[Role of laparoscopy in surgery of the adrenal glands]

It has been recently demonstrated that resection of the adrenal glands can be performed laparoscopically, providing certain advantages over conventional open surgery. The aim of this work was to determine the role of laparoscopy in the surgical approach to the adrenal glands. From June 1994 to December 1995, transperitoneal laparoscopic procedures were proposed in patients with a unilateral 8 cm or less non-malignant tumors of the adrenal gland. For tumors under 4 cm in diameter, only secreting tumors were removed. One patient had Cushing's disease and underwent bilateral resection. Among 58 patients requiring ablation of the adrenal gland; 37 (64%) underwent a laparoscopic procedure: 20 Conn adenomas, 8 Cushing adenomas, 1 Cushing's disease, 5 pheochromocytomas, 3 incidentalomas. Mean tumor size was 26 mm (7-75 mm). Two tumors were found to be malignant: one cortisone-secreting tumor and one leiomyosarcoma. Conversion was required in 4 cases (11%) due to difficulties in exposing the dissection in 3 cases and due to malignancy in 1. Mean operative time for unilateral operations was 159 minutes (75-300 minutes). There were no deaths. Morbidity included one hemorrhage via the trocar orifice requiring reoperation, one infarction of the spleen which regressed spontaneously, one parietal hematoma, and one case of phlebitis of the lower limb. The endocrinopathy was successfully cured in all patients with secreting tumors. The 21 other patients underwent open surgery. Laparoscopic access was contraindicated due to suspected malignancy in 10 cases, past surgical history in 7 and bilateral or extra-adrenal lesions in 4. Laparoscopic resection of the adrenal glands is the preferred technique in patients with Conn adenomas, Cushing adenomas and in most cases of pheochromocytoma. It is not indicated for malignant and/or very large tumor (> 8 cm). In our experience, the laparoscopic approach has replaced open posterior approach which is now only used exceptionally. Currently two-thirds of our patients with an indication for resection of the adrenal glands are operated laparoscopically.