Laparoscopic adrenalectomy: the optimal surgical approach.
OBJECTIVE
Laparoscopic adrenalectomy has emerged as the treatment of choice for most adrenal surgical disorders. We describe our experience with 176 laparoscopic operations.


METHODS
The patients were treated for hyperaldosteronism (N = 62), pheochromocytoma (N = 43), "incidentaloma" (N = 21), Cushing's syndrome (N = 20), suspected adrenal metastasis (N = 16), Cushing's disease (N = 8), adrenal hemorrhage (N = 3), or virilizing tumor (N = 1). In 154 of the 176 laparoscopic operations, a lateral transabdominal approach (15 bilateral, 76 left, and 63 right) was used. In the remaining 22, a posterior laparoscopic approach (3 bilateral, 10 left, and 9 right) was used.


RESULTS
The average total operating time for unilateral laparoscopic adrenalectomy was 2.8 hours, and for bilateral adrenalectomy, it was 5.2 hours. The mean tumor size was 4.6 cm (range 1-15 cm). There was no significant difference in operating time according to the tumor size. The average length of hospitalization was 1.7 days (range 1-9 days). The perioperative complication rate was 5.1%. There were no conversions to an open procedure. The operating time, length of hospitalization, and perioperative complication rate were stable over the period. Although we used the posterior laparoscopic approach only for smaller tumors (<6 cm), we found no differences in patient outcome between the lateral and posterior laparoscopic approaches.


CONCLUSIONS
For almost all adrenal surgical disorders, an initial laparoscopic approach is optimal. It is safe and is associated with the best patient outcome.
Kebebew
E
E
Department of Surgery, University of California-San Francisco, USA.
Siperstein
A E
AE
Duh
Q Y
QY
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome