Laparoscopic adrenalectomy: the preferred choice? A comparison to open adrenalectomy.
OBJECTIVE
We compare the effectiveness and efficiency of laparoscopic adrenalectomy to open surgical management of adrenal disorders.


METHODS
A retrospective comparison was undertaken of 21 patients who underwent transperitoneal laparoscopic adrenalectomy between April 1996 and May 1997 with 17 patients who underwent open adrenalectomy between October 1994 and January 1996. Any patient suspected of having primary adrenal carcinoma and/or an adrenal lesion larger than 6 cm. was excluded from the study.


RESULTS
Patient demographics were matched well. Mean laparoscopic surgical time was 79 minutes longer than for open surgery. After overcoming the learning curve, the surgical time decreased by 59 minutes in the last 10 laparoscopic adrenalectomies. All laparoscopic intraoperative complications were managed without the need for open surgical conversion. Postoperative characteristics demonstrated significant benefits in the laparoscopic group (p=0.001) with respect to days to return to full diet (1.7 versus 4.6), analgesic pain requirements and days of hospitalization (2.7 versus 6.2).


CONCLUSIONS
Laparoscopic adrenalectomy offers significant postoperative benefits to patients with benign adrenal disease requiring surgical intervention. The surgical time is longer than that for open adrenalectomy but there was an encouraging reduction in time after overcoming the laparoscopic learning curve. Laparoscopic adrenalectomy is an excellent choice for tumors smaller than 6 cm. Its role for larger lesions and/or primary adrenal carcinoma is currently under investigation.
Department of Urology, The Cleveland Clinic Foundation, Ohio, USA.
H N
HN
Winfield
B D
BD
Hamilton
E L
EL
Bravo
A C
AC
Novick
D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D004032:Diet; D004435:Eating; D005260:Female; D006760:Hospitalization; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D010537:Peritoneum / Q000601:surgery; D010673:Pheochromocytoma / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors
D000700:Analgesics