title: Perioperative results of 214 laparoscopic adrenalectomies by anterior transperitoneal approach.
abstract: 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.
authors: Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Ancona, Italy.
authors: Emanuele
authors: E
authors: Lezoche
authors: Mario
authors: M
authors: Guerrieri
authors: Francesca
authors: F
authors: Crosta
authors: Alessandro
authors: A
authors: Paganini
authors: Giancarlo
authors: G
authors: D'Ambrosio
authors: Giovanni
authors: G
authors: Lezoche
authors: Roberto
authors: R
authors: Campagnacci
mesh_terms: 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
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