title: Clinical role of gasless laparoscopic adrenalectomy.
abstract: BACKGROUND
  Several studies have demonstrated that the pneumoperitoneum (PNP) may have several hemodynamic, metabolic, neurologic, and humoral effects; in a limited number of patients, these effects represent a contraindication to the use of the PNP in the presence of glaucoma, cardiovascular insufficiency, advanced chronic obstructive bronchitis, and neurologic disease.
  
  
  METHODS
  Between May 2002 and July 2008, we performed 9 laparoscopic gasless adrenalectomies in 8 patients (5 male and 3 female): 4 left, 3 right, and 1 bilateral, treated in 2 different operations. Mean age was 54.8 years (range: 34 to 76 y). Preoperative diagnosis was Cushing in 5 cases, pheochromocytoma in 1 case, incidentaloma in 1 case, and Conn in 2 cases. Postoperative histologic findings were cortical adenoma in 6 cases, pheochromocytoma in 1 case, and cortical hyperplasia in 2 cases. Contraindication to PNP were vascular endocranicanic malformation, acute glaucoma, history of vascular cerebral accident and hypertensive retinopathy, and recent neurosurgical intervention. We performed laparoscopic adrenalectomy in lateral flank position, using the LaparoTenser, an abdominal wall retractor, with 2 curved needles (Aghi Pluriplan) placed in the subcutaneous tissue of the anterolateral abdominal wall that allows low-pressure PNP offering a better view without negative effects of intra-abdominal pressure.
  
  
  RESULTS
  The mean operative time was 73 minutes (range: 45 to 120 min): left average 71.2 minutes, right average 75.0 minutes. The mean postoperative hospital stay was 3.38 days (range: 3 to 5 d). There was no conversion to open surgery. There were no intraoperative or postoperative complications. All patients are alive and there were no recurrences.
  
  
  CONCLUSIONS
  The gasless technique is a valid alternative to PNP when patients present a contraindication to the PNP, as it makes it possible to avoid the risks of intra-abdominal pressure and to conserve the advantages of a mini-invasive access.
authors.affiliation: Chirurgia Generale II e Centro di Chirurgia Mini Invasiva, Department of Surgery, University of Turin, Turin, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giraudo
authors.forename: Gianni
authors.initials: G
authors.lastname: Pantuso
authors.forename: Federico
authors.initials: F
authors.lastname: Festa
authors.forename: Eleonora
authors.initials: E
authors.lastname: Farinella
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
mesh_terms: D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D055815:Young Adult