[Adrenalectomy under celioscopy. Experience of 25 operations]

Determine the indications for laparoscopic adrenalectomy on the basis of our experience.

We performed 25 laparoscopic adrenalectomies for primary hyperaldosteronism (n = 10), non-ACTH-dependent hypercortisolism (n = 6), Cushing's disease (n = 2 including one bilateral operation), pheochromocytoma (n = 1) and tumoral formation (n = 5).

The operation required conversion to an open procedure in 4 cases (16%). The post-operative period was uneventful in 19 and was clearly less painful. Improved delay to normal intestinal function and rapid return to normal activities was also beneficial in these patients with no parietal damage. Complications occurred in two cases: one local asymptomatic collection and one localized pancreatitis requiring surgical drainage of an abscess.

Compared with our experience with open procedures, the inconvenience of a long laparoscopic procedure (2h 45 min for unilateral adrenalectomy), is counterbalanced by the reduction in risk to complications in 64% of the cases due to the simplicity and lack of parietal damage. We currently propose the laparoscopic procedure for tumours under 6 cm in diameter and for certain pheochromocytomas and rely on the open procedure for proven or suspected corticoadrenalomas.