Laparoscopic adrenalectomy: the New York-Presbyterian Hospital experience.
OBJECTIVE
Laparoscopic adrenalectomy has become the standard technique for the surgical removal of the adrenal gland. The advantages of the laparoscopic approach include shorter length of stay (LOS), a decrease in postoperative pain, faster return to preoperative activity level, improved cosmesis, and reduced complications. We report our experience with laparoscopic adrenalectomy via a lateral transperitoneal approach.


METHODS
Between September 1993 and April 2001, we performed 100 lateral transperitoneal adrenalectomies in 91 patients. In 82 cases, the adrenalectomy was unilateral and in the other 9, it was bilateral. A total of 59 left-sided lesions and 41 right-sided lesions were removed. The indications for surgery were Cushing's syndrome (24), aldosteronoma (34), pheochromocytoma (17), nonfunctioning adenoma (13), Carney's syndrome (1), and a metastasis from colon cancer (1)


RESULTS
The overall success rate was 98%. Complications occurred in the two patients who required open conversion. In addition, three patients suffered pneumothoraces because of direct iatrogenic injury to the diaphragm during laparoscopic dissection. One additional patient suffered a splenic laceration. Operative time, blood loss, and intraoperative complications were similar in the laparoscopic and open surgery control group (N = 32).


CONCLUSIONS
Laparoscopic adrenalectomy is technically feasible and reproducible. The lateral transperitoneal technique offers distinct advantages to the laparoscopist, including better visibility of familiar anatomic landmarks, easy access to other organ systems, the use of gravity to retract the spleen and liver, and a wide exposure, which allows removal of large adrenal lesions.
Del Pizzo
Joseph J
JJ
Department of Urology, the New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York 10021, USA. jod2009@med.cornell.edu
Shichman
Steven J
SJ
Sosa
R Ernest
RE
D000306:Adrenal Cortex Neoplasms / Q000556:secondary / Q000601:surgery; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D018246:Adrenocortical Adenoma / Q000601:surgery; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000473:pathology; D003289:Convalescence; D003480:Cushing Syndrome / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007902:Length of Stay; D009518:New York; D010529:Peritoneal Cavity / Q000601:surgery; D010673:Pheochromocytoma / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome