Laparoscopic adrenalectomy: a report of the first experience in Iran

To report the first experience in laparoscopic adrenalectomy and to study its efficacy and safety in the treatment of different adrenal diseases.

From March 1997 to July 2001, 11 patients underwent laparoscopic adrenalectomy through transperitoneal approach, five of whom were males and 6 were females. Their mean age was 35.5 (range 28 to 52) years. Lesion was located on the left side in 6 patients and on the right side in 5. All necessary evaluations were done preoperatively including CT scan, MRI, MIBG scan, and endocrine tests such as ACTH, cortisol, mineralocorticoid, 17-hydroxyprogesterone, and urinary VMA. Three (5, 10, and 12 mm) trocars were used in left laparoscopic adrenalectomy and three or four (12, 10, 5, and 5 mm) trocars were applied in right laparoscopic adrenalectomy. All the patients were followed up for three months with physical examination and paraclinical tests.

Mean operative time (including anesthesia and surgery) was 205+/-65.95 (range 130 to 310) minutes. No significant difference was seen between the operative time in the left side and the right side adrenalectomy (p=0.5). Mean hospitalization was 5.54+/-3.4 (range 3 to 15) days. Mean size of mass was 5.45+/-1.7 (range 2 to 8) cm. Blood transfusion was performed in 2 patients and open surgery was conducted for one because of extensive adhesions. No mortality was reported. During a 3-month follow-up, hormonal tests and blood pressure were normal for all the patients, with no medical treatment being required.

Our study demonstrated that transperitoneal laparoscopic adrenalectomy is an effective and safe approach in the treatment of adrenal masses with the least morbidity.