The case for laparoscopic adrenalectomy.
OBJECTIVE
The current status of laparoscopic adrenal surgery was assessed.


METHODS
A current MEDLINE search revealed 308 articles pertaining to laparoscopic surgery of the adrenal gland. Based on this literature review laparoscopic surgical anatomy, current indications and contraindications, and laparoscopic techniques were identified. The role of laparoscopic surgery for various adrenal disorders, including aldosteroma, pheochromocytoma, Cushing's syndrome, incidentaloma and adrenal cancer, were evaluated. Studies specifically comparing open versus laparoscopic adrenalectomy and the financial implications of laparoscopy were evaluated. Furthermore, newer advances in the minimally invasive management of surgical adrenal disease were identified.


RESULTS
Available data from multiple institutions imply that laparoscopic adrenal surgery is safe and efficacious for aldosteroma, pheochromocytoma, Cushing's disease and incidentaloma. Compared to open surgery laparoscopy provides equally effective treatment, while minimizing patient morbidity. Laparoscopic adrenalectomy is financially superior to open adrenalectomy. For adrenal cancer open surgery currently remains the treatment of choice.


CONCLUSIONS
In the majority of patients with surgical adrenal disease except those with adrenal cancer laparoscopy may now be considered an established treatment modality.
Gill
I S
IS
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
D000310:Adrenal Gland Neoplasms / Q000556:secondary / Q000601:surgery; D000315:Adrenalectomy / Q000191:economics / Q000379:methods*; D003480:Cushing Syndrome / Q000601:surgery; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery; D010535:Laparoscopy; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery