Surgical treatment options for aldosteronomas.
BACKGROUND
Single access retroperitoneoscopic adrenalectomy (SARA) is the most feasible approach for removing aldosteronomas.


OBJECTIVE
To analyse the advantages and disadvantages of surgical approaches to treating small adrenal tumours.


METHODS
In the period 2002-2011, 31 patients were operated on at Vilnius University Hospital Santariskiu Clinics for aldosteronomas. Adrenalectomies were performed in the lateral laparoscopic (group A, n = 6), the endoscopic retroperitoneal (group B, n = 20), and the single incision laparoscopic surgery (SILS) and SARA (group C, n = 5) approaches. Seventy five percent of patients were operated on by the same surgeon. The duration of adrenalectomies, and intraoperative and postoperative complications were compared. The possibility of minimally invasive adrenalectomies was evaluated.


RESULTS
According to the patients' age, body mass index and tumour size, the groups were equal. The average duration of surgery in group A was shorter than in groups B and C (91 ±23 min vs. 118 ±57 min vs. 144 ±88 min). Right laparoscopic adrenalectomy was longer than the left (105 ±26 min vs. 77 ±6 min), whereas right endoscopic retroperitoneal adrenalectomy was shorter than the left (109 ±50 min vs. 126 ±57 min). The best cosmetic view was in group C. The SARA method was converted into the endoscopic retroperitoneal approach and then into the laparoscopic for one patient. There were no intraoperative or postoperative complications.


CONCLUSIONS
Evaluating the minimal invasion of the method, its abilities and simplicity of conversion into another type of endoscopic surgical way, the SARA approach should be the first option for removing aldosteronomas.
Centre of Abdominal Surgery, Vilnius University Hospital Santariskiu Clinics, Lithuania.
Virgilijus
V
Beiša
Marius
M
Kryžauskas
Gintaras
G
Simutis
Audrius
A
Sileikis
Kęstutis
K
Strupas
aldosteronoma; endoscopic adrenalectomy; hyperaldosteronism; laparoscopic adrenalectomy; single access retroperitoneoscopic adrenalectomy; single incision laparoscopic surgery