title: Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma.
abstract: OBJECTIVE
  Laparoscopic surgery has become a standard method for adrenal treatment. Primary hyperaldosteronism is known to be frequently characterized by multiple adrenal lesions. The indication of laparoscopic partial or total adrenalectomy in patients with aldosterone producing adenoma (APA) remains controversial. We performed the 2 procedures and compared the outcomes of these 2 operations retrospectively.
  
  
  METHODS
  A total of 92 patients with primary hyperaldosteronism were laparoscopically treated at our institution from 1995 to 2004. A total of 29 patients underwent partial adrenalectomy or enucleation, while unilateral total adrenalectomy was performed in 63. A single pathologist examined the number and histopathological characteristics of APAs. Postoperative median followup was 60.3 and 29.3 months, respectively.
  
  
  RESULTS
  Laparoscopic adrenalectomies were successfully performed in each group, although the partial type had fewer ports and shorter operative time. All 63 patients with total adrenalectomy showed recovery from hypertension, suppressed plasma renin activity and high plasma aldosterone. Two of 29 patients with partial adrenalectomy or enucleation still experienced hypertension with high plasma aldosterone. Of the 63 extirpated specimens 17 adrenals (27.0%) demonstrated multiple space occupying lesions along with the main APA.
  
  
  CONCLUSIONS
  Primary hyperaldosteronism is highly associated with multiple adrenal space occupying lesions. The risk-to-benefit ratio must be carefully weighed against the potential advantage of partial adrenalectomy. We chose total laparoscopic adrenalectomy in patients with unilateral APA and primary hyperaldosteronism.
authors.affiliation: Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan. ishidoya@uro.med.tohoku.ac.jp
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ishidoya
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Sakai
authors.forename: Makoto
authors.initials: M
authors.lastname: Satoh
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Chiba
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Sato
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Arai
mesh_terms: D000236:Adenoma / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000310:Adrenal Gland Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000450:Aldosterone