[Laparoscopic adrenalectomy for large tumors]

To analyze indications and results of laparoscopic adrenalectomy for large tumors (> 6 cm).

It is a retrospective study including patients between January 1994 and December 2003 operated on for large adrenal lesions > or =6 cm. The size was given by the pathologist. All the patients had a flank transperitoneal approach. Analysed Parameters were: operative difficulties; operative time; conversion rate; postoperative morbidity, follow-up and histologic data.

Fourteen patients (10 female and 4 male) were included. Mean age at the time of the diagnosis was 52 years (range: 17-79). Mean size of the lesions was 7 cm (range: 6-10 cm). Mean operative time was 132 mn (range: 120-240 mn). None of the patients experienced surgical complications. Two conversions were needed (for vena cava attachments in one case and because of a retrocava localization in the other case). Three patients had morbidity: one intraperitoneal hemorrhage occurring at the second postoperative day and needing laparotomy; one left pneumopathy; and one case of neuralgia due to a port insertion. Mean hospital stay was 4,5 days. Histologic data showed: five ganglioneuromas, three pheochromocytomas, three adenomas, two adrenocortical carcinomas, and one postpancreatitis cytosteatonecrosis.

Laparoscopic adrenalectomy is feasible for large lesions > or =6 cm when no evidence of malignity is demonstrated neither by the preoperative imaging study nor by the surgical exploration.