[Laparoscopic adrenalectomy--experiences with transperitoneal approach].
BACKGROUND
We report our results of laparoscopic anterior transperitoneal adrenalectomy.


METHODS
Between 4/1996 to 05/2001, a laparoscopic adrenalectomy was performed in 34 patients (median age 48 years). The adrenalectomy was performed transperitoneally (31 unilateral; 3 bilateral). The adrenaline level was measured in 7 patients with a pheochromocytoma.


RESULTS
All tumors (mean size 3.5 cm; 0.4 to 8.0 cm) could be extirpated by laparoscopy. 9 pheochromocytomas; 9 cortisol producing tumors (one patient with a Carney's syndrome); 7 Conn's adenomas and 9 incidentalomas constituted these tumors. In the first third of the observation period, the surgery lasted 176 (95-270) minutes, in the last third 82 (50-130) minutes (p < 0,01). We postoperatively observed the following complications: one abdominal wall hematoma at a port-site and one edematous pancreatitis after alteration of the pancreatic tail. The adrenaline level continually rose from the beginning of surgery to the ligature of the suprarenal vein.


CONCLUSIONS
Transperitoneal adrenalectomy in benign tumors (< 8 cm) is our method of choice. The resulting learning curve allowed the performance of adrenalectomy within an acceptable operative time and without significant blood loss. The transperitoneal technique is safe and well reproducible. The cosmetical results are convincing. We recommend an early ligature of the suprarenal vein in a pheochromocytoma.
Pross
M
M
Klinik für Chirurgie, Otto-von-Guericke-Universität Madgeburg, Madgeburg.
Manger
T
T
Heres
F
F
Klose
S
S
Lehnert
H
H
Ridwelski
K
K
Wolff
S
S
Mantke
R
R
Marusch
F
F
Lippert
H
H
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D018246:Adrenocortical Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D009384:Paraneoplastic Endocrine Syndromes / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery; D010673:Pheochromocytoma / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology