Laparoscopic posterior adrenalectomy: technical considerations.
OBJECTIVE
Although laparoscopic posterior adrenalectomy (LPA) offers a more direct access to the adrenal gland, it is not as popular as laparoscopic transabdominal adrenalectomy, and the worldwide experience has been limited. We hypothesized that LPA is a safe and efficacious procedure that could best serve certain patients with adrenal tumors.


METHODS
Case series of patients undergoing laparoscopic adrenalectomy in a single institution.


METHODS
University teaching hospital.


METHODS
Medical records of 31 patients with 33 tumors who underwent LPA were reviewed. Indications for operation included hormone secretion in 23 patients (74%), suspected or known malignant neoplasms in 7 patients (23%), and local symptoms in 1 patient (3%).


METHODS
The LPAs were performed with the patients in prone position. Preoperative ultrasonography localized the adrenal tumor and kidney to guide balloon trocar placement for the creation of a working retroperitoneal space. The LPAs were performed with three 10-mm trocars using laparoscopic ultrasound to localize the tumor and the harmonic scalpel to perform the dissection.


METHODS
Demographic data, type and size of tumor, operative time, blood loss, intraoperative and postoperative complications, and hospital stay were analyzed.


RESULTS
All operations were successfully completed without conversion. Excluding the bilateral cases, the mean +/- SD operative time was 176 +/- 104 minutes. Estimated blood loss averaged 32 mL (range, 10-200 mL). There were no intraoperative complications. The mean +/- SD tumor size was 3.2 +/- 1.8 cm (range, 0.8-7.0 cm). Pathological evaluation revealed benign tumors in 25 patients (81%) and malignant tumors in 6 patients. The average hospital stay was 1.4 days (range, 1-3 days). There were no deaths.


CONCLUSIONS
Although technically more demanding, LPA should be considered in patients with tumors less than 6 cm, bilateral tumors, or extensive previous abdominal surgery.
Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA. sipersa@ccf.org.
A E
AE
Siperstein
E
E
Berber
K L
KL
Engle
Q Y
QY
Duh
O H
OH
Clark
D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007431:Intraoperative Complications; D007668:Kidney / Q000000981:diagnostic imaging; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016684:Prone Position; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D013997:Time Factors; D014464:Ultrasonic Therapy / Q000295:instrumentation; D018084:Ultrasonography, Interventional