Laparoscopic Adrenalectomy for Primary Aldosteronism

Endoscopic Retroperitoneal Adrenalectomy: Lessons Learned From 111 Consecutive Cases

“…The first endoscopic adrenalectomy was reported in 1992 by Higashihara et al 1 This report was followed by other early experiences with minimally invasive removal of adrenal tumors. [2][3][4][5][6][7] Initially, the patient was placed in the supine position and the adrenal tumor was approached transperitoneally. However, laparoscopic removal of the left adrenal gland proved particularly difficult because access required retraction of surrounding organs such as the pancreatic tail, transverse and descending colon, and spleen.…”

“…11 However, the laparoscopic transmesocolic approach to the left adrenal gland proved difficult because simultaneous retraction of both the pancreatic tail and descending colon was necessary to expose the adrenal gland. 7 Therefore, this approach was abandoned in 1995 and ERA was started. Laparoscopic transperitoneal adrenalectomies with the patient in the lateral decubitus position were performed in only two patients in 1999.…”

Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute

“…More than 10 years after the first report of LA, 1–3 this type of operation is now considered to be the ‘standard of treatment’ for most adrenal diseases requiring surgery 5–10 . In our institute, since LA was first performed for aldosteronoma in July 1993, a total 103 LA have been performed by three operators by the end of 2003.…”

Screening for primary aldosteronism: progress and frustration

“…glucocorticoid remediable aldosteronism) have been characterized as specific mutations accounting for causative gene products [3]. More relevant to the large population of hypertensives who lack specific genetic disorders: (i) hypokalemia need not always be found in primary aldosteronism, thus limiting this finding as a screening test; (ii) the plasma renin activity assay is suppressed in primary aldosteronism, but is not unique to that syndrome as low renin essential hypertension has became recognized; (ii) bilateral adrenal hypersecretion of aldosterone by hyperplastic glands with or without nodules can produce hormonal aberrations similar to those found with Conn's tumours, but is rarely cured by either unilateral or even bilateral adrenalectomy; (iv) enhanced adrenal imaging with contrast CT or MRI could detects many small adrenal tumours (incidentalomas) whose significance requires assessment by functional tests; and (v) unilateral adrenalectomy, by laparoscopy, can reduce the risk of surgery making it more acceptable to patients whose hypertension can be cured with reduction in the need for life-long drug treatment [4,5].…”