Surgical management of adrenal tumours. Lessons from a 10 years personal experience

To review our personal experience of the last 10 years with adrenal surgery in order to define the indications of laparoscopic adrenalectomy (LA) and open adrenalectomy (OA), respectively.

From November 1993 to June 2003, we performed 105 adrenalectomies on 97 patients (29 males and 68 females). The lesions resected were preoperatively considered non-secreting in 47 cases (45%) and hormonally active in 58 cases (55%). In 78 patients (80%), LA was performed and 84 adrenal glands were resected. In 19 patients (20%), OA was considered the best modality of resection and 21 adrenal glands were resected. The average tumour size was 37.2 mm (range 25-90) in LA group and 82.6 mm (30-260) in the OA group. All the LA were performed using a trans-peritoneal approach. Depending on the particularities of the lesions and of the patients, the OA were performed by anterior or lumbar incisions.

There was no mortality. Conversion from LA to open surgery was necessary in two patients. Mean operating time was 110 minutes for LA and 135 minutes for OA. Two (2.6%) patients suffered complications after LA and 4 (19%) after OA.

In our experience, trans-peritoneal LA proved to be a safe and reliable procedure for benign adrenal disease. In our institution, it has become the gold standard technique for the resection of adrenal tumours, except for those suspected or proven malignant.