenalectomy. Comparison of the lateral and posterior approaches.
OBJECTIVE
To compare the lateral transabdominal and posterior retroperitoneal laparoscopic methods for performing adrenalectomy.


METHODS
Nonrandomized.


METHODS
Hospitals affiliated with the University of California, San Francisco.


METHODS
Thirty-six patients (15 men and 21 women), aged 5 to 78 years (mean age, 49 years), were treated for the following conditions: aldosteronoma, 18 patients; pheochromocytoma, 4 patients; Cushing syndrome, 6 patients; androgen-secreting tumor, 1 patient; nonfunctioning adenoma, 3 patients; adrenal hemorrhage, 1 patient; metastatic neoplasm, 2 patients; and myelolipoma, 1 patient.


METHODS
Twenty-three lateral and 14 posterior laparoscopic adrenalectomies.


METHODS
Success rate, operating time, complications, and length of hospital stay.


RESULTS
The tumors, which ranged in size from 1 to 13 cm (mean, 4.2 cm; median, 2.5 cm), were all successfully resected laparoscopically. All 8 tumors larger than 6 cm were resected by the lateral approach. One critically ill patient died. No patient required blood transfusions or conversion to laparotomy. Mean operating time was 3.8 hours vs 3.4 hours (median, 3.5 hours vs 3 hours) and mean hospital stay was 2.2 days vs 1.5 days (median, 2 days vs 1 day) for the lateral and posterior approaches, respectively. All patients without concomitant procedures were ready to be discharged within 48 hours.


CONCLUSIONS
Both approaches were effective and safe. We prefer the lateral approach for tumors larger than 6 cm and the posterior approach for bilateral tumors.
Duh
Q Y
QY
Department of Surgery, University of California, USA.
Siperstein
A E
AE
Clark
O H
OH
Schecter
W P
WP
Horn
J K
JK
Harrison
M R
MR
Hunt
T K
TK
Way
L W
LW
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome