ENDOSCOPIC RETROPERITONEAL ADRENALECTOMY

Background. The anterior transabdominal approach for adrenalectomy is associated with a longer postoperative recovery period than a posterio r extraperitoneal adrenalectomy. The posterior approach is useful for patients requiring bilateral adrenalectomy or in those undergoing unil ateral adrenalectomy for benign adenomas smaller than 5 cm. Recently t ransabdominal laparoscopic adrenalectomy has been used in patients wit h adrenal tumors. Endoscopic retroperitoneal adrenalectomy (ERA) is an alternative method that provides excellent exposure and should be ass ociated with less postoperative morbidity. Methods. Between 1993 and 1 994 11 ERAs were performed in eight patients in the Department of Surg ery, Istanbul Faculty of Medicine. The patients were placed in the pro ne semijackknife position. on. the operating table. After the retroper itoneal space was expanded with a balloon trochar, four 10 mm trochars were placed to perform the procedure. Results. Among the eight female patients 23 to 65 years of age (mean 42 +/- 12.4 years), three had bi lateral adrenal hyperplasia caused by Cushing's disease, three patient s had functioning adenoma, one patient had nonfunctioning adenoma (thr ee on right and one on left adrenal), and one patient had right adrena l cyst. The mean operation time was 150 minutes (range, 90 to 300 minu tes). No changes in PCO2 values have been found during intraoperative blood gas analyses. No intraoperative or postoperative complications o ccurred. All patients were discharged on the third postoperative day. Conclusions. ERA is a new and safe method of adrenalectomy. It is less invasive than the posterior approach. Patients treated by ERA seem to experience less postoperative pain and discomfort and have a shorter postoperative hospitalization and recovery period.