Transperitoneal laparoscopic adrenalectomy: a review and single-center experience

Abstract

Background: Laparoscopic adrenalectomy (LA) is the preferred approach to adrenal gland tumors. Objective: To evaluate the perioperative and functional outcomes of transperitoneal LA. Methods: We retrospectively reviewed data of all consecutive patients who underwent transperitoneal LA at our institution between April 2000 and December 2011. Results: Two hundred two patients with mean age of 46 years were included in the study. There were 109 left, 89 right, and 4 bilateral tumors. Preoperative diagnosis included 126 aldosterone-producing adenomas (APA), 33 patients with Cushing syndrome, 19 pheochromocytomas, 20 nonfunctional tumors, and 4 adrenal metastases. Mean tumor size was 3.3 cm (range 0.4-22 cm). Mean operative time was 109 min and estimated blood loss 90 mL for unilateral adrenalectomy; and 195 min and 300 mL for bilateral adrenalectomy. Four patients with pheochromocytoma required transfusion and 2 required conversion to an open approach. Seven intraoperative complications and 18 30-day postoperative complications occurred. These included 5 major complications (Clavien-Dindo grade 3-5). Ninety-seven percent of APA patients had normal serum potassium levels after surgery. Among the patients with functioning endocrine tumors, complete resolution rate from secondary hypertension was significantly higher in the pheochromocytoma group compared with those with APA or Cushing syndrome (82% vs. 48% vs. 68% respectively, p = 0.02). Mean follow up was 35.2 months. Conclusion: LA is the treatment of choice for most adrenal gland tumors with excellent outcomes and low complication rates. There was a high chance for complete resolution of secondary hypertension after surgery for pheochromocytoma.

Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience

“…All LAs were performed by a standard lateral transperitoneal approach with patient in the lateral decubitus position as previously described [ 13 ]. In brief, four trocars were used for a right adrenalectomy and three for a left adrenalectomy.…”

Perioperative complications of adrenalectomy – 12 years of experience from a single center/teaching hospital and literature review

“…We encountered one iatrogenic perforation of the colon, one hemorrhagic infarction of the spleen, one diaphragm perforation and one hemoperitoneum caused by torn capsule of the spleen – see patients no. 2, 4, 6 and 8 [ 1 , 5 , 7 , 12 , 14 , 15 ].…”

“…It is less invasive than an open procedure and thus enables the elderly, the obese or those suffering from circulatory diseases to qualify for treatment. Laparoscopic procedures are associated with lower postoperative morbidity (8% vs. 13–20%) [ 6 , 11 , 12 , 14 , 15 , 17 , 18 ].…”

“…Laparoscopic resection of malignant masses increases the risk of intraoperative tumor spillage and incomplete clearance. Position of laparoscopic excision of adrenal malignancies is controversial and debatable [ 6 , 11 , 12 , 14 , 15 , 17 , 18 ].…”

“…Laparoscopy is recommended in the case of a simultaneous abdominal operation, ectopically located adrenal glands and after nephrectomy on the ipsilateral side. Alesina pointed out that splenic injuries and intra-abdominal abscesses occurred only after laparoscopic procedures, while relaxation and/or hypoesthesia of the abdominal wall was observed only after retroperitoneoscopic ones [ 2 , 7 , 12 , 15 , 17 ].…”