Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach.
BACKGROUND
The present study attempts to evaluate the perioperative results of the anterior approached laparoscopic adrenalectomy (LA) in a large cohort of patients, and report the advantages and disadvantages of this route.


METHODS
204 patients, 125 female and 79 male with a mean age 52.8 years (range, 19-75 years), underwent LA by the anterior transperitoneal approach from 1994 to 2005 in our institution. There were 100 right and 114 left LAs. Ten patients underwent bilateral LA. Associated surgical procedures were performed in 17 cases. During the same period 47 LAs had been performed by different approaches (flank and submesocolic).


RESULTS
Mean operative time was 80 minutes for right (40-150), 109 minutes for left (64-300) and 194 minutes for bilateral adrenalectomy. Intraoperative major complications were observed in six patients. Mortality occurred in one diabetic patient who was converted to open surgery because of a colonic perforation and subsequently developed a Candida sepsis in the postoperative course. The mean size of lesion removed was 6.2 cm (1.5-12 cm). Oral intake started within 24 hours and the mean hospital stay was 2.5 days (1-8 days). Histology results were as follows: nonsecreting adenoma 65, Cushing's adenoma 58, Conn's adenoma 53, pheochromocytoma 24, metastases 9, myelolipoma 3, adrenogenital syndrome 1, carcinoma 1.


CONCLUSIONS
LA by anterior transperitoneal approach is safe and effective in our experience, despite the inherent limitation that this was not a prospective randomized study. The main advantage of this route is early ligature of the adrenal vein on both sides, enabling the performance of associated surgical procedures and bilateral adrenalectomy.
Lezoche
Emanuele
E
Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Ancona, Italy.
Guerrieri
Mario
M
Crosta
Francesca
F
Paganini
Alessandro
A
D'Ambrosio
Giancarlo
G
Lezoche
Giovanni
G
Campagnacci
Roberto
R
D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
World J Surg. 2002 Aug;26(8):1043-7
12045859
Surg Endosc. 2003 Dec;17 (12 ):1905-9
14577024
Surg Endosc. 2003 Feb;17(2):264-7
12399875
Br J Surg. 1997 May;84(5):679-82
9171764
Urology. 2002 Nov;60(5):801-5
12429302
Surg Endosc. 2002 Jan;16(1):100-2
11961615
Surg Endosc. 2005 Mar;19(3):379-85
15624053
Surg Endosc. 2000 Oct;14(10):920-5
11080404
N Engl J Med. 1992 Oct 1;327(14):1033
1387700
Surg Endosc. 2002 Jan;16(1):96-9
11961614
Surg Endosc. 2005 Jul;19(7):977-80
15920687
World J Urol. 1999 Feb;17(1):48-53
10096151
J Urol. 2001 Aug;166(2):437-43
11458043
Br J Surg. 2004 Oct;91(10):1259-74
15376201
Am J Surg. 2005 Apr;189(4):405-11
15820450
Surg Endosc. 2004 Apr;18(4):621-5
15026894
Ann Surg Oncol. 2002 Jun;9(5):480-5
12052760