Laparoscopic adrenalectomy for large tumours: Single team experience

Abstract

BACKGROUND:Laparoscopic adrenalectomy (LA) has become the procedure of choice to treat benign functioning and non-functioning adrenal tumours. With improving experience, large adrenal tumours (> 5 cm) are being successfully tackled by laparoscopy. This study aims to present our single unit experience of LA performed for large adrenal masses.MATERIALS AND METHODS:Forty-six laparoscopic adrenalectomies performed for large adrenal lesions more than 5 cm during the period 2001 to 2010 were reviewed.RESULTS:A total of 46 adrenalectomies were done in 42 patients. The mean tumour size was 7.03 cm (5-15 cm). Fourteen patients had tumour size more than 8 cm. The lesions were localised on the right side in 17 patients and on the left side in 21 patients with bilateral tumours in 4 patients. Functioning tumours were present in 32 of the 46 patients. The average blood loss was 112 ml (range 20–400 ml) with the mean operating time being 144 min (range 45 to 270 min). Five patients required conversion to open procedure. Three of the 46 patients (6.52%) on final histology had malignant tumours.CONCLUSION:LA is safe and feasible for large adrenal lesions. Mere size should not be considered as a contraindication to laparoscopic approach in large adrenal masses. Graded approach, good preoperative assessment, team work and adherence to anatomical and surgical principles are the key to success.

Laparoscopic Transperitoneal Lateral Adrenalectomy for Large Adrenal Tumors

“…Some authors consider a diameter of ≥6 cm a relative contraindication to laparoscopic adrenalectomy [3,4]. On the other hand, there are recent publications where authors report the feasibility of laparoscopic adrenalectomy of large tumors [15,16,17,18,19,20]. …”

“…Moreover, there are reports of high rate of intraoperative complications [14]. However, tumor size as a limitation for laparoscopic adrenalectomy is questioned by some authors [15,16,17,18,19,20]. …”

Retroperitoneal laparoscopic adrenalectomy with transient renal artery occlusion for large adrenal tumors (≥8 cm)

“…The average operative time, estimated blood loss, perirenal drainage time, postoperative hospital stay, postoperative drainage, and transfusion rate were 176.3 ± 49.7 min, 247.2 ± 274.1 mL, 4.1 ± 1.02 days, 6.3 ± 1.4 days, 73.6 ± 47.9 mL, and 1/18, respectively. Compared with those in a previous study in which patients with large adrenal tumors (8 cm) underwent LTA, the operative time and hospitalization time were longer and the blood loss was greater, but complications such as conversion to OA and blood transfusion were reduced (Table ) . Moreover, Insang et al evaluated the surgical feasibility of RLA for tumors ≧5 cm and found that the operative time, estimated blood loss, postoperative hospital stay, transfusion, and surgical complications were 214.54 ± 76.04 min, 367.24 ± 275.11 mL, 9.26 ± 3.10 d, 6 (7.9%), and 13 (17.1%) respectively, for large adrenal tumors (7.10 ± 2.15 cm) (Table ) .…”

“…However, RLA may pose serious additional technical difficulties, such as a smaller working space, poor surgical landmarks, a steeper learning curve, and discomfort when working with tumors larger than 8 cm . As the size of the adrenal tumor increases, the surrounding anatomy is disturbed; the tumor tends to exhibit local invasion with intense adhesions to periadrenal structures, the vessels in the tumor vicinity become more dilated, and there is a greater number of intraoperative hemodynamic events in pheochromocytomas . Therefore, adrenal masses >8 cm are technically more difficult to remove, because the tumor limits manipulation with devices and obstructs the operative field.…”

Lateral retroperitoneoscopic adrenalectomy for complicated adrenal tumor larger than 5 centimeters

“…Since the improvement of laparoscopic instruments and proficiency of operation skill, the tumor diameter may not be the major restricting factor 32 . While, there were discrepant opinions on the application of laparoscope in the management of large (> 5cm) adrenal tumor 33,34 . The aim of the present study was to compare the results of LRA and OA in the management of large adrenal tumors (> 5cm).…”