title: Laparoscopic transperitoneal anterior adrenalectomy in pheochromocytoma: experience in 62 patients.
abstract: BACKGROUND
  Aim was to evaluate the results in 62 patients undergoing laparoscopic adrenalectomy (LA) for the treatment of pheochromocytoma (PHE), with a transperitoneal anterior approach for lesions on the right side, and with a transperitoneal anterior submesocolic approach in case of left-sided lesions.
  
  
  METHODS
  Sixty-two patients underwent LA for the treatment of PHE at two centers in Rome and Ancona (Italy). Two patients had bilateral lesions, for a total of 64 adrenalectomies. Sporadic PHE occurred in 57 patients (91.9 %) and in 5 (8.0 %) it was familiar. Thirty-six patients (58.0 %) underwent right adrenalectomy, 24 (38.7 %) left adrenalectomy, and in 2 cases (3.2 %) LA was bilateral. In 38 cases of right adrenalectomy (59.3 %) and in 5 cases of left adrenalectomy (7.8 %), the approach was a transperitoneal anterior one. A transperitoneal anterior submesocolic approach was used in 21 left adrenalectomy cases (32.8 %).
  
  
  RESULTS
  Mean operative time for right and left transperitoneal anterior LA was 101 min (range 50-240) and 163 min (range 50-190), respectively. Mean operative time for left transperitoneal anterior submesocolic LA was 92 min (range 50-195). For bilateral adrenalectomy, mean operative time was 210 min (range 200-220). Conversion to open surgery occurred in 2 cases (3.22 %) due to extensive adhesions (1) and hemorrhage (1). One major and three minor complications were observed. Mobilization occurred on the first postoperative day. Hospitalization was 4.8 days (range 2-19). The lesions had a mean diameter of 4.5 cm (range 0.5-10).
  
  
  CONCLUSIONS
  Early identification with no gland manipulation prior to closure of the adrenal vein is the main advantages of the transperitoneal anterior approach. PHE may be treated safely and effectively by a laparoscopic transperitoneal anterior approach for right-sided lesions and with a transperitoneal anterior submesocolic approach for left-sided ones.
authors.affiliation: Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy, alessandro.paganini@uniroma1.it.
authors.forename: Alessandro M
authors.initials: AM
authors.lastname: Paganini
authors.forename: Andrea
authors.initials: A
authors.lastname: Balla
authors.forename: Mario
authors.initials: M
authors.lastname: Guerrieri
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lezoche
authors.forename: Roberto
authors.initials: R
authors.lastname: Campagnacci
authors.forename: Giancarlo
authors.initials: G
authors.lastname: D'Ambrosio
authors.forename: Silvia
authors.initials: S
authors.lastname: Quaresima
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Antonica
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lezoche
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000601:surgery; D000311:Adrenal Glands / Q000473:pathology / Q000601:surgery*; D000315:Adrenalectomy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010673:Pheochromocytoma / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D055815:Young Adult
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