Laparoscopic transperitoneal adrenalectomy using the LigaSure vessel sealing system.
BACKGROUND
Laparoscopic adrenalectomy is being performed with increasing frequency in the surgical treatment of adrenal tumors. Among laparoscopic approaches to the adrenal glands, the transperitoneal access is preferred. Along with advances in technology, different energy systems have been utilized. Laparoscopic adrenalectomy has become easier with the use of the LigaSure vessel sealing system (Valleylab, Boulder, Colorado).


METHODS
Between January 2002 and August 2004, 23 laparoscopic transperitoneal adrenalectomies were performed in 22 patients using the LigaSure vessel sealing system: 16 of the patients were female, 6 were male and the mean age was 44 years (range, 17-70 years). Indications for surgery were non-functioning adenoma (n = 10), pheochromocytoma (n = 4), Cushing's syndrome (n = 5), Conn's syndrome (n = 2), and lymphoma (n = 1). The mean diameter of lesions was 4 cm (range, 1-7 cm). The distribution was 12 left, 9 right, and 1 bilateral adrenalectomies.


RESULTS
The mean operative time for unilateral adrenalectomies was 57 minutes (range, 30-75 minutes). The operative time for the patient with Cushing's disease in whom a bilateral adrenalectomy was performed was 180 minutes. All operations were completed laparoscopically. A nonsteroidal anti-inflammatory drug (Lornoxicam) was sufficient for postoperative analgesia. Oral feeding was started 6 hours postoperatively. When used, drains were removed on postoperative day 1. The mean postoperative hospital stay was 1.5 days (range, 1-3 days). Wound infections developed in two patients with Cushing's syndrome. There was no mortality. Histopathologic examination of specimens revealed a cortex adenoma in 16 cases (10 of which was nonfunctional), a pheochromocytoma in 4 cases, a bilateral cortical hyperplasia in 1 case, and a lymphoma in 1 case.


CONCLUSIONS
Laparoscopic adrenalectomy is an established method in the treatment of adrenal masses. Laparoscopic adrenalectomy as well as other laparoscopic procedures has become easier with the introduction of new energy systems. Vascular control and dissection of the gland by Liga- Sure is feasible. It makes the procedure easier and eventually shortens the operation time.
Yavuz
Nihat
N
Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey. nyavuz@istanbul.edu.tr
D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008026:Ligation / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome