title: Laparoscopic adrenalectomy in children: a multicenter experience.
abstract: BACKGROUND
  Laparoscopic adrenalectomy is now being recognized as the standard approach for adrenalectomy for benign lesions in adults. The published experience in children and adolescents has been limited to sporadic small case series. Therefore, we conducted a large multicenter review of children who have undergone laparoscopic adrenalectomy.
  
  
  METHODS
  After Institutional Review Board's approval, a retrospective review was conducted on all patients who have undergone laparoscopic adrenalectomy at 12 institutions over the past 10 years. Operative times included unilateral adrenalectomy without concomitant procedures.
  
  
  RESULTS
  About 140 patients were identified (70 males [50%]). Laterality included 76 (54.3%) left-sided lesions, 59 (42.1%) right, and 5 (3.6%) bilateral. Mean operative time was 130.2 ± 63.5 minutes (range 43-406 minutes). The most common pathology was neuroblastoma in 39 cases (27.9%), of which 23 (59.0%) had undergone preoperative chemotherapy. Other common pathology included 30 pheochromocytomas (21.4%), 22 ganglioneuromas (15.7%), and 20 adenomas (14.3%). There were 13 conversions to an open operation (9.9%). Most conversions were because of tumor adherence to surrounding organs, and tumor size was not different in converted cases (P=.97). A blood transfusion was required in 2 cases. The only postoperative complication was renal infarction after resection of a large neuroblastoma that required skeletonization of the renal vessels. At a median follow-up of 18 months, there was only one local recurrence, which was in a patient with a pheochromocytoma.
  
  
  CONCLUSIONS
  The laparoscopic approach can be applied for adrenalectomy in children for a wide variety of conditions regardless of age with a 90% chance of completing the operation without conversion. The risk for significant blood loss or complications is low, and it should be considered the preferred approach for the majority of adrenal lesions in children.
authors.affiliation: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri 64108, USA. sspeter@cmh.edu
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Valusek
authors.forename: Sarah
authors.initials: S
authors.lastname: Hill
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wulkan
authors.forename: Sohail S
authors.initials: SS
authors.lastname: Shah
authors.forename: Marcello
authors.initials: M
authors.lastname: Martinez Ferro
authors.forename: Horatio
authors.initials: H
authors.lastname: Bignon
authors.forename: Pablo
authors.initials: P
authors.lastname: Laje
authors.forename: Peter A
authors.initials: PA
authors.lastname: Mattei
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Graziano
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Muensterer
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Pontarelli
authors.forename: Nam X
authors.initials: NX
authors.lastname: Nguyen
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Kane
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Qureshi
authors.forename: Casey M
authors.initials: CM
authors.lastname: Calkins
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Baerg
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
mesh_terms: D000293:Adolescent; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult