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[Transperitoneal anterior access in video-laparoscopic adrenalectomy]
N Gullà1, A Patriti, F Lazzarini
1Università degli Studi, Perugia, Dipartimento di Scienze Chirurgiche, Sezione di Chirurgia Generale e d'Urgenza, Policlinico Monteluce, Perugia.
Background:
The more wide spread laparoscopic technique to operate on the adrenal gland is transabdominal approach with a lateral flank adrenalectomy. However, the transabdominal anterior approach can be a sure and safe alternative in selected patients.
Methods:
From 1997 to 1999, 18 selected patients underwent laparoscopic anterior adrenalectomy. Mean age was 43 years (range 25-63) with a male/female ratio of 1:1. Indications were Conn's adenoma in 10 patients, pheochromocytoma in 3 cases, Cushing syndrome in 1 and incidentaloma in 4. All the procedures were carried out laparoscopically and only one patient required conversion to an open adrenalectomy for clear signs of malignancy. The mean time for adrenalectomy was 140 minutes and the shorter times were recorded in the right-sided procedures (mean time 84 minute). Estimated blood loss was minimal and no transfusion was done. There were no postoperative complications related to the surgical technique and the hospital stay was 4 days in average.
Results:
Our data confirm, according with other authors, that this method is feasible in selected patients. Longer times recorded for the left-sided lesions were due to the more difficult dissection required to gain the left adrenal gland.
Conclusions:
Transabdominal adrenalectomy with patient in the supine position is feasible, but its use is restricted to the cases with suspect bilateral or multifocal pheochromocytoma, to patients with concomitant abdominal pathologies that can be operated on laparoscopically, to surgeons who prefer to have a frontal view of the operative field.