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Use of laparoscopic techniques improves outcome from adrenalectomy
S Horgan1, M Sinanan, W S Helton
1Department of Surgery, University of Washington, Seattle, USA.
Background:
Laparoscopic adrenalectomy is a promising alternative to open approaches but safety and efficacy remain unproven.
Methods:
A recent experience with laparoscopic adrenalectomy at the University of Washington was analyzed for efficacy, complications, evolution of technical steps, and clinical outcome.
Results:
Nineteen adrenalectomies were performed in 16 patients with a mean age of 52 years. Indications included pheochromocytoma (4), functional adenoma (12), and uncontrolled Cushing's disease (3). All patients had computed tomography scans. Meta-iodo-benzyl-guanidine (MIBG) or iodocholesterol scans were done in selected patients. Three patients had bilateral procedures, 7 were on the left and 6 on the right, all via a transperitoneal flank approach. There were no conversions and all procedures were successful. Complications included subcapsular liver hematomas (2), one transfusion, and a bleeding port site requiring repeat laparoscopy. Except for 1 patient with COPD, the mean length of stay was 2.9 days.
Conclusions:
Laparoscopic adrenalectomy in appropriate patients is safe and effective. For endocrine surgeons with advanced laparoscopic skills, it should be considered a new standard therapy for benign adrenal tumors.