Laparoscopic partial adrenalectomy for aldosterone-producing adenomas with needlescopic instruments.
BACKGROUND
Laparoscopic total adrenalectomy is the treatment of choice for aldosterone-producing adenomas (APAs). There have not been many reports of laparoscopic partial adrenalectomy, although this procedure offers benefits to patients with suspected bilateral APAs or an APA in a solitary adrenal gland. We describe the feasibility of a novel technique of laparoscopic partial adrenalectomy for APA solely using 2-mm working instruments and a 5 to 10-mm telescope.


METHODS
Six unilateral and two bilateral partial adrenalectomies were performed laparoscopically. Only one umbilical 12-mm port for the telescope and two (for left adenomas) or three (for right adenomas) subcostal 2-mm working ports were used. Hemostasis and transection of adrenal tissues were performed using a 2-mm mini-bipolar coagulator and 2-mm scissors.


RESULTS
All laparoscopic operations were successfully performed using only 2-mm working instruments and a 5 or 10-mm 30 degree telescope with no intraoperative or postoperative complications. Blood loss was minimal, and the operative times were comparable to those of previous reports. All patients had low pain scores, required minimal amounts of narcotics postoperatively, and reported excellent cosmetic results for the wounds. The pathologic examinations confirmed complete excision of all adenomas with intact capsules. The plasma aldosterone concentrations and renin activities returned to normal ranges postoperatively in all patients. At a mean follow-up of 25 months (range 13 to 48), 7 (87.5%) were cured of their hypertension and 1 had the hypertensive medications significantly reduced.


CONCLUSIONS
Laparoscopic partial adrenalectomy for APAs using 2-mm working instruments and a 5 to 10-mm telescope is a safe and effective treatment alternative.
Liao
Chun-Hou
CH
Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chueh
Shih-Chieh
SC
Wu
Kwan-Dun
KD
Hsieh
Ming-Hsueh
MH
Chen
Jun
J
D000236:Adenoma / Q000378:metabolism* / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009339:Needles
D000450:Aldosterone