title: Laparoscopic adrenalectomy for pheochromocytoma: evaluation of experience and strategy at a single institute.
abstract: OBJECTIVE
  To assess the utility, safety and feasibility of laparoscopic adrenalectomy (LA) for pheochromocytoma. We reviewed our experience, focusing on surgical outcomes compared with our historical open adrenalectomy (OA) and modifications in surgical procedures.
  
  
  METHODS
  Between 1997 and 2007, 23 patients with pheochromocytoma underwent LA at our institution. As controls, 18 patients undergoing OA were examined retrospectively. In the first cases of LA, we used an abdominal wall-lifting device with low pneumoperitoneal pressure and initial ligation of the adrenal vein. In subsequent cases, we adopted similar methods to those we perform for other benign adrenal tumours, including a 'regular' pneumoperitoneal pressure, and disconnection of the adrenal vein as the last step of tumour dissection.
  
  
  RESULTS
  Rates of hypertension crisis (systolic blood pressure (sBP) of >200 mmHg) and sudden hypotension subsequent to ligation of the adrenal vein (sBP of <80 mmHg) were 17% and 48% in the LA group, and 44% and 72% in the OA group, respectively. Instability of blood pressure was not amplified by the modifications in surgical procedures of laparoscopy. The groups were comparable for operative duration. The intraoperative blood loss among LA patients in whom adrenalectomy was completed laparoscopically was significantly less than that among OA patients, at a median (range) of 70 (10-530) mL vs 400 (10-990) mL (P < 0.001). However, four LA patients with conversion to open surgery had severe blood loss. Regarding postoperative complications and convalescence, the LA group had more favourable outcomes.
  
  
  CONCLUSIONS
  Laparoscopic removal of pheochromocytoma can be safely and feasibly accomplished by surgical approaches similar to those used for other pathological conditions of the adrenal gland. However, conversion to open surgery should be considered in cases with unexpected difficulty in dissection, invasion or adhesion.
authors.affiliation: Niigata University Graduate School of Medical and Dental Sciences, Department of Urology, Niigata, Japan. takakasa@med.niigata-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Kasahara
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nishiyama
authors.forename: Kota
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D000315:Adrenalectomy / Q000009:adverse effects / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D016022:Case-Control Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult