title: Laparoscopic adrenalectomy: the retroperitoneal approach.
abstract: OBJECTIVE
  Retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is an interesting approach to urological surgery. We report our initial experience with retroperitoneal laparoscopic adrenalectomy.
  
  
  METHODS
  Between January 1995 and April 1997, 23 adrenalectomies were performed by retroperitoneal laparoscopy in 10 men and 12 women. The patients were placed in the lateral decubitus position and 5 trocars were used. The retroperitoneal working space was created by digital dissection and was completed by insufflation without balloon dissection. The surgical indications were Conn's adenoma in 12 cases, Cushing's adenoma in 4, bilateral adrenal hyperplasia (Cushing's disease) in 1 (treated in a single procedure), a nonfunctioning adenoma in 2, pheochromocytoma in 2 and adrenal metastasis in 1.
  
  
  RESULTS
  We removed 7 right and 16 left adrenal glands in an average operating time of 97 minutes (range 45 to 160). Average tumor size was 26 mm. (range 10 to 40). Average hospital stay was 3.3 days (range 1 to 10). Blood loss was minimal. Postoperative analgesic requirements were moderate. Conversion to open surgery was not necessary. The morbidity rate was low, with 1 postoperative hematoma and 1 case of persistent fever (greater than 38.5C).
  
  
  CONCLUSIONS
  Retroperitoneal adrenalectomy is a reliable and effective technique. At our institution retroperitoneal laparoscopy is now the standard adrenal surgery procedure for tumors less than 5 cm.
authors.affiliation: Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
authors.forename: D
authors.initials: D
authors.lastname: Gasman
authors.forename: S
authors.initials: S
authors.lastname: Droupy
authors.forename: A
authors.initials: A
authors.lastname: Koutani
authors.forename: L
authors.initials: L
authors.lastname: Salomon
authors.forename: P
authors.initials: P
authors.lastname: Antiphon
authors.forename: J
authors.initials: J
authors.lastname: Chassagnon
authors.forename: D K
authors.initials: DK
authors.lastname: Chopin
authors.forename: C C
authors.initials: CC
authors.lastname: Abbou
mesh_terms: D000236:Adenoma / Q000601:surgery; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D003480:Cushing Syndrome / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D016896:Treatment Outcome